Refugee tent school

Health & Education

More than half of Afghans (52.0%) report having no formal or informal government or private education, including two-thirds (66.4%) of women and 37.7% of men. - Afghanistan in 2016: A Survey of the Afghan People, The Asia Foundation

The provision of essential services including healthcare and education is a basic function of any government.  However, following decades of conflict in Afghanistan which have disrupted government services, large parts of the responsibility have fallen to international and national NGOs, including some of our member organisations. 

Achievements

Significant progress has been made.  According to the Afghan Ministry of Public Health, the population with access to healthcare facilities increased from 9% in 2001 to 86.7% in 2011.  Community-based programmes have resulted in greater public awareness of vaccinations, hygiene practices and specific maternal and baby healthcare needs.  These and other approaches have led to improved health indicators – maternal mortality rates have dropped, life expectancy has increased.

In education, a focus on infrastructure and teacher training has increased access – the Ministry of Education figures state 9 million children are now enrolled in schools, compared to 900,000 in 2001 (however in December 2016 the Education Minister revised this to 6 million).  The number of teachers rose from 20,000 to 172,000 during the same period. Adult literacy rates have risen accordingly, and more vocational training is available.

However, these primarily quantitative successes must be matched with qualitative improvements. This is proving more complicated to resolve. 

Challenges

Whilst many more health facilities now exist, they are often under-staffed.  Where these clinics are based in insecure districts, the problem is exacerbated – and yet it is often these areas that have the greatest healthcare needs.  Patients are sometimes forced to seek treatment further afield.  In a 2014 study, Medecins Sans Frontieres found that over 10% of their surveyed patients had travelled for over 2 hours by car to reach their hospitals, often with critical injuries.  And some of these indicated they had by-passed local clinics because of concerns over the quality of staff and services provided there.  Whilst insecurity remains a major access problem, healthcare costs also prevent significant numbers of Afghans from seeking treatment.

And in education, despite an increase in facilities and school enrolment, too many students do not complete their education.  Girls are still particularly disadvantaged – parents will pull their daughters from school if there aren’t enough female teachers, if the journey to school is considered too dangerous, where their sons’ education is prioritised and due to cultural practices such as early marriage.  Some schools are forced to organise classes into three or four shifts a day due to student numbers – meaning the school hours provided per child is too low for them to attain a quality education.

Additionally, armed group attacks on health centres and schools continue, as does violence against healthcare and education staff. An April 2016 UN report documented 125 conflict-related incidents affecting healthcare facilities and 132 affecting schools in 2015, representing significant increases on previous years. These attacks on vital services are in direct contravention of international law and are largely avoidable – the Afghan security forces, for instance, have been known to occupy schools in conflict-affected provinces and thus directly place them at risk of attack.

And the access problems are exacerbated for the most vulnerable and marginalized groups such as internally displaced persons and returnees, people with disabilities, isolated minors, and nomadic communities.  These groups are both discriminated against and excluded from communities, whilst some service implementers ignore them due to perceived higher support costs or specialist technical expertise requirements.

What BAAG is doing

BAAG highlights the concerns of its members and Afghan civil society regarding these service gaps and issues.  Many service delivery issues relate to poor governance, management, accountability and monitoring, as well as inadequate consideration of gender-specific needs and policies.  BAAG raises these issues through its information sharing, events and research activities, striving to convey a more accurate picture of service provision to policy makers and the public, and recommending practical solutions.

What our members are doing

As seen on our Map, many of our members support the education and health systems in Afghanistan.  They do so through activities including building schools, training teachers and developing community-based education (such as Afghan Connection and CARE UK), providing vocational training (such as Afghan Action), promoting  sanitation and building latrines (Christian Aid) or delivering medical services and training volunteers in first aid and basic health treatments (such as HealthProm and the British Red Cross).  Our members also deliver or support advocacy efforts to improve policies in these sectors. 

BAAG’s recommendations to the UK Government:

1. Support efforts to enable all children to complete their education: despite increased overall school enrolment, there are significant disparities between urban and rural areas, girls and boys, and for marginalised groups such as children with disabilities, working children, nomadic families, and displaced children.  Support is needed for improved delivery of Afghanistan’s National Education Policy with particular emphasis on inclusion of the most marginalised and excluded groups.

2. Support retention of girls in education: Whilst the National Unity Government states ‘there are no conditions under which we will reduce our commitment to the education of girls’ (Realising Self-Reliance, 2014), more practical efforts are required to enable girls to enter and complete their education.  These include supporting community schools (and greater community participation in education decisions), increasing security around schools, training more female teachers and raising awareness about the harm of early marriage.

3. Support children’s education during emergencies and conflict: Education in Afghanistan is highly vulnerable to disruption as a result of natural disasters and insecurity.  When populations face food shortages or are displaced as a result of conflict or natural disaster, children are often withdrawn from school as families prioritise resources towards survival.  Not only does their education suffer, but also their psychosocial coping mechanisms for recovery. Targeted interventions to enable education to continue must be seen as a core component of humanitarian assistance. Donors should ensure that an appropriate proportion of humanitarian funding is channelled towards education in emergencies and protection, in line with the priorities outlined in the Common Humanitarian Action Plan for Afghanistan. In doing so, they will support valuable community-level education action. The UK Government and international community should ensure future aid to the country is based on levels of need and prioritises protection and education of all children across the country.

4. Support Afghan Government to align vocational education to local market needs and tailored to literacy levels. Technical and vocational training should be based on practical work by local artisans, incorporating skills-related ‘imbedded literacy’ and focused on work demonstrably demanded in local markets, in order to allow graduates immediate access to employment. Inclusion of women should be promoted through use of training venues that have local community approval, (not necessarily formal TVET institutions) reducing barriers to female participation. 

5. Ensure improved national capacity to deliver services: With continued unacceptably low levels of access to health and education, service delivery must expand. However expansion must focus on increasing quality and generating efficiencies in human and financial resources.  This should in part include drawing on the sectoral expertise of civil society organisations (CSOs) in service delivery, better utilising them as focal points to coordinate and initiate collaborative programmes, and more flexibly funding them to deliver these roles. Multilateral support for health services needs to be complemented by partnerships between Afghan CSOs and international NGOs with the aim of raising standards of performance and coverage.  

6. Prioritise women’s specific health and reproductive needs:As adequate improvement in rural roads and transport will take decades, more attention needs to be directed to provision of basic healthcare in villages by Community Health Workers (CHWs), including for referral to health facilities. CHWs are best placed to address the main child killers, pneumonia and dysentery. Extensive training in neonatal resuscitation should be supported by provision of basic equipment in all health facilities and to CHWs. Donors should work with the Government of Afghanistan to ensure that provincial reproductive health co-ordinators are appointed throughout Afghanistan. Antenatal care by midwives needs to be extended and accompanied by birth planning with women and, where possible, their husbands. This should include complications readiness.

 

 

 

For those who do manage to reach health facilities, their journeys are often fraught with fear and danger - Medecins sans Frontieres

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