Scaling up primary health services for improving reproductive, maternal, and child health: a multisectoral collaboration in the conflict setting of Afghanistan

In their informative paper Jai Das and colleagues cite the WHO Trends in maternal mortality: 1990 to 2015, which gives an estimate (in Annex 7) of maternal mortality ratio of 396 per 100,000 live births. 1 Many have regarded such low estimates as too good to be true. Surprisingly Das and colleagues nowhere mention the Demographic and Health Survey 2015, which gives an estimate of MMR of 1,292 per 100,000 live births. 2

This paper, like a number of others on healthcare in Afghanistan, also fails to mention that data in that country are often corrupted. The massive inflow of funds for aid and development, with insufficient monitoring and audit, has fostered corruption, and that extends to data. It is no surprise that some recipient organisations aim to please their international donors with high achievements. A report by the Afghan government in 2016 said “fraud, falsification, fakes, and forgeries have become a routine aspect of documentation in the Public Health sector. This has had dire consequences for the integrity and reliability of each of the main elements of the health system”, including health services delivery and management information systems.

1. World Health Organization (WHO). Trends in maternal mortality: 1990 to 2015. Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 2015. https://www.who.int/reproductivehealth/publications/monitoring/maternal-....
2. Ministry of Public Health and Central Statistics Organization, Afghanistan, and DHS Program, ICF, Maryland, USA, 2015. Demographic and Health Survey. http://cso.gov.af/Content/files/Afghanistan%20DHS%202015%20KIR/AFDHS_Fin...
3. Independent Joint Anti-Corruption Monitoring and Evaluation Committee, 2016. Vulnerability to Corruption Assessment in the Afghan Ministry of Public Health.
http://www.mec.af/files/2016_06_04_MOPH_Special_Report_(English).pdf