As the popularity of continued involvement in Afghanistan begins to decline and talk of a coordinated exit becomes more prevalent, international efforts to contain Afghanistans health crisis develop a new sense of urgency. Despite struggles to improve health, there has been significant progress in certain areas. Programs that target specific diseases have boosted immunization rates. Tremendous strides have also been made in expanding access to care in rural areas. But serious challenges remain, in particular maternal health. If not properly addressed, Afghanistan will remain at the bottom of the rankings on maternal mortality. Given the conditions for women in Afghanistan, a health issue in such urgent need cannot afford to be ignored.
In this paper, I argue that comprehensive delivery of health services must include a stronger commitment to lowering mortality rates through innovative and targeted methods. Efforts to improve the health sector must take a diagonal approach, using low-skilled health workers as community-level representatives while working to continue the sector-wide improvements currently underway. While the sector-wide approach has expanded access to care and improved oversight of services delivered, it has not produced improvements in key health indicators such as maternal health. Health experts must work to bridge the divide between vertical approaches that target particular indicators and horizontal approaches that focus on the health system as a whole.
Mortality rates will remain high and improvements in the health sector will go unnoticed if further efforts are not made to promote the utilization of health services, especially by pregnant women. Working to further incorporate pregnant women into the health sector will result in declining mortality rates and will further legitimize the efforts of the central government by demonstrating its capacity to provide essential public services.
Keeping in mind Afghanistans immense health crisis and the need to improve its deficient managerial capacity, the most sensible approach to improving the health system should be neither exclusively vertical nor horizontal but rather a combination of both, with a focus on vertical efforts to educate pregnant women about the need to utilize health services and promote healthy lifestyle choices relating to breastfeeding and nutrition.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-08092010-101849 |
| Date | 01 September 2010 |
| Creators | Condee-Padunov, Nikolai |
| Contributors | Karen Feinstein, David Dausey, Jonathan Harris, Jennifer Murtazashvili |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-08092010-101849/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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