What We Are Doing

Afghanistan's national call-to-action to end preventable child deaths 28 May 2015

(Written by Dr. Jamil Rahmankhel, Health & Community Mobilization Advisor for Save the Children in Afghanistan)

As a final year for the unfinished business of MDGs, May 10-12, 2015 witnessed “New Hope” for Afghanistan, The national call to action to renew promise on ending preventable maternal and child deaths.  

A symbol of mother with baby to her bosom “Nuway heela” or new hope was the slogan of the call to action. This symbol appeared everywhere. On the screen, walls, veils of ladies, and more importantly on the words of every speaker at the event. This call made high profile people from line ministries, donors, UN agencies, NGOs, CSOs, and parliamentarians to account for maternal and child survival.

In response to the global call to action to mobilize countries to achieve an ambitious on the attainable goal “To end preventable maternal and child deaths”, the ministry of public health called on key actors of the country, to act for ending preventable maternal and child deaths.

Hundreds of representatives from different entities including, Chief Executive Officer for the Government of National Unity, Health and Education Advisor to President Ghani, and other ministers, ambassadors, UN agencies and other high level individuals of NGOs, donors, coalition’s civil society and media were engaged in this call.  

An exited presentation, using special software on maternal and child health in Afghanistan in global perspectives was presented by Professor Hans Rosling. This presentation impressed every participant at the event. In his presentation, Hans Rosling switches back and forth between the animation software and Power Point to make global development trends enjoyable and understandable in animated graphics. 

The findings of case study “countdown to 2015 evaluation of Afghanistan” aimed to conduct a systematic, assessment of reproductive, maternal, newborn and child health (RMNCH), nutrition, and survival trends in Afghanistan in the 2001-2014 “post-Taliban” era, analyze RMNCH-specific health systems components, policies, and financial flows, and determines key predictors of change in health service utilization.

Considering the mentioned findings, Afghanistan has made remarkable progress over the last decade; however several challenges remain including vast sub-national inequities. Maternal Mortality Rates (MMR) were reduced to 50% of its 2003 level (UN-MMEIG (UN Maternal Mortality Estimation Inter-agency Group estimates). MMR decreased 62% (1057 to 402) from 2000 to 2013; therefore, Afghanistan has met MDG5. Over 85% of all deaths could be averted by scaling up all intervention packages to 90% coverage level by 2025. Around 135,000 deaths averted annually. 

The findings recommended the need to focus on high-quality maternal & newborn care and strategies to reach marginalized populations, focus on education, infrastructure such as communication and transport systems and health system strengthening. The need for donor support, strong stewardship coupled with effective health policy frameworks have contributed to notable gains in MNCH to-date. Afghanistan was ready to embrace the aspirational sustainable development goals.

Technical review of BPHS/ EPHS interventions for future action indicated about the landscape analysis of the existing intervention in the EPHS and BPHS package. In addition, standard high-impact interventions recommended by the global RMNCH policy were presented. The finding of review pointed out the missing interventions for feasibility, cost, impact, social acceptability and scalability with recommendations for inclusions.

Two scenarios used for projecting decrease in maternal and child deaths: one scenario, from 2015 to 2020, in line with Afghanistan’s Reproductive Health Strategy and at the end point for its Millennium Development Goal targets. The second scenario used for a later date, 2015 to 2030 as the target date for the new Sustainable Development Goals.

For baselines, data was taken from national surveys. For end line, target coverage was taken from national strategies when available or these were based on realistic increases.

Decreases in the neonatal mortality rate are evident, at current rates it looks unlikely to achieve the target for neonatal deaths set by A Promise Renewed of 10 deaths per 1,000 live births by 2035. 

The event was witnessed of Save the Children’s innovation “Operation Research Project” implemented in two districts of Kabul province with support of UNICEF during 2011 and 2012. The cost-effective community-based MNC interventions (Newborn care, antenatal, delivery and postnatal care and birth preparedness) brought considerable improvements in the mentioned indicators compared to the baseline.

To conclude, the event was not only the new hope and renewal of the promise; it was the example of social accountability. It was the written commitment on the paper signed by key decision makers. And finally, it was the windows of opportunity for ending preventable maternal and child deaths by 2030.