چکیده مقاله
Background: Afghanistan's health system has undergone substantial transformations over the past two decades, enabled by extensive donor investment and a vertically structured national service delivery framework While improvements in access, health indicators, and community based models are well documented, recent shifts in governance and funding have imperiled these gains This paper examines the role of local governance and urban management in shaping health sector performance, with particular attention to post 2021 developments and decentralization constraints Methods: We analyzed national health policy documents, survey data, peer reviewed literature, and grey sources to map historical and contemporary governance structures in Afghanistan's health sector We focus on health outcomes, financing, service delivery models, and municipal capacity, incorporating updated data from 2023–2025 where available Results: Maternal mortality declined from ~1,600 per 100,000 live births in 2000 to 521 in 2023, but rose to ~620 in 2025 amid funding cuts and service closures While under five mortality dropped significantly, service coverage has deteriorated since 2021 Health spending peaked at 22% of GDP in 2021, driven by crisis level aid, yet domestic financing fell to 0 8% of total health expenditure in 2022 Community health workers CHWs remain pivotal, covering 60 70% of communities However, municipal and provincial authorities retain minimal authority over health services, limiting decentralized innovation and accountability Conclusion: Afghanistan's recentralized health governance model has delivered gains but now faces acute risks Revitalizing health outcomes requires reimagining local governance capacity, sustaining frontline delivery mechanisms, and safeguarding equity in service access amid systemic shocks
کلیدواژهها
نویسندگان
Ali Rahimi
Department of Pediatrics, Faculty of Medicine, Herat University, Herat, Afghanistan
Mohammad Masudi
Department of Curative Medicine, Faculty of Medicine, Jami University, Herat, Afghanistan
Basir Ahmad Hasin
Department of Administration and Diplomacy, Faculty of Law and Political Sciences, Jami University, Herat, Afghanistan
شیوه ارجاع
Rahimi, Ali and Masudi, Mohammad and Hasin, Basir Ahmad,1404,Local Governance and Urban Health in Afghanistan: Progress, Challenges, and Future Directions,11th National Conference and 4rd International Conference on Urban Planning and Management,Mashhad
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مجموعه مقالات یازدهمین کنفرانس ملی و چهارمین کنفرانس بین المللی برنامه ریزی و مدیریت شهری14 آبان 1404 · مشهد