LITMIR.BIZ

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health indicators were the worst in the world. The Afghan government, supported by donors, in particular USAID, the World Bank and the European Union, has overseen real progress indicating that Afghans are living longer, more women have access to medical care during pregnancy and childbirth and more children survive to reach their fifth birthday.

      For example, access to primary health care services has increased from less than 10 percent in 2002 to around 65 percent now. The infant mortality rate has decreased from 257/1000 live births in 2000 to 97/1000 live births in 2010, according to a 2010 nation wide survey. According to the same survey, the maternal mortality rate decreased from 1600/100 000 in 2008–2009 to 372/100 000 two years later. Of course, this is still unacceptably high and the EU will continue to work with the Afghan government to improve the health of all Afghans.

      The considerable progress in the health sector is largely due to the implementation of a government-led Basic Package of Health Services (BPHS) and an Essential Package of Hospital Services (EPHS) implemented by NGOs and funded by USAID, the World Bank and the EU.

      Since 2001, the EU has committed a total of € 216 million in support of the health sector (including health policy & administration management, infectious disease control and basic health care). By funding non-state actors for the delivery of BPHS and EPHS, the EU supports the provision of basic health cares services to more than five million Afghans in ten provinces, even in some of the most insecure and underserved areas of the country.

      The BPHS has been critical in ensuring that all stakeholders focus on the common strategy established by the Ministry of Public Health (MoPH). This approach has made BPHS shorthand for a series of policies and strategies focused on the delivery of high impact primary health care, with adequate resources and efforts dedicated to improving service coverage to rural populations, equity in access to services and maintaining the focus on the poor, carefully monitored and evaluated.

      EU institutional support to MoPH at central and provincial levels focuses on better linking service delivery and sector governance as well as on improving sector stewardship, as essential milestones towards a sector-wide approach to health. Pivotal governance areas (policy, planning, health care financing, human resources management, procurement and financial management, pharmaceutical affairs) have gradually become more prominent in EU support. Areas linked to health service delivery include streamlining care for disability, mental health and prison health.

      In addition, the Provincial Health Directorates (PHDs) have been supported to play a key role in supervising the performance of NGOs' service delivery and provision of technical advice. Progressively, PHDs are expected to assume regulatory functions at the provincial level and be able to work effectively with the for-profit sector.

      In 2010, the EC allocated a fresh € 73 million to ensure the continuation of its support to the Afghan Public Health and Nutrition Sector. Institutional support to the Ministry of Public Health continues to produce positive results in terms of the health and nutrition status of the Afghan population.

      On 28 January 2013, the European Commission announced the agreement for new EU aid to Afghanistan to support health and agricultural programmes. In this case, €125 million were allocated to provide basic health care and essential hospital services for 14 million people, almost half of the Afghan population, in 21 provinces across the country. European Commissioner for Development, Andris Piebalgs commented: «the Afghan people have suffered tremendously in recent years due to war, instability and overwhelming poverty. With EU development aid we shall help these people to give them hope for a better tomorrow. This new funding will support Afghanistan in its quest to move from 'transition to transformation' and then to a self-sustainable country».

Agriculture and rural development

      Seventy per cent of the Afghan population is dependent on agriculture for their livelihoods. But this work is affected by seasonal and chronic unemployment and many Afghans are forced to find work in the illegal economy as a better source of revenue.

      Agriculture and rural development remains the most promising growth sector. Agriculture has a high multiplier impact on developing countries’ economies and contributes to environmental protection. The needs of the sector are huge in terms of financing as well as in terms of re-organising intervention logic. The EU has emerged as the leader of this sector. More than its funding levels, this leadership has been built on the ability to coordinate donors and communicating on their behalf with all cluster ministries in order to frame a national policy approach. Outside agriculture, existing rural development programmes aiming at developing secondary transport infrastructure critical to linking up rural communities, fostering off-farm employment through rural enterprises and consolidating local governance institutions have strong conceptual complementarities.

      The emergent link with local governance institutions is partially the outcome of strong EU policy dialogue with both the Ministry of Rural Development and the Independent Directorate for Local Governance. Considering the poor state of Afghan rural communities and the potential of the agricultural sector, the absorption capacity of the sector is huge – and since a substantial part of the population lives in rural areas, the impact will be broad and significant. In terms of poverty reduction and stabilisation of growth, agriculture and rural development should therefore remain a priority for the government. This is confirmed by the fact that the government has indicated its desire that ARTF expands its support to this sector, a process which has been largely facilitated by the EU.

      The European Union works in rural areas throughout the country helping to tackle food insecurity, supporting agricultural development, animal husbandry, water management and environmental conservation. Almost all EU agriculture and rural development related projects have been aimed at rehabilitating the economic and social fabric of Afghan society. As one example among many, one major irrigation dam repaired by the European Union on the Khanabad river now provides irrigation to 35 000 ha of land, increasing the food production for a population of some 50 000 people.

Counter-narcotics

      Drugs in general and heroin in particular are a major concern for neighbouring countries, including Russia, as well as for the European Union. According to a UNODC report published last year, «in 2010 an estimated 25 per cent of the 380 tons of heroin manufactured in Afghanistan -some 90 tons- was trafficked northwards through Central Asia via the Northern route and onward to the Russian Federation. The 90-ton total includes heroin consumed within Central Asia and the Russian Federation, as well as heroin seized by law enforcement or trafficked onward. More than three quarters of this amount are destined for the Russian market. Furthermore, in 2010 between 35 and 40 tons of raw opium were trafficked through northern Afghanistan towards Central Asian markets». The number of addicts in the Russian Federation has multiplied by 10 during the past 10 years. The Russian government estimates around 30 000 to 40 000 Russian people die from drugs per year26.

      Opium is Afghanistan’s most important agricultural crop by value and provides much-needed livelihoods for many people in rural areas. The illicit production of opium still overshadows licit agriculture, accounting for nearly half of overall agricultural production on a much smaller portion of arable land. Opium revenue, boosted by prohibitionist measures in most of the client markets, counters the incentives to develop a sustainable formal agriculture sector. In addition, the large criminal profits of the drug industry undermine governance, fuels corruption, nurtures deeply dysfunctional and highly extractive politics and, ultimately, stimulates insecurity and conflict. Moving away from economic reliance on opium is thus a priority development objective. But given opium’s characteristic as both a high-value, storable commodity with a ready market and a secure cash crop for an insecure environment, putting this into practice will not be easy.

      Nonetheless, sustainable progress made in eliminating opium cultivation in some areas, suggests that phasing out opium production in Afghanistan over the next 10–20 years is achievable. Estimates for the area size planted with opium poppy have fallen sharply in recent years, from 193,000 ha in 2007 to 131,000 ha in 2011. This decline has largely been driven by the saturation of markets and lowered prices, even though trends are rather volatile. However, opium production grew again in 2011 after a plant disease wiped out nearly half of the harvest in 2010 to reach an estimated level of 154,000 ha in 2012. Given the insecurity level, poppy production remains unfortunately a safe investment.

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