The people of Afghanistan are long-suffering. For 30 years they faced constant threats—from Soviet military forces, from the barbaric Taliban regime, and from the continual destruction of basic services—all of which had disastrous effects on public health. According to World Health Organization data, prior to the 2001 U.S.-led invasion, Afghanistan was one of the sickest places on earth: a woman died every 27 minutes from pregnancy-related complications; more than 25,000 women died from such complications every year. Communicable and water-borne diseases were rife; cholera and malaria epidemics occurred frequently; and HIV infections were increasing. 

But as Dr. Sayed Mohammed Amin Fatimie, the energetic 56-year-old Afghan health minister, told me recently, things seem to be improving. According to Dr. Fatimie, the under-five mortality rate dropped by 25 percent between 2002 and 2007, from 257 deaths per 1,000 children in 2002 to 191 deaths in 2007. That is still a very high number, but a marked improvement nonetheless. 

In 2007, 7,876 Afghan women died from pregnancy-related conditions, two-thirds less than did so in 2002.

Maternal mortality has fallen even faster: in 2007, 7,876 Afghan women died from pregnancy-related conditions, two-thirds less than did so in 2002. Tuberculosis cases fell by 60 percent over that same period, thanks largely to a tripling of the number of healthcare facilities capable of treating the disease. In 2002, there were 370 such facilities; there are now at least 1,200. Cases of leishmaniasis, a particularly nasty disease spread by sand flies and dubbed “Baghdad boil” by U.S. troops serving in Iraq, were almost unheard of last year, with only seven reported incidents. There have been no recent malaria epidemics; Dr. Fatimie credits the adoption and use of insecticide-treated bed nets, as well as some indoor spraying of insecticides and larviciding of mosquito breeding grounds. 

He attributes Afghanistan’s broader progress on public health to mass immunizations, increased funding of community health workers, and the development of more sophisticated general and medical infrastructure. Dr. Fatimie also points to the adoption of an essential drugs list, along with a government commitment to make the drugs it lists available in more areas. The quality of drugs received by the government for distribution is good, he says, and there are no problems with counterfeit products—which is surprising, considering that several nearby countries (including Pakistan, India, and Russia) have been facing a proliferation of fake drugs. 

Afghanistan has made undeniable progress. But will it be sustainable? Dr. Fatimie acknowledges that help from overseas government agencies and NGOs has been vital. The Afghan government receives less than a third of all aid flowing into the country; the rest is distributed by for-profit U.S. contractors, Western aid-agency programs, and myriad global and local NGOs (themselves supported by international aid). Donors could get aid fatigue; locals may tire of aid-agency interference.

Indeed, none of these aid groups are especially popular in Afghanistan. As several New American Foundation scholars report in the latest issue of Foreign Policy magazine: “in 2005, Ramazan Bashardos, a parliamentary candidate in Kabul, sailed to electoral victory by running on an anti-NGO platform, threatening to expel nearly 2,000 NGOs that he claimed were corrupt, for-profit ventures providing little service to the country.”  

Of course, Afghanistan’s problems will not end when the foreigners leave. With per capita income still under $400 a year and a fragile security situation in the southern part of the country, Afghanistan is unquestionably dependent on foreign aid support. There are also signs of deeper troubles, including hints of corruption in the government’s inability to squash the opium trade. Some suggest that local politicians have secretly collaborated with the opium traders. This may explain why opium revenues remain high and are directly financing Taliban activities. 

Over the long term, Afghanistan must curb corruption in local politics and craft a pro-growth economic agenda. Such initiatives are beyond Dr. Fatimie’s control. But his team can and should continue to improve Afghanistan’s health infrastructure and make health resources more readily available. It should also bring more women into healthcare jobs, even if this means fighting against cultural restrictions. While Dr. Fatimie’s achievements have been impressive, he has much more work to do. 

Roger Bate is a resident fellow at the American Enterprise Institute.

Image by Getty.