WHO Working Brief
Symposium on Reconstruction of the Health System in Afghanistan
Seminar at the London School of Hygiene and Tropical Medicine
22 January 2002
At the Brussels conference in December 20, it was stated that the international community wants the
Afghan Interim Authority to play a leading role in partnership with the international community. The
Authority should address early on how it will coordinate with the donor community. It is recognized that
the goal is to ensure smooth and effective coordination.
A real leadership of Afghans in the health reconstruction process implies different requirements:
competence (senior Afghans staff), sincere recognition by external actors of the legitimacy of MoPH,
existence of accountability mechanisms (for both the government and international agencies), genuine
willingness of international partners to contribute and not to push for their own agenda, etc.
Globally, there are already many mechanisms of coordination in place: e.g. the Afghanistan
Reconstruction Steering group (ARSG), the implementation group, the Integrated Mission Task Force
(IMTF), comprising representatives of key UN departments and Agencies set up at the UN HQ in New
York, agencies involved in the Immediate and Transitional Assistance Programme (ITAP), those which
prepared the Preliminary Needs Assessment (ADB, WB, UNDP), the UN Assistance Mission to
Afghanistan (UNAMA) under the authority and leadership of the Special Representative of the Secretary
General (SRSG),…
It can be expected that external aid will cover the total health expenditure for the first years of
reconstruction. In the medium and long-terms, external aid will gradually scale down and other sources of
domestic financing will be required in order to fill the gap.
Initially, reconstruction will depend on external assistance, plans should be developed not only on the
basis of needs, but also on a realistic frame.
Consequently, the international aid and donor community have immense responsibilities to ensure that the
health needs of Afghans are being addressed and met accordingly. Simultaneously, support must be given
to the Ministry of Public Health to assume the leadership role in health sector development and regulation.
All health partners can assist the MoPH in the immediate time frame to ensure that humanitarian needs are
addressed by all partners according to a clear strategy; contribute to upholding health performance
standards and increase accountability of partners engaged in the sector; as well as mobilizing technical
resources and financial means for fulfilling the recovery and rehabilitation process.
The underlying principle is to designate one agency as the overall lead for the sector, thereby becoming
responsible for planning, coordination, and partnerships with other implementing agencies in that sector
including other UN agencies and NGOs and to guide the donors in establishing their financial
commitments for reconstruction of the health sector.
National and local authorities will be able to play a central role, at the beginning in identifying priorities
and formulating policies and subsequently in coordinating external assistance, managing aid and
implementing programmes; the necessary mechanisms must be in place to ensure good communication
and coordination between these two levels.
Effective and strong coordination mechanisms and aid management instruments are crucial to address
urgent needs, improve absorption, reconciliate humanitarian, short-term objectives with long-term
developmental goals, channel an expanded support, reduce inefficiencies, and bind donors and
implementing partners to the long-term reconstruction programme that the sector needs.
The Questions:
What type of co-ordination is needed? What is its scope?
Who are the actors?
What are the barriers to an effective co-ordination?
What can be done to overcome them?
What actions are needed?
For further information please contact:
Dr Stéphane Vandam
World Health Organisation
vandams@who-eu.be