Strategic Framework Integrated Civ-Mil Campaign Plan Expansion of Accountable and Transparent Governance – Expand coverage of basic public services, including basic health and education services Advancing Livelihoods and Sustainable Jobs – Increase access to vocational and technical training opportunities that prepare a skilled and productive workforce which counters the insurgency and is able to contribute to the development of population centers and corridors. Social sector development enhances human capital. Mission Strategic and Resource Plan Building an Economic Foundation for Afghanistan’s Future – – Improved government services, vocational training and basic strengthening of health and education systems. Providing Health and Education Aid to Promote Long-Term Stabilization – Support health and education initiatives designed to improve key indicators in these sectors, particularly maternal health and girls’ education. Regional Stabilization Strategy Advance the rights of Afghan women and girls across all areas of effort, with particular focus on expanding economic opportunities; improving access to justice, improving basic service delivery in education and health, and increasing women’s participation in the political process. Service Delivery and Capacity Building - Improve service delivery at the sub-national level in the critical areas of health, education, and security (e.g., expand access to basic healthcare and schooling at the district level; expand vocational training opportunities at the provincial level). 1

Overall Assessment: Improving Health Status: Align USG and coalition efforts to support GIRoA goals to improve health for all Afghans to increase human capital, advance livelihoods and further economic and social development. Narrative: Trend: Indicators StatusData Source Percentage of population with access to health services within 2 hours walking distance 60%Afghanistan Rural Health Survey, 2006 Number of health facilities providing basic services nationally1972 (USG-539) MoPH Health care utilization rate, national1.3 (2010) MoPH Percentage of program budget that goes to direct assistance $67 million planned for FY2010 (46% ) USAID Number of trained midwives (1640+ USG) Afghan Midwifery Accreditation Board 2 The availability of basic health services and utilization of these services continues to increase steadily. Currently, 1,972 facilities provide basic services nationally; USG funding supports 539 of these facilities. Numbers of trained female health care providers, including midwives, are also increasing. 3,100 trained midwives are currently in place; 1,640 of these were trained with USG support. Health care utilization rose during the last quarter, with patients making on average 1.3 visits to a facility annually. On-budget assistance is continuing to demonstrate good results, with on-budget support projected to expand in 2011 and on track for meeting the 50% Kabul process commitment by Overall Assessment: Healthcare in Afghanistan

BPHS 2010 Below BPHS Standard14 Meets BPHS Standard15 Exceeds BPHS Standard57 Basic Package of Health Services (BPHS) Access & Quality 2009 Below BPHS Standard41 Meets BPHS Standard14 Exceeds BPHS Standard31 Objective 1: Improved Access and Quality

2011 AOIs Below BPHS Standard1 Meets BPHS Standard10 Exceeds BPHS Standard KTDs Below BPHS Standard2 Meets BPHS Standard34 Exceeds BPHS Standard57 Objective 1: Improved Access and Quality: 2011

Objective 1: Access to Data Source: NRVA 2007/2008 Baseline Objective 1: Access to Improved Water Baseline

Medical Training Advisor Group (MTAG) Training Sites MTAG Training Courses National Military Hospital Regional ANA Hospitals Forward Support Depots ANP Medical Facilities Kandahar Mazar- e-Sharif Herat Gardez Kabul Shor’ab Objective 3: MTAG-Supported Key Institutions

Objective 3: Midwifery Program Map

Infant, child and maternal mortality remains among the highest in the world Reaching insecure and remote areas Numbers of facilities expanding faster than the trained workforce, esp. female providers Lack of MoPH organizational and human resource development plan Lack of adequate mental health services Lack of MoPH decentralization and empowerment at the provincial level Lack of licensure and accreditation systems for physicians or health care institutions Insufficient MoPH salaries to attract and retain skilled staff Continuing Healthcare Challenges/Constraints

Way Ahead: Healthcare in Afghanistan Increasing coordination with military counterparts for the use of CERP funds for construction and water, sanitation and hygiene interventions Supporting a multiyear strategic framework and operational plan for the MoPH, including organizational and workforce development Fostering country-ownership by transitioning key programs and activities to the MoPH through increased on-budget support Strengthening MoPH financial management and procurement systems Assisting the MoPH to establish an Interim Steering Committee on Public-Private Partnerships, particularly focused on hospitals Promoting the development of a semi-autonomous Afghan Medical Council responsible for accreditation and licensure Exploring opportunities to unify inter-ministerial health systems and medical education and training programs (MoPH, MoHE, and MoD) Building MoPH capacity in health economics and financing to identify sustainable financing solutions that reduce dependency on donors Strengthening MoPH capacity to legislate, regulate, quantify, procure and distribute essential medicines to the people Increasing capacity of Provincial Health Directorates to strengthen management and oversight of health programs and services 9

Afghan Health Services Structure

CERP Support FY2010

USAID: Resource Allocations Health & Education

Province Est. Disbursements FY st Quarter FY 2011 Health (in $ Million)Education (in $ Million)Total (in $ Million) Badakhshan$6.36$1.01$7.36 Badghis$0.23$0.00$0.23 Baghlan$1.99$0.99$2.98 Balkh$0.23$6.16$6.39 Bamyan$4.15$2.06$6.21 Daykundi$0.10$0.99$1.08 Farah$0.11$1.09$1.19 Faryab$4.74$0.76$5.49 Ghazni$5.64$2.83$8.47 Ghor$0.02$1.23$1.25 Hilmand$0.24$0.44$0.68 Hirat$5.40$7.09$12.50 Jawzjan$3.36$3.13$6.50 Kabul$30.96$31.51$62.47 Kandahar$3.10$3.11$6.21 Kapisa$0.07$1.80$1.86 Khost$3.44$3.08$6.52 Kunar$0.26$0.00$0.26 Kunduz$0.21$0.96$1.16 Laghman$0.34$0.99$1.33 Logar$0.18$1.10$1.28 Wardak$0.28$2.61$2.88 Nangarhar$0.34$4.65$5.00 Nimroz$0.03$0.00$0.03 Nuristan$0.01$0.00$0.01 Paktika$3.47$0.00$3.47 Paktya$4.51$1.50$6.02 Panjsher$0.08$1.61$1.70 Parwan$0.03$2.21$2.25 Samangan$0.05$0.13$0.19 Sari Pul$0.00$2.62 Takhar$4.89$0.60$5.49 Uruzgan$0.04$0.19$0.23 Zabul$0.09$0.00$0.09 Grand Total$84.94$86.46$ USAID: Resource Allocations Health & Education

USAID: Programs Health & Education