1. Hayat Burhani, Nadera, MD, MPH, MPPM (Fellow, Melbourne University) Melbourne 7May 2015 Can Aid be delivered effectively in insecure contexts? The MoPH, Donors and the NGOs Partnership and its Impact on Maternal and Child Health in Afghanistan

2.  Health sector Key information  Health system Pyramid  strategies for health services  BPHS, success and challenges

3. Total Population (CSO)27.5 Million Population Growth (AMS )2.4% Women of Child Bearing Age(15-49)5.5million Literacy Rate (General Population)29 – 38% Women Literacy Rate14%

4. Indicators2002 Maternal Mortality Ratio 1600 Under five Mortality Rate 257 Infant mortality rate per 165 Life expectancy rate 42 Number of midwives 462 Coverage of Primary Health Care (1h walk from Health Facilities) 5% Health Situation in 2002

7. The MoPH Strategies for provision of health services and Number of Health facilities per year.  Basic Package of Health Services  Supported by donors agencies  Implemented by NGOs and SM  Essential Package of Hospital Services  Supported by Core budget  Implemented by the MoPH  Tertiary Services  Supported by government budget

8. Aid Channelled through different agencies, 2007-2009

9. Success and Achievements  Increased access from 8% to 57% from 2003 to 2013  Defined all PHC service in a single package and provided opportunity to holistic implementation  Through contract out of service delivery MoPH focused on stewardship role  BPHS is a pro-rural concept and responded to health need of most essential interventions for mother, child, under-served and hard to reach population

10.  The establishment of 34 Community Midwifery programs, trained, 3334  The establishment of Community Nursing Programs started 2011, 360 graduated and 994 under training  Training of 28837 Community Health Workers Continue

11. Indicators2010 (AMS) Maternal Mortality Ratio 327 Under five Mortality Rate 97 Infant mortality rate per 77 Life expectancy rate 64 Number of midwives 3334 Coverage of Primary Health Care (1h walk from Health Facilities) 57% Key National Indicators in 2010

12.  Improve the quality of health service at all levels with intention to improve the health outcomes  Expansion of service to marginalized population (left out from BPHS, Nomades, IDPs, and highly mobile population)  Enhance the health services to under-served components of the package (mental health, disability, essential drugs)  Financial and programmatic sustainability of services in long term and defining an exit strategy for BPHS  Having special package to security compromised area in Afghanistan Challenges