Getting Health Results in Afghanistan

A feature story by Beryl Lieff Benderly

For many people who keep up with world events, the news from Afghanistan has long appeared to consist mainly of terror attacks, counter-insurgency campaigns and the opium trade. Behind the sensational reporting, however, another major story is unfolding: how one of the world’s poorest countries, after decades of brutal conflict that claimed more than a million lives and made millions more people into refugees, is working to
build a modern health system. In a rugged land of mountain and desert that would present major obstacles even without the effects of war and widespread poverty, Afghanistan has made significant progress.

Central to this achievement has been the collaboration of the Afghan government with international donors including the World Bank in fashioning a system suited to the nation’s values, culture, priorities and geographic setting. Each of three major donors—the World Bank, the European Commission (EC), and the United States Agency for International Development (USAID)—has taken a different approach to funding and managing its contribution to the effort. The one chosen by the World Bank uses results-based financing (RBF), a system that provides rewards—in this case monetary ones--for improved performance. RBF has, some health experts believe, features well suited to the opportunities often present in countries with histories of conflict.