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Afghanistan: peace and development go hand in hand

With ongoing conflict for more than 30 years and the highest under-five mortality rate in the Asia and Pacific region, Afghanistan is one of the worst places in the world to be a child.

Little progress on reducing child mortality

Progress on reducing under-five mortality rate has remained stagnant over the past decade and can clearly be attributed to the ongoing conflict and instability.

According to the Countdown to 2015 report published last year, Afghanistan made considerable progress on reducing the under-five mortality between 1990 and 2000, with an average annual rate of reduction (AARR) of 5.9.

However, in the subsequent decade to 2010, little progress has been made and the AARR of under five mortality rate has remained at an alarming 0.1 per year.

Needless to say, Afghanistan is not on track to meet its millennium development goal 4 target to reduce by two-thirds the under-five mortality rate by 2015.

With the current pace of progress, it wouldn’t reach this target until 2803!

Troop withdrawal

With the impending withdrawal of all foreign troops from Afghanistan by the end of next year, peace and stability in Afghanistan is becoming even more uncertain.

The House of Commons cross-party Defence Committee in its new report, Securing the Future of Afghanistan, calls for increasing efforts to promote peace and reconciliation, and warns that the country could descend into yet another civil war within a few years after International Security Assistance Force (ISAF) troop withdrawal if all parties are not engaged in a peace process.

It is widely acknowledged that national reconciliation is needed to ensure enduring peace and stability in Afghanistan and an imposed solution will not work, yet little or no progress was made towards achieving this goal in the past decade.

Dependence on foreign funding

As the last group of Royal Marines started to leave Afghanistan this week, there are growing concerns among the local people and government officials alike for the future.

In my recent discussion with a senior official at Afghanistan’s Ministry of Public Health (MoPH), increasing uncertainty over the health service was evident.

The Afghan MoPH receives more than 95% of its funding from foreign donors and nearly all health service delivery is done through local and international non-governmental organisations.

Limited capacity to implement

Over the past decade, MoPH systems have been strengthened, but local health departments still lack the capacity to implement basic health services.

There is a need to reduce the dependence on both foreign funding and contracted-out services to improve access to health and child survival in Afghanistan.

MoPH systems must be strengthened further to enable it to directly deliver the essential packages of health services, especially in insecure and remote communities that are unattractive to contractors.

Experience from Brazil demonstrates how a combination of public and private sub-systems, under the umbrella of a unified health system and a decentralised management structure, can scale-up access to health for all and bring down mortality rates, contributing to economic development of the country.

Need for governance reforms

Afghanistan is rich in minerals, however instability has hindered development and weak monetary policies account for little revenue generation.

Widespread corruption has meant that less than half of overseas development aid pledged since 2001 has been disbursed.

According to a recent report, only about 43% of pledged funding was disbursed during the past decade, and 77% of the disbursed amount had little or no involvement of the Afghan government.

There is a need for effective measures that will enable the government to generate funds internally.

Services promote peace

There is increasing evidence that service delivery promotes peace-building in fragile and conflict-affected states.

In Afghanistan, conflicting sides have routinely agreed to a few days of truce to allow immunisation campaigns to be conducted.

In a recent research by Save the Children and partners, we found that the delivery of basic services can make a positive contribution to peace-building and state-building goals through strengthening the legitimacy of the state.

Peace promotes development

The British government’s recent decision to increase its efforts to promote peace in fragile and conflict-affected states is a welcome decision; however this should not be at the cost of development aid.

International aid is the lifeline for health services in Afghanistan, and this assistance should continue, as the Commons Defence Committee report has called for, until the country is able to sustain services on its own.

It is only through enduring peace in Afghanistan that we’ll be able to pave way for the much needed human and economic development, ending three decades of conflict and instability in the region.

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