Has War Been Good for the Health of Afghans?

Health levels in Afghanistan have for many years been among the very worst in the world. The Population Reference Bureau's 2011 World Population Data Sheet shows a life expectancy there of 44 years (compared to the world average of 70), an infant death rate of 131 deaths in the first year of life per 1000 live births (compared to the world average of 44), and a total fertility rate of 6.3 children per woman (compared to the world average of 2.5). This latter figure is also associated with a very high maternal mortality rate--often acknowledged to be the highest in the world. There is, however, a new US-sponsored health survey that seems to challenge these figures--which has of course led to the results of the survey being challenged. NPR has reported on the story.

A U.S.-sponsored mortality survey released last year announced huge improvements in health across Afghanistan. But the gains are so great that experts are still arguing about whether it's correct.
During three decades of war, Afghanistan remained a black hole of health information. The few mortality studies looked at a small slice of the population and then extrapolated.
Enter last year's $5 million Afghanistan Mortality Survey, which was funded by the U.S. Agency for International Development with a contribution from the U.N. Children's Fund. Officials say the new survey provides the most accurate snapshot ever of health in Afghanistan — and it delivered shockingly good news.
Afghan surveyors in all 34 provinces brought back data suggesting that life expectancy at birth is now 62 years. Child mortality under age 5 dropped to 10 percent. Of 100,000 live births, the maternal mortality number was down to 327.
"We were all surprised," says Susan Brock, health adviser with USAID in Kabul. "That's what led to additional review and much more analysis."

Some experts who worked on the survey still think it shows too much of a leap forward to be credible. Dr. Kenneth Hill, a Harvard University demographer and technical adviser on the survey, says there are too many anomalies.
"If the results had come out closer to expectations, they would have been hugely valuable, I think," Hill says. "But because there are still huge question marks hanging over the estimates, I'm not sure there is an enormous value in the data."

But defenders of the study say people can't believe the numbers because they've become accustomed to thinking of Afghanistan as hopeless.
Dr. Mohammad Rasooly, with the Afghan Ministry of Public Health, was the lead technician from the Afghan side of the survey. He says health care in his country is improving dramatically, and in many different ways.
"If we consider only the example of midwives, 10 years back we had only 400 midwives at the national level. So, today we have more than 3,000. This is very important for maternal care," Rasooly says.
Now, new paved roads mean that a journey to one of the thousands of newly built clinics takes hours instead of days in rural areas, says Rasooly. Widespread mobile phones have helped save the lives of people who in the past had no way to call for help. And there is little doubt that women have much more access to health care.

My own view is that if Ken Hill is skeptical, then so am I. There is probably no one in the world who knows demographic data of this kind better than he does. Still, I can understand the hope for progress that exists within these numbers, and can appreciate that there are many who really want to believe that this is true (and, of course, it might be--only another survey will be able to tell us for sure).