Building a state or saving lives? : the processes, motives and politics behind the reconstruction of Afghanistan's health system

Abstract

Startlingly poor health statistics in Afghanistan clearly indicate that, in order to enhance the socio-economic status and overall stability of the state, a complete overhaul of its health care system is imperative. However, providing health is not simply a technical endeavor involving the construction of clinics, the training of doctors, and adequate medical supplies, for instance. In the stage of policy formulation for the reconstruction of Afghanistan's health system, there was in fact a dynamic, political process. The specific form of health reconstruction being implemented in Afghanistan was a result of a global consensus regarding the importance of health and general best-practice methods for health reform, external pressure to act quickly, power dynamics, and differing priorities of participating actors. The decisions and the resulting nuances of the plan conceived during this period also have broader implications regarding how and if long-term goals of development for Afghanistan, such as state building, could be reinforced or neglected. Development aid that overtly includes long-term state building goals seems like a plausible and possibly even more appealing solution than the current plan that concentrates on quick, high-impact health results. However, in a post-conflict state where the weakness of the state primarily characterizes the political context, should state building be a primary goal? Where does state building fit into the world of humanitarian aid and development policy? What do the nuances within the health policy being examined imply for state building efforts in Afghanistan?

(cont.) While there are not any straightforward answers to these questions, it is necessary that planners, health policy makers, and those working in international development are cognizant of the trade- offs of policy decisions, most particularly in post-conflict countries. Keywords: Afghanistan, health care reform, state building, politics of health policy, post- conflict, reconstruction