Актуальные проблемы Европы №3 / 2013

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.