Building better healthcare in Afghanistan and Pakistan

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Disasters, whether natural or man-made, destroy and disable healthcare systems just when they’re needed most. But disaster can also create an opportunity to make healthcare better, even in the world’s most troubled places.


Afghanistan, for example, a country ripped apart by decades of war with its healthcare system in shambles. In 2001, life expectancy was below 50 for both men and women, and under-five mortality at a staggering 257 per 1,000 live births. That’s over one-quarter of everyone born in the country. How do you fix something like that?

But Afghanistan is doing something about it. Since 2003, the Afghan government has been quietly reforming its healthcare system by contracting NGOs, through open tenders, to deliver services throughout the country rather than deliver them directly. As a result, all provinces in the country have basic healthcare services. Key indicators show dramatic improvements—the under five mortality rate, for example, is now 166. Still high - but a big improvement.

War isn’t the only cause of disaster. Pakistan’s 2005 earthquake, which killed 73,000 people and injured over 70,000 more, also ravaged its healthcare system just when people needed it the most. Millions of people had no access to health services. What did the government do? In Battagram, one of the affected districts, it contracted out healthcare delivery services through a public tender, which was won by Save the Children, an international NGO. The result? A big improvement in healthcare services, especially for women and children.

What do the healthcare solutions in Afghanistan and Pakistan have in common? First, both were rooted in relieving profound human suffering. Second, in both countries, the government did not try to deliver services directly, but used public tenders to contract healthcare service delivery to experienced NGOs. Finally, both countries saw significant improvements in healthcare, bringing them closer to meeting Millennium Challenge goals. Not too bad, I think.

But the positive stories don’t only come from Afghanistan or Pakistan. There are plenty of other communities rebuilding after war and natural disasters. I’d be interested in hearing from readers who’ve lived or worked in post-disaster/post-conflict environments. How did healthcare systems develop to meet the needs of people there, and who (or what) drove the change? Let me know!


David Lawrence

International Development Consultant

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