Priority setting in a context of insecurity, epidemiological transition and low financial risk protection, Afghanistan

In the last two decades, the Government of Afghanistan has achieved improvements in population health despite serious episodes of violence. Between 2000 and 2015, the maternal mortality ratio reduced from 1100 to 396 deaths per 100 000 live births and under-five mortality from 257 to 55 per 1000 live births. The high level of insecurity in some provinces has had a negative effect on the provision and coverage of health services, especially for child vaccination. However, thanks to the concerted efforts of all health system actors, between 2000 and 2015 all provinces in the country increased the coverage of maternal and child health services. Despite these improvements, significant differences exist in terms of health outcomes and coverage of health services, for instance between the poorest and the wealthiest populations, between rural and urban areas, and between provinces. Afghanistan faces several health challenges, including a high burden of communicable diseases, increase of noncommunicable diseases, maternal morbidity and mortality, injuries and, in many provinces, groups of populations with low nutritional status among children. Among noncommunicable diseases, ischaemic heart disease, congenital defects and cerebrovascular disease rank among the leading causes of premature mortality. In 2016, injuries from armed conflict and road injuries ranked respectively second and fifth as causes of premature mortality. Deaths from conflict rose by almost 1100% between 2005 (1711 deaths) and 2017 (19 735 deaths). A total of 52.0% civilian fatalities (880 deaths out of 1692) were caused by suicide and complex attacks during the first half of 2018. Furthermore, according to the 2015 Afghanistan National Drug Use Survey, almost 3 million Afghans abuse from substances, that is, about 11.0% of the total population.