Operational Principles

• Quality of Care: All interventions for Reproductive health should be made available with the highest standard of quality and safety, and services should be delivered according to evidence-based best practices. Addressing providers’ needs and community views, particularly those of women, on the quality of service provision is key to ensuring improved quality and increased access and utilisation.
• Continuum of Care: All women have a right to the best possible care before and during pregnancy, childbirth and the postpartum period at all levels of the health system, as appropriate for each woman or newborn’s needs. These levels range from the household to the first service level, and to the higher level service site. Primary care should be strongly connected to a referral system in order to effectively manage life threatening complications. This continuum of care encompasses the life-cycle of the woman, from adolescence through to the birth of her own child.
• An Integrated Approach: Comprehensive services are made available to all especially to women and newborns, integrating maternal and newborn care, family planning, nutrition, immunization, child survival, prevention and treatment care of malaria, sexually transmitted and HIV infections, and other aspects of primary health care. Because of the close links between the different aspects of reproductive health, interventions in one area are likely to have a positive impact on the others.  services will be strengthened and used as entry points for new interventions, looking for maximum synergy.
• Good Governance, Peace and Security: These elements are vital components of a sustained effort to improve the health of all people including the health and survival of mothers and their newborns, and are especially relevant to the country;
• Policies and Strategies Based on Evidence and Best Practices: The choice of policies, strategies and practices is informed by research findings, surveillance, monitoring and evaluation, need assessments, economic analysis, and by the sharing of lessons learned and other available evidence-based norms and standards.

Afghanistan house hold survey showed that 19 percent of births are attended by SBAs while NRVA, 2007 shows that the overall proportion of women delivering with a skilled birth attendant is 24 percent. Assessment of health services using the balanced score card (BSC) approach in 2006 found that women were more likely than men to access services. The 2010 National EmONC assessment shows none of the health facilities at any level achieved the goal of one skilled attendant for every 100 expected births.. The reviews make clear; however, that maternal mortality in Afghanistan remains extremely high by international standards even though there has been some progress since the year 2000.

High infant mortality is also a concern in Afghanistan. The infant mortality rate (IMR) was estimated at 129 deaths per 1,000 live births in 2006 (MoPH, 2006), and the neonatal mortality rate at 60 per 1,000 live births in 2004 (UNICEF, 2010).

Total fertility rate is 6.6 (2008) and contraceptive prevalence rate (CPR) is 22.8% (2007). The national household survey conducted by the Ministry of Public Health (MoPH) in 2006 reported that 33% of currently married women demonstrated knowledge of at least one modern method of contraception.

Afghanistan is still far from its goal of making quality reproductive health care available to all the people of the country and thereby improving their health and nutritional status. Use of health services for antenatal, delivery, postpartum and newborn care and family planning services is still far below the average of other countries in Asia.

The ANDS identifies a number of challenges and constraints that must be addressed if continued progress is to be made, including:

• Inadequate financing for many of the key programmes;
• Continued reliance on external sources of funding;
• Inadequately trained health workers;
• Persistent lack of qualified female health workers in rural areas;
• Dispersed population, geographical barriers and a lack of transportation infrastructure
• Low levels of utilization for certain health services, especially preventive services;
• Variable levels of service quality;
• Insecurity which makes program implementation difficult, recruitment and retention of staff, expansion of service coverage and monitoring by the provincial and central levels;
• Lack of effective financial protection mechanisms for poor households to receive the care they need without experiencing financial distress;
• Lack of mechanisms for effective regulation of for-profit private sector clinics and pharmacies.

Current reproductive health results ,have been defined in the HNS Strategy as follows:

• Percentage of deliveries by skilled birth attendants (SBAs)  18.9%
• Percentage of women receiving antenatal (ANC) 32.2% .
• Contraceptive prevalence rate (CPR) 15.4% .
• Maternal mortality ratio (MMR) 21% or  1600
• Total fertility rate (TFR)  6.6
• Percentage of population having access to RH services  65% .

Other HNS targets to be achieved by 2013:

• Number of facilities providing basic essential obstetric care (BEOC) 309 .
• Number of facilities providing comprehensive essential obstetric care (CEOC) 82 .
• Percentage of health facilities with a SBA  60 .
• Percentage of health facilities providing at least two modern family planning (FP) methods 29% .
• Percentage of all births that are accomplished by caesarean section 2.6% .
• Percentage of deliveries at health facilities  14.6%
• Percentage of pregnant women receiving at least two doses of tetanus toxoid 54%

Health needs in Afghanistan continue to be enormous as the country seeks stability, attempts to develop its infrastructure, accelerate the education of its people and raise their standard of living all at the same time. Nevertheless, in less than a decade of effort, significant improvements have been made in the health status of the population and the strengthening of its health system.