Submission ID 118176
| Issue/Objective | International partners-including bilateral donors and multilateral organizations-play influential roles in shaping public policy in low- and middle-income countries. These roles extend beyond technical guidance to influencing national policy agendas through mechanisms such as earmarked funding or tied aid. While actors like the World Health Organization (WHO) offer normative support, donor-driven models often reflect global north priorities and marginalize national voices. Amid growing calls to decolonize global health, our work seeks to interrogate donor dynamics in Afghanistan. |
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| Methodology/Approach | This study draws on electronic key informant interviews with 15 current and former staff members of Afghanistan's Ministry of Public Health (MoPH), all of whom have worked directly with international donor agencies over the past 15 years. Interviews explored perceptions of donor influence, national ownership, and health policymaking before and after the collapse of the national government. |
| Results | Preliminary findings reveal several persistent challenges. Donor coordination has been fragmented, often leading to duplicative or conflicting initiatives. The Ministry of Public Health has had limited authority in shaping national health strategies, with donors frequently setting priorities. Since the collapse of the national government, donor engagement has declined significantly, weakening health system capacity. Donors have often contracted services to non-governmental organizations without involving the MoPH, further sidelining national leadership. In addition, there has been a chronic neglect of tertiary care and specialist training. For instance, despite the training of over 100 public health professionals through international programs, Afghanistan still lacks even five specialists in critical fields like cardiology-an omission that undermines efforts to address leading causes of death in the country. |
| Discussion/Conclusion | Findings indicate enduring donor dominance and weakened national ownership in Afghanistan's health policymaking processes. These dynamics underscore the urgent need for a decolonized, context-aware approach that re-centers local priorities and decision-making. |
| Presenters and affiliations | Michelle Amri University of British Columbia Masoud Rahmani University of British Columbia |
