In August 2021, Afghanistan’s security situation rapidly deteriorated following the Taliban forces’ recapture of the country. The regime change severely affected Afghanistan’s health system. The banking system froze, so funds could not flow in or out of the country to finance health systems’ needs.
The security situation forced the Afghan Social Marketing Organization (ASMO), the leading private-sector provider of family planning (FP) and maternal and child health products in Afghanistan, to close its offices briefly, restricting activities to product sales. In October 2021, ASMO, which was established with support from the U.S. Agency for International Development (USAID), resumed operations with express permission from the Ministry of Public Health.
The Sustaining Health Outcomes through the Private Sector (SHOPS) Plus project has provided technical and financial support to ASMO since 2016. The chief of party for the SHOPS Plus project in Afghanistan, Abt Senior Associate Soumitra Ghosh, recently sat down to discuss how the project is working following the regime change.
1. Can you tell me a little bit about the SHOPS Plus Afghanistan Program?
SHOPS Plus has worked in Afghanistan since January 2016. We provide financial and technical support to ASMO with the aim of increasing the organization’s impact and resilience. It promotes FP, diarrhea prevention and management, anemia prevention, newborn care, and nutrition by distributing associated products at an affordable price nationally and by motivating Afghans to use these products through social and behavior change activities.
2. How has the regime change affected the ability of the program to operate?
Since the Taliban assumed control of the Afghan government in mid-August 2021, the Afghan financial system is strained by currency depreciation, a liquidity crunch in the banking system, and rampant inflation. This contributes to a cascade of economic consequences that are reducing the buying power of providers and clients. Consequently, ASMO’s sales across all products have declined significantly. While the private market has witnessed some recovery, ASMO’s product sales are far from the levels before the regime change.
Additionally, Afghanistan is highly dependent on imports, including for many pharmaceuticals that ASMO distributes. Banks have placed restrictions on payments to international suppliers, and international suppliers have limited confidence in Afghanistan’s ability to pay. ASMO receives donated condoms and oral contraceptives from USAID through the Global Health Supply Chain program. These products are significant sources of revenue for ASMO and have met with significant delays. Drastic reduction in sales revenue have affected ASMO’s ability to procure commodities on its own.
ASMO’s sustainability is further threatened by attrition of key staff and lack of mobility immediately following the regime change. This situation has stabilized a bit over time, but the availability of skilled professionals has become more challenging.
Given the changing context and factors described above, ASMO’s reliance on donor funding and support is likely to remain high until the operating environment improves.
3. What challenges has the program faced in continuing the program, and what strategies has the private sector used to overcome these challenges?
The program has faced significant challenges maintaining operations in Afghanistan. The team has identified solutions to address some of these challenges. For example, the disrupted banking system required creative, flexible strategies and close collaboration with both ASMO and USAID to pay for operations and keep activities moving forward. It also required working with ASMO to develop a detailed risk mitigation plan to ensure its staff could operate safely. ASMO relies heavily on product sales and prolonged stockouts are disastrous for its reputation and financial viability. ASMO has been building strong relationships with the de facto government to try to expedite approval and clearance for commodity shipments. To stay on top of new policies and guidelines, ASMO engages regularly with key individuals in government. ASMO is also consulting with the Ministry of Public Health, including its Religious Compliance Unit, to comply with government requirements for representation of women in communications campaigns and ads.
4. What impact is this having on the ability of clients to access contraceptives and other key health commodities?
Clients, especially women, have reduced access to and availability of health products and services. In addition, rising prices and costs are making health provisions unaffordable.
5. While it’s still early, are there lessons you can draw from the experience that others in fragile settings should consider?
We are constantly learning and adapting our approaches to respond to Afghanistan’s changing context. Being flexible and open to finding creative solutions is certainly a lesson that applies in other fragile settings. In addition, the private health sector is often able to respond and adapt more quickly than the public health sector to change. Effectively engaging them and focusing on market-based solutions are critical to ensuring continued access to essential health products and services. More broadly, we’ve learned that overreliance on donor funding poses a significant risk to sustainability, particularly when funding is suddenly stalled or diverted. When supporting local organizations, it is crucial to prioritize interventions that improve their long-term resiliency and capacity to withstand these shocks and funding gaps.
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Global Health - June 2024
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