ENABLING THE GOVERNMENT OF AFGHANISTAN TO GIVE ITS CITIZENS

UNCLAS SECTION 01 OF 03 KABUL 003907 SIPDIS DEPT FOR GWI, S/SRAP, SCA/FO, SCA/RA, SCA/A DEPT PASS AID/ANE CENTCOM FOR USFOR-A AND CSTC-A NSC FOR JJONES DASD FOR DSEDNEY E.O. 12958 N/A TAGS: ESTH SOCI AF SUBJECT: ENABLING THE GOVERNMENT OF AFGHANISTAN TO GIVE ITS CITIZENS WHAT THEY WANT: HEALTH AND EDUCATION ¶1. (U) Summary: With one of the lowest literacy rates and some of the worst health statistics in the world, the lack of an educated and healthy population is a severe impediment to social and economic progress and stability in Afghanistan. Enabling the Government of the Islamic Republic of Afghanistan (GIRoA) to deliver critical, high demand services in health and education is one of the most simple and effective methods for increasing citizen's active and continued support of their government. Citizen support increases with further expansion of GIRoA service delivery as reflected in President Obama's recent messages on Afghanistan and our COIN strategy. Health and Education are two of Afghan citizens' most demanded and appreciated services from the GIRoA. USG commitment to strengthening the GIRoA's ability to expand and deliver health and education services into more districts needs greater support - especially since other donors are either unwilling or unable to help. The gains we have made in education and health and the increased support of the citizens for the GIRoA because of these gains are not reflected in current USG funding levels. We have requested separately additional funding for these two important sectors. End Summary. Progress in Health but a Long Road to a Healthy Afghanistan - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ¶2. (U) The Ministry of Public Health (MoPH) has vastly improved its health service provision in the last six years with USG assistance. Afghanistan's under-five mortality rate has dropped 25%, infant mortality 22%, and access to health care rose by 76%. The number of midwives has quadrupled and health facilities with a female health worker have more than doubled. A model for good governance, the MoPH is also the first ministry in Afghanistan eligible to receive large amounts of direct funding from the USG due to its high level of transparency and accountability. The funds travel through a Host Country Contracting (HCC) mechanism that allows USG assistance to flow directly to the GIRoA for the provision of basic health services. Currently, USAID has agreed to channel $236 million through the MoPH in the next five years. Already managing $40 million a year in USG funding the MoPH could easily manage three times the resources due to their proven management and capability. ¶3. (U) Despite these gains, Afghanistan continues to struggle with one of the poorest public health situations in the world. According to the United Nations Children's Fund (UNICEF),Afghanistan is the worst place in the world for children to be born as it has the highest infant mortality in the world, and the World Health Organization (WHO) lists Afghanistan as the second highest maternal mortality rate in the world. To put this into perspective, in 2008, four times as many women died in pregnancy and childbirth than anyone did from insurgent/battle related causes in Afghanistan. Women and girls suffer more by these statistics, and Afghanistan is one of few countries in which women have a lower life expectancy than men. Fifty-seven percent of Afghan women marry before the legal age of 16, and the average Afghan woman has 6.75 children in her lifetime before dying at age 44. Afghanistan continues to have extremely poor access to clean water and adequate sanitation and a high burden of infectious diseases such as tuberculosis (TB), malaria, and polio. Equally alarming, the population will likely double in the next 15 years, posing a real threat to the Afghanistan's stability. Education - Major Success Could Lead to Major Problems - - - - - - - - - - - - - - - - - - - - - - - - - - - - ¶4. (U) The USG and the GIRoA are continuing their successful partnership extending access to and quality of education. The Ministry of Education (MoE) and the Ministry of Higher Education (MoHE) vastly improved education service delivery and management capacity with USG assistance. Key achievements include a seven-fold increased student enrollment in primary and secondary education, especially for females; increased quality of the teaching force at primary, secondary and university levels; increased quality of key university-level degree programs; increased numbers of adults enrolling in literacy programs; improved MoE management of the education system; increased availability of teaching and learning materials, especially textbooks and teacher guides; a new primary school curriculum; and improved school infrastructure. ¶5. (U) These successes will create an estimated 100,000 high school graduates by 2010 and 600,000 by 2014. These impressive gains create a high demand for university education, where places are extremely limited. With 56,000 students enrolled in higher education institutions in 2008, the rapidly increasing demand easily outstrips the available places - adding to the instability caused by KABUL 00003907 002 OF 003 large numbers of out-of-school children and youth and the lack of workforce skills training opportunities. Women are severely disadvantaged due to their limited access to secondary schools with female teachers. In fact, the MoE states that 214 of 400 districts in the country do not have any female teachers. The MoE estimates that Afghanistan needs 160,000 new teachers by 2014 to keep pace with current demand for education as Afghanistan's school-age population grew by more than 3 percent or 250,000 children last year. Even if the insurgents stopped destroying schools and obstructing attendance, the government would face a momentous challenge in furnishing enough classrooms and teachers for this burgeoning generation. Can Other Donors Step Up? - - - - - - - - - - - - - ¶6. (U) Thanks to excellent donor coordination by the MoPH, the overall amount needed by the USG is rather small compared to the amount of funding needed for measurable success in other USG funded sectors such as rule of law, democracy, and agriculture. The MoPH has coordinated donor financing by assigning provinces to the three main donors: USAID has thirteen; the World Bank has eleven; and the European Commission has ten. Unfortunately, despite the division of labor, the World Bank (the second largest funder after the USG) is decreasing their funding from $20 million to $12 million a year for the next four years to the health sector, while there are no new donors stepping up to fill the gap. USAID/Afghanistan has engaged other donors working in health - the German Embassy, the French, the Lithuanians, the Asian Development Bank, the British, the Canadians and Norwegians with discouraging results. Due to smaller budgets and a focus on provinces in which their troops are stationed, other donors are unwilling or unable to contribute anything meaningful enough to make a difference in USG strategy. ¶7. (U) Due to most donors' desire to only work in primary education, USAID remains one a few that will fund secondary and higher education - the two most underfunded parts of the education system. Additive funding would enable USAID to expand much needed programming in secondary education to allow girls the opportunity to continue with their education. Moreover, assistance to improve the quality and accessibility of secondary education is critical to counterinsurgency objectives as it engages youth in productive activities at an age when they are most susceptible to recruitment by the insurgency. USAID could also build on its successes in higher education by supporting expanded access to females and by improving quality in fields of study relevant to economic growth. So Now What? - - - - - - ¶8. (U) In a country with the some of the lowest literacy rates and some of the worst health status statistics in the world, the USG has had phenomenal success in only a six-year time frame with a relatively small budget. But, as fruitful as USG investments have been, much more is needed to build an Afghanistan that can manage its own future. USAID's health and education budgets have decreased since FY 08. The USG should be expanding on its success by increasing support with an increased budget in health and education to support the GIRoA in these critical areas. Previous budgets have only been a fraction of the $650 million necessary to support fully the MoPH and the MoE as they extend their services to the furthest districts in the USG supported provinces as well as other targeted districts in other donor supported provinces. Such an amount of funding could also create a workforce development program and respond to GIRoA's need to create basic skills training and advanced university degrees. ¶9. (U) The health budget could quickly be expanded and expended in one of the most high-impact, visible and Afghanized means possible, if we had additional resources into the direct-funding to HCC with the MoPH. The structure is in place, and it is now a matter of expanding its reach to further provinces and districts in the South and East. Filled with both Afghans and expatriates, USAID believes the MoPH Grants and Contracts Management Unit (GCMU) can triple the amount it manages while continuing its strong oversight and accountability. With increased funding, the USG can scale up successful health programs to meet Afghan citizens' needs and achieve USG COIN objectives. More specifically, the USG can enable the GIRoA to offer critical health services to more than 13 million Afghans through the HCC mechanism with the Public Health Ministry. Health and education services are often the only face of GIRoA in remote or non-permissive regions recognized by communities as an essential service - something the Taliban definitely cannot provide. It remains critical that the number of local NGOs contracted by KABUL 00003907 003 OF 003 GIRoA to deliver health services will continue to increase. ¶10. (U) Much like the HCC with the MoPH, an increase in funding would enable the USG to support the Education Ministry's goal of achieving universal primary education by 2020. As Afghanistan's largest donor to basic education since 2002, USAID is well-positioned to solidify its gains in the education sector. These include a quadrupling (from 70,000 children to nearly 300,000) of the reach of community-based primary and secondary education. Further funding could also provide assistance to the long-overlooked madrassas which provide education in areas with high insurgent activity. As the only formal education accepted by conservative communities, USG support would promote less radical agendas and reduce the numbers of youth susceptible to insurgent recruitment. Madrassa engagement includes support for the implementation of the GIRoA's secular curriculum with a focus on providing practical skills to help students transition from school to work. Requested Levels - - - - - - - - ¶11. (U) With a $212 million FY 10 initial request ($95 for education and $112 for health) both portfolios will remain severely underfunded. Post hopes the USG will be able to triple both portfolios in order to meet the needs of the GIRoA as it further expands its services into additional districts. An overall USG commitment to an increased budget is critical for expanding these services - especially in light of the new US Military commitment. Expanding access and coverage of high-impact quality health and education services to currently underserved populations, especially in insecure areas, through ways that are highly visible and provide immediate benefit to target communities, will increase legitimacy and support for the government. Not only do these activities help improve health and education status in Afghanistan, they support job creation and employment. Support for building functional and efficient health and education systems in Afghanistan is a high-impact, necessary investment for Afghanistan's vulnerable rural population that will reap benefits for generations to come. ¶12. (U) COMMENT: Post has requested separately a large plus up in developmental assistance portfolios to support the emergence of a legitimate Afghan state that meets the needs and has the support of its citizens. Despite their importance to COIN, high Afghan citizen demand, and success in combating some of the worst conditions in health and education in the world, the portfolios have received low funding. Therefore, commensurate with the requested increases slated for the USG economic growth, agriculture, and democracy portfolios, post believes the health and education portfolios require an increase and sustained additional support. END COMMENT. RICCIARDONE