Afghans are living longer, fewer infants are dying and more women are surviving childbirth because health care has dramatically improved around the country in the past decade, according to a national survey released Wednesday.
The survey indicates that increased access to health care in Afghanistan, more hospitals and clinics and more trained health care workers and doctors have significantly contributed to an overall improvement in the health of most Afghans.
"There have been many changes in the health sector and that is why we have so many positive changes," said Bashir Noormal, director general of the Afghan Public Health Institute.
Conducted by the Afghan Health Ministry in 2010, the survey was sponsored and funded by international organizations such as UNICEF, the World Health Organization, the U.S. government and the British Department for International Development. It was the most comprehensive to date in Afghanistan, despite the exclusion of some rural areas in the south where international forces are fighting insurgents.
It showed that the estimated life expectancy is up to between 62 and 64 years for both men and women. That compares with previous studies that showed life expectancy from 47 to 50 _ the latter figure reported by the WHO in 2009.
More importantly, the survey showed that infant mortality has been cut in half in recent years, and is now down to 97 deaths per 1,000 live births. The survey said one in 10 children in Afghanistan dies before they are five years old while previous surveys, carried out about five years ago, showed that one child in five died before reaching that age. The 2009 WHO study reported 199 deaths per 1,000 live births.
Women in this war-ravaged country also are far more likely to survive pregnancy today. The survey indicated that the number of women who die from pregnancy-related causes has dropped to one in every 50. Afghan women on average have just over five children, it said.
Still, one Afghan women dies about every two hours from pregnancy-related causes and while childhood mortality is decreasing, it remains the highest in the region.
Despite the progress, Afghan Public Health Minister Suraya Dalil said, "we still have a very long way to go."
Recent improvements are visible at Kabul's Malalai Maternity Hospital, the oldest and biggest such facility in the capital. The teeming 200-bed hospital is crowded with women seeking mostly emergency help with difficult pregnancies. It handles 80 births a day, including 30 Cesarian sections.
Dr. Hafeeza Amar Khail, the facility's medical director, says the hospital is "seeing decreasing mortality every year _ last year, the year before and the year before that" and attributed the improvements to constant training.
"We now update doctors, midwives and all the staff of this hospital," she told the AP. "We also have a midwife clinic and supply midwives to the provinces."
In 2003, there were just 450 health facilities around Afghanistan, including hospitals, according to the health ministry. Now, there are more than 1,800. The number of trained midwives has risen from 400 in 2003 to more than 2,000, in 2010, including many trained by organizations such as Save the Children.
"These encouraging results show that even in the most challenging and difficult environments, dramatic improvements in child mortality can be achieved," said David Skinner, country director for Save the Children.
Since 2003, around 20,000 community health workers have been trained nationwide by various groups and organizations. "As a result of this, and other community-level activities, fewer children are dying from preventable causes like diarrhea or pneumonia," Skinner said.
The study, however, revealed significant gaps between rural and urban areas and showed that wealth and education play a key role in the level of health care Afghans receive.
The Afghan government, experts and sponsors say it also shows that development aid to Afghanistan in the health sector has worked, despite obstacles, bureaucracy and endemic corruption.
They argue that aid must not be reduced as the international community gradually trims the funds it provides the government as it starts drawing down the 130,000 troops currently in the country. That troop withdrawal, which is slated to be completed by the end of 2014, has already begun with the transition of security responsibility from U.S. and NATO to Afghan forces in many areas of the country.
"International aid, which has funded many of the public health programs in Afghanistan, has made a real difference _ saving many children's lives," Skinner said. "Donor governments need to build on this success and continue to invest in Afghanistan in ways that directly benefit ordinary Afghans."
The World Bank said last week that Afghanistan will need billions of dollars in aid for a decade or more, especially if it hopes to fund services such as health. The health ministry receives the majority of its funding from foreign donors, with the biggest being the United States, World Bank and European Union.
The World Bank said Afghanistan this year received $15.7 billion in aid, representing more than 90 percent of its public spending.
The study surveyed 225,351 households and 47,848 women from ages 12 to 49. Survey organizers acknowledge that although it covered 87 percent of the country _ 98 percent of the urban population and 84 percent of the rural one _ the survey had data collection problems.
Because of security reasons, it did not include rural areas of three major southern provinces, Kandahar, Helmand and Zabul, which have seen some of the most intense fighting between insurgents and Afghan and NATO troops.
(This version CORRECTS in paragraph 15 that 20,000 community health workers have been trained nationwide by various groups and organizations, not just by Save the Children.)