Quantifying interprovincial health and poverty disparities in Afghanistan: a secondary analysis of national survey and administrative data.
4 affiliations
- 1Institute for Global Health Sciences, University of California, San Francisco, CA, USA.
- 2Monitoring and Evaluation Department, Moraa Educational Complex, Kabul, Afghanistan.
- 3Center for Immigrant and Refugee Health, Public Health Institute, Oakland, CA, USA.
- 4Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA, USA.
Abstract
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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BibTeX
@article{saeedzai2026quantifying,
title = {{Quantifying interprovincial health and poverty disparities in Afghanistan: a secondary analysis of national survey and administrative data.}},
author = {Sayed Ataullah Saeedzai and Kanishka Ahmadyar and Mohammad Sediq Hazratzai and Alison M El Ayadi},
journal = {Global health action},
year = {2026},
month = oct,
doi = {10.1080/16549716.2026.2751910},
url = {https://europepmc.org/article/MED/42922371},
note = {CC BY},
}
RIS
TY - JOUR
TI - Quantifying interprovincial health and poverty disparities in Afghanistan: a secondary analysis of national survey and administrative data.
AU - Sayed Ataullah Saeedzai
AU - Kanishka Ahmadyar
AU - Mohammad Sediq Hazratzai
AU - Alison M El Ayadi
PY - 2026
DA - 2026/10/23
JO - Global health action
DO - 10.1080/16549716.2026.2751910
UR - https://europepmc.org/article/MED/42922371
AB - 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.
SN - 1654-9716
SN - 1654-9880
ER -