From Devastation to Hope: Rebuilding Afghanistan's Broken Health System
A few weeks after September 11, 2001, William Newbrander, MHA ’75, PhD ’83, received a phone call from a friend in the U.S. Agency for International Development, asking whether the organization for which Newbrander worked, Management Sciences for Health (MSH), could do something to address the health care crisis in Afghanistan. The scale of the crisis was just beginning to be visible as international forces toppled the Taliban regime.
Statistics told the story: in 2001, one out of every six Afghan infants died in his or her first year of life, and one in four Afghan children died before the age of five. In some parts of the country, maternal mortality rates exceeded 2,000 per 100,000 births. Only seven percent of deliveries were assisted by skilled birth attendants. More than half of all health facilities had no female staff member. Life expectancy for both men and women in Afghanistan was less than 50 years.
Newbrander knew he had to act. Through MSH, a nonprofit organization that since 1971 has provided technical assistance in public health management to over 140 developing countries, he had devoted his career to helping nations create health systems that could provide equitable, quality care to the underserved. What’s more, his wife, Nancy, had grown up in Afghanistan, the daughter of Americans working there. So when MSH was chosen to help rebuild the Afghan health system, Newbrander volunteered to open the organization’s office there.
“I had to seize this chance to make a difference in the lives of people who had known nothing but pain, suffering, and war for 23 years,” Newbrander remembers. He arrived in Kabul on March 6, 2002, just a few months after the Taliban’s ouster. The capital was a ghost town. Three weeks went by before he saw a single woman on the streets. Land mines riddled the airport and surrounding countryside, and armed bodyguards roamed the city.
Newbrander’s task was huge: in the midst of this devastation, he and his company were to help the country’s brand-new Ministry of Health rebuild Afghanistan’s devastated health system.
They had three top priorities: reduce maternal and infant mortality rates, build the Ministry of Health’s capacity to plan and manage the nation’s health system on its own, and extend health services equitably to Afghanistan’s vast rural population—a factor critical to winning the peace and rebuilding the country. Under the Taliban, countless health professionals had fled Afghanistan, and only five percent of its rural population had access to basic health care. Three years later, Newbrander says, that number has risen to 77 percent.
In collaboration with the Ministry of Health, Newbrander identified the major conditions and causes of mortality and morbidity in the country and developed “A Basic Package of Health Ser-vices for Afghanistan,” which would form the foundation of the Afghan health system for decades to come. The package had seven key elements: maternal and newborn health, child health and immunization, public nutrition, the control of communicable diseases, mental health services, assistance to the disabled, and the supply of essential drugs.
Newbrander and his colleagues saw quick results. Within a year of devising the package, MSH joined forces with UNICEF and the World Health Organization to launch a massive immunization campaign to prevent measles in children. Thanks to that campaign, Newbrander says, an estimated 80,000 children did not die that year—children who otherwise would have succumbed to the disease.
Is he optimistic? “Life, in general, is better,” he says. Security in Kabul has improved, and Newbrander feels safe enough to indulge in a daily jog through the capital’s hilly streets.
“I hear the laughter of children, the music of teenagers, the loud sounds of construction as buildings rise from the rubble. I can see hope in people’s eyes. We are making progress in health, too. Much of that progress is simply the graves that do not exist because of the work of international agencies and organizations such as mine.”
Work remains, of course. Newbrander and his colleagues want to expand and improve health services throughout the country, a task that can only happen when both public and private institutions in Afghanistan are able to plan, manage, and deliver those services.
And the country’s health sector desperately needs more women. “We are working against the effects of the years of rule of the Taliban,” says Newbrander. “Because the Taliban did not allow women to attend school, there is a gap of about six to eight years during which no women were being educated.” Consequently there’s a drastic shortage of female health workers, and Newbrander and his colleagues are conducting remedial adult education in the hope of getting women to a sufficient level so that they can train as midwives and address the country’s dire maternal mortality rate.
Newbrander says his School of Public Health training has been “invaluable” in his work, particularly his efforts to redevelop a complete hospital system for Afghanistan—from 25-50 bed district hospitals to 400-500 bed regional hospitals. Newbrander is especially grateful to Professor John Griffith, who gave him a quantitative view of health care management, and Professor and SPH Dean Ken Warner, who showed him how to integrate an economics perspective into health care management.
Above all, Newbrander credits the late Avedis Donabedian with having taught him “to carefully examine and analyze complex problems with discipline and rigor.” From Donabedian, an expert in health care quality, Newbrander also learned “the universal importance that all people place on the quality of health care, no matter how rudimentary or advanced their health system.”
Clearly, it’s a lesson that stuck.
Article written by Leslie Stainton; photos courtesy of William Newbrander.
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