From Evidence to Action: Assessing Health Systems and Newborn Outcomes in Afghanistan

About the Project

Afghanistan continues to face major maternal and newborn health challenges, shaped by decades of conflict, political instability, economic fragility, and disruptions to health service delivery. Newborn survival remains a critical public health concern, with neonatal mortality rates varying significantly across provinces and communities.

This project brings together evidence generation and he​alth systems assessment to better understand newborn health outcomes and programme monitoring systems in Afghanistan. The work includes an updated analysis of newborn and child health trends, determinants of neonatal mortality, geographic disparities, and the potential impact of scaling up evidence-based interventions.

The project also includes an evaluability assessment of High Impact Value Added Interventions (HIVA) across 733 health facilities in 10 provinces. This assessment examines monitoring and evaluation systems, data quality, facility readiness, and programme accountability mechanisms.

Together, these activities aim to support stronger planning, implementation, and evaluation of maternal, newborn, and child health programmes in Afghanistan.

Project Objectives

• Assess trends in newborn and child mortality, morbidity, and coverage of essential health interventions in Afghanistan.
• Examine geographic disparities in health outcomes and identify key drivers of neonatal mortality.
• Assess the potential impact of scaling up targeted, evidence-based healthcare interventions.
• Review the availability, validity, and use of programme monitoring and evaluation data.
• Provide recommendations to strengthen monitoring, evaluation, and accountability systems across health facilities.

Methodology / Approach

The project uses a mixed-methods approach, combining national data analysis, health systems assessment, programme evaluation, and stakeholder consultation.

The newborn health component draws on national household surveys, Health Management Information System data, facility assessments, and United Nations inter-agency estimates to examine mortality trends, service coverage, and provincial disparities. Geospatial analysis is used to map differences in newborn health outcomes across Afghanistan.

The evaluability assessment includes Third Party Monitoring across 733 health facilities in 10 provinces, including data verification, facility functionality assessments, and health worker interviews. Qualitative insights were also gathered through regional stakeholder consultations involving representatives from government, United Nations agencies, non-governmental organizations, the private sector, professional bodies, and academia.

Study Location

Afghanistan

The newborn health analysis covers all 34 provinces. The HIVA evaluability assessment covers 733 health facilities across 10 provinces in Afghanistan’s Southern, Western, and Central regions.

Target Population / Beneficiaries

The project focuses on newborns, mothers, pregnant women, and families who depend on Afghanistan’s health system for essential maternal, newborn, and child health services. Particular attention is given to marginalized, remote, and hard-to-reach communities where access to quality care remains limited.

The project also supports health workers, programme managers, policymakers, development partners, United Nations agencies, non-governmental organizations, and civil society actors by providing evidence and recommendations to strengthen maternal and newborn health programming.

Project Team​

Principal Investigator

Dr Zulfiqar A. Bhutta Founding Director, Institute for Global Health and Development, Aga Khan University, Pakistan
Co-Director​, Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada

Co-Principal Investigator

Dr Jai K. Das Associate Director, Institute for Global Health and Development, Aga Khan University, Pakistan

Team Members

Arjumand Rizvi

Ayesha Arshad Ali

Naureen Rehman

Muzna Hashmi

Abdul Haq Qiam

Malalai Naziri

Apurva Chaturvedi

Eresso Aga

S. M. Hossain

Asif Hussainyar

Jamal Noory

Rizwanullah Hassan

Research Partners

Institute for Global Health and Development Aga Khan University, Pakistan

Centre for Global Child Health The Hospital for Sick Children, Toronto, Canada

Ataturk Children’s Hospital Kabul, Afghanistan

UNICEF Afghanistan Afghanistan

French Medical Institute for Mothers and Children Afghanistan

Committed to Good Company Kabul, Afghanistan

Supported By

UNICEF Afghanistan

Mother & Child Care & Research Inc. Canada

Aga Khan University Pakistan

Grant Status

Completed / Finished

Key Achievem​​ents

• Completed five regional stakeholder consultative workshops across Afghanistan.
• Conducted national and provincial-level analysis using household survey, facility, and HMIS data from 2012 to 2023.
• Generated geospatial analyses of neonatal mortality disparities and health service coverage gaps.
• Applied the Lives Saved Tool to estimate the potential impact of scaled-up intervention packages.
• Completed the HIVA evaluability assessment and shared findings with key stakeholders.
• Newborn health country case study manuscript is currently under review for peer-reviewed publication.

Reports and Resources

Assessment of the Monitoring Mechanisms of the High Impact Value Added Interventions (HIVA), 2025

Assessing Gains, Drivers and Projections for Newborn Health in Afghanistan: A Country Case Study, 2025

Keywords

Newborn Health; Neonatal Mortality; Maternal and Child Health; Afghanistan; Monitoring and Evaluation; Health Systems Strengthening; Evidence-Based Interventions; Geographic Health Disparities; Community-Based Primary Care; Programme Evaluability

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