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Developing a new Basic Package of Health services for Afghanistan

Photo: Mr. Gerard Joseph Abou-Jaoude (UCL), Dr. Jolene Skordis-Worrall (UCL), Dr. Hassan Haghparast-Bidgoli (UCL), Dr. Neha Singh (LSHTM), Dr. Karl Blanchet (LSHTM), Ms. Stephanie Simmonds (Afghanistan MoPH), His Excellency Dr. Ferozuddin Feroz (Afghanistan MoPH), Prof. Dame Anne Mills (LSHTM). Credit: LSHTM

Similar to a number of other conflict-affected countries, Afghanistan developed its basic package of health services (BPHS) in 2003 with the intention of delivering effective, targeted, equitable, and sustainable health interventions to the Afghan population. The BPHS is implemented by the Ministry of Public Health (MoPH) in Afghanistan and currently outsourced to 40 national and international NGOs, who are mandated with delivering BPHS services in 31 provinces. In Afghanistan’s remaining three provinces, the MoPH directly delivers BPHS through a contracting-in initiative entitled strengthening mechanism (SM). To date, BPHS is covering around 85% of the Afghan population. 

In October 2017, the Health in Humanitarian Crises Centre at the London School of Hygiene & Tropical Medicine was commissioned by the MoPH in Afghanistan, with financial support from the Bill & Melinda Gates Foundation, to provide technical expertise to support the MoPH on the development of a new BPHS.
Between 2003 and 2015, Afghanistan made substantial progress in improving women’s and children’s health, with a 64% reduction in the maternal mortality ratio, and a 29% reduction in under-five mortality. Access to and utilisation of primary health care services has improved, while at the same time the country’s health information system has become increasingly functional. Given slow progress in improving other key health indicators, and in light of emerging health challenges such as non- communicable diseases and increasing levels of insecurity limiting civilian access to health services, it is clear that a new package of health services for Afghanistan must be defined. The package needs to be better aligned with the changing health needs of its population and the capacities of its health system. 

Working alongside the MoPH in Afghanistan, with support from Dr. Jolene Skordis-Worrall, Director of the Centre for Global Health Economics her UCL team, and Professor Ala Alwan and his colleagues at the Disease Control Priorities Network, the project aims to support the MoPH in developing an innovative package of top priority health interventions for use in Afghanistan. The research group will review the burden of disease in Afghanistan, conduct cost-effectiveness analyses, and apply novel modelling methods to inform decisions on defining the new BPHS, with inputs from national and international experts. 

Our first meeting took place on 30 October 2017 at the London School of Hygiene & Tropical Medicine. In attendance was His Excellency Dr. Ferozuddin Feroz, Minister of Public Health of Afghanistan, Stephanie Simmonds, Senior Advisor and Mentor to the Minister and former Senior Health Advisor at the UK’s Department for International Development and a former School staff member, and the UCL team. Project Senior Advisor Professor Zulfiqar Bhutta, Aga Khan University and Sickkids in Toronto also joined the meeting, which provided the opportunity to define research activities that we will undertake with an aim of delivering a new costed and evidence-based BPHS for Afghanistan by December 2018.

This partnership between the Afghanistan MoPH, UCL DCP and the School is unprecedented and will be extremely useful for the Afghani population and their access to health services. The new initiative will open avenues for other countries to initiate similar collaboration to improve the health of their population.