On human rights, the EU realises that it is necessary to take a long term approach, recognising the long lasting significance of apparently only small improvements.
In 2001, Afghanistan's 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.