AKDN in Afghanistan
At the conference on the reconstruction of Afghanistan, held in Tokyo in 2002, His Highness the Aga Khan made an initial pledge of US$ 75 million to Afghanistan’s reconstruction. To date, AKDN’s assistance to Afghanistan has exceeded His Highness’ original pledge by 80 percent. With the support of its donors and partners, nearly US$ 750 million has been channelled through the AKDN for Afghanistan’s reconstruction. Among other things, this investment has helped to produce large-scale rural development, health, education and civil society programmes; the provision of a range of microfinance services; the safeguarding of historic landscapes and neighbourhoods in Kabul and Herat; a rapidly growing mobile phone network; and the renovation of a five-star hotel in Kabul.
In his statement at the Tokyo conference, His Highness identified three priorities for national recovery:
- the creation of a “safety belt” in Central Asia through selective investments in areas within the wider region that remain volatile and fertile grounds for permanent instability
- the repatriation of refugees and reintegration of former combatants in a manner that fully recognises and respects the rights, cultures and traditions of the country’s ethnic communities;
- and the establishment of competent, stable, transparent and accountable institutions which emerge from, and respond to, the needs of the majority of the population, and through which the processes of building confidence, strengthening democracy and fostering development can be channelled.
The Aga Khan Development Network considers that the most effective way to stimulate social and economic development is to promote improvements in a coordinated fashion across the full range of development sectors. This multi-sectoral approach is most effective when investments are focused on specific geographical areas over an extended period of time. By focussing development interventions geographically, AKDN aims to bring a variety of disciplines to bear in a given area and create a critical mass of development activities which will eventually reinforce each other.
For instance, support for education to increase literacy and vocational skills will help to stimulate entrepreneurialism and long-term economic development. Likewise, improvements in healthcare will enable a healthier population to seek gainful employment or to take a more active role in civil society and social regeneration. AKDN refers to this approach as Multi-Input Area Development (MIAD) – a multi-sectoral effort to respond to development needs and opportunities in particular geographical areas by targeted interventions in education, healthcare, agriculture, private sector development and governance. Over time, AKDN hopes to foster a strong network of capable Afghan individuals and institutions which can drive their own indigenous development process.
The integration process is most advanced in Badakhshan, Baghlan and Bamyan/Parwan, while Takhar is being developed as another geographical focus. In Badakhshan, area development is being taken a step further with the implementation of cross-border programmes aimed at improving social and economic ties between Afghanistan's Badakhshan province and the region of Gorno-Badakhshan in neighbouring Tajikistan. This integration process is aimed at promoting greater regional economic development for the benefit of both areas, which are among the most isolated in their respective countries.
Beyond its own agencies, the Aga Khan Development Network works to strengthen broader systems of Afghan institutions. For example, the Aga Khan Foundation’s AKF governance work is coordinated closely with the Afghan Ministry of Rural Reconstruction and Development and the Independent Directorate of Local Governance to ensure an approach that is consistent with government priorities. In education, the Aga Khan Foundation coordinates with the Afghan Ministry of Education and works to build the skill levels of Ministry staff at provincial and district levels.
The Network also works closely with the private sector, including the national Chamber of Commerce and its regional affiliates, business associations and entrepreneurs that are creating jobs and income for vulnerable rural households. Local civil society organisations are also strengthened as critical partners. In Bamyan, for example, Afghan civil society groups supported by the Aga Khan Foundation have begun implementing community savings programmes in districts outside those areas where AKF works.
AKDN’s approach is based on the belief that comprehensive area development, led by Afghan institutions, built on partnerships between government, business and civil society, is the surest way to secure Afghanistan's transition to stability and prosperity. In order to achieve area development, all partners must make long-term commitments, and coordinated investments must respond to the priorities set by local communities and their elected representatives.
The Aga Khan Development Network’s (AKDN) initial response in the health sector in Afghanistan has been based on its experience in Northern Pakistan and Tajikistan. However, over the last two years, the Ministry of Health in Afghanistan – supported by UN organizations, donors and NGOs, including Aga Khan Health Services (AKHS) and the Aga Khan Foundation (AKF) – has formulated a strategy which includes a basic package of core services that any agency wishing to provide health services to Afghans must deliver before adding any other services.
At level 1, volunteer male and female community health workers (CHWs) are trained, supervised and given basic provisions by the AKDN -- and remunerated by the communities served.
At levels 2 and 3, Basic Health Centres (BHC) provide for out-patient care, immunizations, normal deliveries, supervision of village-based community care with a recommended coverage at minimum of 10,000 people, and Comprehensive Health Centres (CHC) provides in addition to BHC complete obstetrical care coverage, emergency surgery, and has limited inpatient capacity. The recommended minimum coverage area encompasses 25,000 people. CHCs are constructed or rehabilitated, then managed and operated by AKDN on land donated by the communities to the Ministry of Health. 31 BHCs and 7CHCs are now operational in Badakshan province , as well as the district hospital in Baharak, and the provincial hospitals in Bamyan and Feyzabad. In the catchment areas of the health centres a health post is located in every village, and each health post is staffed by two CHWs – one male and one female.
With these 41 facilities and trained CHWs in place in all villages, a basic essential healthcare provision infrastructure is in place for 400,000 people. Per capita payment arrangements with the government are the current policy direction in Afghanistan, which allows AKDN to partly share the costs of service provision.