Afghanistan’s health system is under duress, but has not collapsed

Since 2002, the provision of public health care in Afghanistan has relied on non-governmental organisation service providers to deliver most health services nationally. These service providers were awarded contracts by the former government (using predominantly donor funds) to provide free-of-charge primary and secondary health services. Service providers also negotiated with armed opposition groups to gain access to and deliver services in areas under their control. Starting in 2019, expanded managerial autonomy for service providers, coinciding with a shift to linking payments to service volume, resulted in increased service coverage despite the worsening security situation.