RENEE MONTAGNE, HOST:
Even as American troops have been fighting a war in Afghanistan for the past 10 years, American tax dollars have poured in to build up that country's broken institutions. Not all of those efforts are working, bogged down by corruption and insecurity. This morning, we have a snapshot of something that is working. A new report on medical care surveys the work being done by a wide range of players: Afghanistan's Ministry of Health to the U.S. Agency for International Development. The survey shows stunning progress. Alex Thier directs programs for USAID. When the war began, Afghanistan had, as he put it, the worst health care on earth.
ALEX THIER: Afghanistan, in 2001, had an estimated life expectancy of about 45 years. And today, that has gone up to between 62 and 64 years, which is probably the greatest single increase anywhere on the planet in the last decade.
MONTAGNE: Give us an example, if you would, of one project that helped make this pretty astonishing difference in life expectancy.
THIER: Well, one of the most dangerous things in Afghanistan is to be a newborn baby or a pregnant woman. And the reason for that is that that is a high period of vulnerability. And one of the programs that we have created is a program that trains thousands of midwives, health workers who go out before babies are born while women are pregnant during birth and after birth to make sure that basic problems are addressed. And the results are really dramatic. For example, in Afghanistan, children had a 25 percent chance of dying before their fifth birthday in 2001. And today, that figure has gone down to 10 percent. Now, 10 percent is still far too high, but probably hundreds of thousands of Afghan lives have been saved that wouldn't otherwise be here under a Taliban regime.
MONTAGNE: Do the statistics possibly also reflect - crazy as it sounds, because there's a war there - a safer environment for civilians? There's so much talk of civilian deaths in this war, but compared to the 1980s and the 1990s, when hundreds of thousands of people died, could that have affected the life expectancy?
THIER: Well, there's no question. I mean, in the 1990s, Afghanistan was like we think about Somalia today. It was fractured, and government essentially ceased to function. There were no people with skills who were out in the provinces providing medical care, and there was no funding to carry out a system. And all of those things beginning to come together in Afghanistan have allowed people to have access in a way that they didn't previously. But we're also very worried about security. In parts of Afghanistan, security has gotten worse in the last few years.
MONTAGNE: Well, given that 2014 is the target date to have all combat troops out of Afghanistan, who are your concerns about aid to Afghanistan, USAID programs? I mean, are you concerned that the progress that's made will be reversed?
THIER: One of the ways that we believe we have been successful and that we're preparing for the future in Afghanistan is in finding Afghan partners who can carry on this work. The path forward in Afghanistan, which is an issue of security, it's an issue of funding, it's an issue of sustainability, is to make sure that the Afghans are really in the lead.
In the area of health care, there's something called the basic package of health services, which is this very low-cost, high-impact package that is meant to be delivered to the vast majority of Afghans. And one of the most important things is that Afghans pay 75 percent of their own health care costs. So they're not just sitting around waiting for a handout from the government or the international community. They are actually very invested in their own health care. And that has made the health system in Afghanistan sustainable, because while donor resources are critical to the functioning to the system, that's not all it takes to make it work.
MONTAGNE: So, I mean, the fact that they pay a large chunk of their own health care, that's positive because - why? Because there's buy-in by the individuals and the families?
THIER: Both because there's buy-in, and because it's sustainable. And the fact that Afghans already pay out of pocket 75 percent of their health care costs is actually a great sign. That's the holy grail of doing development work in a place like Afghanistan, that you invest today so that they will have greater self-sufficiency tomorrow.
MONTAGNE: Alex Thier directs USAID program in Afghanistan and Pakistan. Tomorrow, we return to the Afghan village of Istalif to visit a potter who was impoverished 10 years ago and is now thriving. Transcript provided by NPR, Copyright NPR.