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Quantifying interprovincial health and poverty disparities in Afghanistan: a secondary analysis of national survey
Sayed Ataullah Saeedzai1, Kanishka Ahmadyar2, Mohammad Sediq Hazratzai3
1Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
Background:
Afghanistan has made national gains in maternal and child health since 2001; however, national aggregate figures may mask important subnational disparities.
Objective:
This study quantifies interprovincial disparities in health outcomes, service coverage, and multidimensional poverty across Afghanistan's 34 provinces to identify areas experiencing the greatest cumulative disadvantage.
Methods:
We conducted a cross-sectional, province-level comparative analysis that integrated three nationally representative secondary data sources: the Afghanistan Multiple Indicator Cluster Survey (MICS) 2022-2023, the 2017 NSIA/MoPH geographic access-to-care report, and the Afghanistan Multidimensional Poverty Index. Nine indicators spanning child health outcomes, service coverage, access to care, and socioeconomic deprivation were scored on a quartile scale (1 = worst, 4 = best).
Results:
Composite scores ranged from 1.0 in Nuristan to 4.0 in Kabul, demonstrating marked geographic disparities. Nuristan recorded the lowest performance nationally, driven by the highest under-five mortality rate (120 per 1,000 live births), minimal skilled birth attendance (9.5%), and limited access to improved drinking water (16.3%). Zabul (1.2), Helmand (1.2), and Badghis (1.4) showed similarly compounded disadvantage, while Kabul, Panjshir (3.6), and Bamyan (3.4) ranked highest. Disadvantage clustered in southern and western provinces and was strongly associated with higher multidimensional poverty, illustrating the overlap between socioeconomic deprivation and poor health outcomes.
Conclusions:
National improvements in Afghanistan's health indicators obscure severe, geographically clustered subnational disparities. Provinces with the lowest composite scores require prioritized, targeted investment in the health workforce, infrastructure, and community-based service delivery, alongside multisectoral poverty reduction, to advance Universal Health Coverage and Afghanistan's human rights obligations.
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