Role of Multilateral Development Banks in Afghanistan's Health Care Sector

Role of MDBs in incentivizing Private Sector

to Participate in Health Care Sector of Afghanistan

WBGx: F4D01X Financing for Development

WBGx: F4D01X Financing for Development | 2017 All Rights Reserved | Tushar Kothavale 2

Afghanistan Country Profile


Source: http://www.maphill.com/afghanistan/location-maps/savanna-style-map/

“Landlocked and Mountainous Afghanistan has suffered from such chronic instability and conflict during its modern history that its economy and infrastructure are in ruins, and many of its people are refugees.”


Country Fact Sheet• Country: Islamic Republic of Afghanistan• Capital: Kabul• Population: 33.37 Million (2016 projected by UN)

• Area: 652,864 Square Kilometers (251,827 Square miles)• Major Languages: Dari, Pashto• Life Expectancy: 59 years (men), 62 years (women)• Currency: Afghani• Gross Domestic Product: 21122 Million USD (2014, UN Data)

• GDP Per Capita: 667.8 USD (2014, UN Data)Image Credits: http://baltic-review.com/severe-food-insecurity-on-the-rise-in-afghanistan/


Afghanistan is a conflict state• The Taliban, who imposed strict Islamic rule

following a devastating civil war, were ousted by a US-led invasion in 2001 but have recently been making a comeback.

• The internationally-recognized government set up following the adoption of a new constitution in 2004 has struggled to extend its authority beyond the capital and to forge national unity.

• Nato-led foreign combat troops had the main responsibility for maintaining security after 2001, and the formal end of Nato's combat mission in December 2014 was followed by an upsurge in Taliban activity.

Image Credits: http://edition.cnn.com/2016/02/25/asia/afghanistan-war-analysis/


Afghanistan’s Health Care Infrastructure is in

Shambles


Afghanistan's health status is one of the worst in the world

• Maternal mortality, is at 1,600/100,000 live births per year (UNICEF 2002), which is among the highest and infant and under-five mortality rates are estimated at 165 and 257 per 1,000 live births per year respectively (WHO 2002).

• The epidemiological profile is dominated by communicable diseases—TB and malaria being the main ones—that can be prevented and/or treated using low-cost and simple strategies.

• In spite of lack of reliable data, there is a consensus that HIV/AIDS is emerging as a serious health concern, given the increasing number of drug users.

• Epidemics are frequent, including cholera, Congo-Crimea haemorrhagic fever, measles, meningitis, pertussis and malaria (population at risk is estimated at 12 million (MoH/NMP 2004)). Outbreaks of scurvy have also been reported.

• The anthropometric data point to high levels of both acute and chronic malnutrition.

Image Credits: http://proof.nationalgeographic.com/2016/04/11/these-haunting-photos-reveal-todays-afghanistan/


Health Sector Issues• The sector needs to recover from decades of neglect,

under-funding, institutional vacuum and fragmentation.

• At the end of the conflict, what was left of the health system was characterized by: inadequate infrastructures with dilapidated facilities unevenly distributed across the country; impaired access to health services due to difficult communications and poor security; chronic shortage of skilled health providers (especially female); poor information system; and weak implementation of the newly approved national health policy.

• Health expenditure is 0.5% of the GDP and represents 6.1% of the current expenditure, for a public health expenditure of $1 per capita (CSO 2003). There are one doctor and one nurse per 6,000 and 2,500 people respectively (CSO 2003), and the population per hospital bed ranges between 1,100 and 16,000 (CSO 2002).



Health Sector Issues• Inequality in access to healthcare is a significant

issue.• DPT3 (Diphtheria Pertussis, Tetanus) routine

immunization has an estimated coverage of only 30%.

• Coverage of Primary Health Care is still low, but increasing; around 50% of the population (and 70% of districts) are covered by the Basic Package of Health Care Services (BPHS) and reinforced by vertical programmes.

• The system is under-funded: the average cost of subcontracting the BPHS is around $4 per capita per year, and expansion of coverage is hampered by a shortage of funds. Further, an insufficient budget is allocated to secondary and tertiary hospitals that are run by the Ministry of Health (MoH).



Why is Private Sector shy in investing in Afghanistan’s Health

Care Sector?


Main Priorities in Afghanistan’s health sector

• Restored and upgraded health care facilities, including expanded provision of services to rural areas still unreachable;

• Ensured availability of essential drugs;• Funding for services expansion, addressing inefficiencies in out-sourcing;• Strengthened Ministry of Health capacity managing and monitoring

contracts;• Strengthened health information system (including surveillance);• Trained health workers for sectors where shortage is acute (e.g. midwives,

female nurses);• Strengthened capacity of national authorities in emergency preparedness and

response, mainly for the recurrent natural disasters.However the Government can not achieve all these main priorities without the help of Private Sector which will aid in scaling the Health Care Infrastructure in Afghanistan.


Obstacles in unlocking Private Sector Participation

• Security is a major issue in conflict state.• For private sector the risks far outweigh

the returns from any venture.• There is no accurate information

available regarding the opportunities – risks –returns.

• There is no one to handhold in a conflict state. (perception that the government is too weak for handholding)

Image Credits: http://www.aljazeera.com/indepth/inpictures/2016/07/frontline-hospital-afghanistan-160719103717841.html


The Potential Solutions


How can MDGs unlock financial opportunities in Afghanistan’s Health Care Sector?

• Financial Additionality: Using a wide range of direct financing and mobilization instruments such as Infrastructure Development Assistance (IDA), the official sector can contribute funding and help build the confidence necessary to attract commercial funding. Image Credits: http://www.aljazeera.com/indepth/inpictures/2016/07/frontline-hospital-

afghanistan-160719103717841.html



• Design Additionality: The MDGs can contribute technical to improve their “bankability” or attractiveness to private-sector investors. This can occur through ensuring efficiency, transparency, and adherence to accepted standards in project design, including environmental standards.Image Credits: http://www.aljazeera.com/indepth/inpictures/2016/07/frontline-hospital-




• Policy Additionality: MDBs and similar entities can provide support to Afghanistan Government/ Ministry of Health to improve the policy and regulatory environment for investment and mitigate the risk of significant policy reversals. Image Credits: http://www.aljazeera.com/indepth/inpictures/2016/07/frontline-hospital-




• Demonstration Additionality: The MDGs can support first few projects in Afghanistan’s Health Care Sector (such as through funding from IDA) to illustrate the possibilities of success by improving private-sector perceptions of the risk/return trade-off for investments undertaken in the Health Care Sector. Image Credits: https://www.nytimes.com/2015/10/04/world/asia/afghanistan-bombing-

hospital-doctors-without-borders-kunduz.html?_r=0


• Specific Targets in SDGs which will be achievable through the intervention:

Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks.


References/ Credits• http://www.un.org/sustainabledevelopment/sustainable-developm

ent-goals/

• http://www.bbc.com/news/world-south-asia-12011352• http://www.who.int/hac/donorinfo/afg/en/index1.html• https://www.usaid.gov/afghanistan/health• http://data.un.org/CountryProfile.aspx• http://

www.aljazeera.com/news/2016/08/afghanistan-health-care-system-struggles-rebound-160810104017464.html

http://www.un.org/sustainabledevelopment/sustainable-development-goals/



http://www.bbc.com/news/world-south-asia-12011352

http://www.bbc.com/news/world-south-asia-12011352

http://www.who.int/hac/donorinfo/afg/en/index1.html

http://www.who.int/hac/donorinfo/afg/en/index1.html

https://www.usaid.gov/afghanistan/health

https://www.usaid.gov/afghanistan/health

http://data.un.org/CountryProfile.aspx

http://data.un.org/CountryProfile.aspx

http://www.aljazeera.com/news/2016/08/afghanistan-health-care-system-struggles-rebound-160810104017464.html




Thank You

Author: Tushar Kothavale

http://in.linkedin.com/pub/tushar-kothavale/15/379/a19

Image Credits: http://www.bbc.com/news/world-asia-37560704



Healthcare

Role of Multilateral Development Banks in Afghanistan's Health Care Sector