Journey to Restoration

Improving the leadership, management, and governance skills of the health workforce at all levels is a catalyst for strengthening the entire health system.

IMPROVED LEADERSHIP, MANAGEMENT, AND GOVERNANCE CAPABILITIES SAVEs LIVES

Delivering quality health services requires more than clinical skills.

WEAK HEALTH SYSTEMS IMPACT HEALTH INDICATORS

In 2002, at the fall of the Taliban regime after two decades of war, Afghanistan suffered some of the world’s worst health indicators.

Most of the health infrastructure was destroyed and many health workers were killed or forced to live in exile.

There were merely 913 active health facilities.

Life expectancy for women was 45 years.

The maternal mortality ratio was 1,600 per 100,000 live births; the infant mortality rate was 165 per 1,000 live births.

Only 12.2% of births were attended by a trained provider.

STRONG HEALTH SYSTEMS IMPROVE HEALTH OUTCOMES

For the past three years, the USAID’s Leadership, Management, and Governance (LMG) Project has worked with Afghanistan’s Ministry of Public Health (MOPH) units that oversee health service delivery systems.

Incredible progress has been made in Afghanistan through this, and other, USAID-supported projects.

Since 2002, life expectancy has increased by almost 20 years; infant mortality has dropped by 53 percent and child mortality by 62 percent.

Since 2003, the dramatic increase in the number of trained midwives present at birth has reduced the maternal mortality rates by nearly 300 percent.

In 2002, only nine percent of Afghans lived within a one-hour walk of a health facility. Today, more than 57 percent of the population does, enabling Afghans to seek medical attention, consult trained staff, and pick up medicine.

More than 25,000 community health workers are now part of the health workforce, bringing health education, basic medicines, and first aid into people’s homes.

Community health committees (shuras) and family health action groups are working with provincial health offices and health facilities to identify and advocate for community health needs.

EXEMPLIFYING LEADERSHIP, MANAGEMENT, AND GOVERNANCE PRINCIPLES

Dr. Zelaikha Anwari, Acting Director of the Reproductive Health Directorate (RHD), Afghanistan Ministry of Public Health

For many years, Dr. Zelaikha Anwari worked as a Program Manager for USAID’s Leadership, Management, and Governance-Afghanistan Project’s Provincial Health Systems Strengthening Program.

She is now the Acting Director of the Reproductive Health Directorate of Afghanistan’s Ministry of Public Health.

She uses strategies she learned from the LMG Project to help leaders, managers, and communities in Afghanistan to build a stronger health system for better health outcomes.

When I first started as Acting Director a few months ago, I used my L+M+G skills to streamline processes. I found that there was a lot of duplication of resources when it came to planning activities, especially for certain interventions on the global agenda – newborn care, for example.

Almost all partners were investing in interventions for improving newborn care, while other components of reproductive health were being ignored.

I thought that I should ask all of our partners to share their work plans.

Dr. Anwari then put the plans into one template, analyzed where duplications existed, and held meetings with all partners to develop restructured plans that allocated resources more effectively.

This mapping exercise was very useful for stewarding resources: we now have a clearer picture of gaps in health services and how we should allocate resources in the future. Also, doing this mapping regularly ensures that the donor money we receive is well spent.

Through direct work with MOPH units that oversee health service delivery systems, the LMG-Afghanistan project improved family planning, reproductive health, and maternal and child health care, in line with USAID, Family Planning 2020, and Ending Preventable Child and Maternal Deaths (EPCMD) initiatives.

Local ownership was a priority and was woven into all LMG-Afghanistan Project activities.

Strategies designed to strengthen health leadership were developed by Afghans, for Afghans, with international technical assistance used to promote global knowledge exchange and quality oversight.