Education
70
Table 7.3 reflects the answers to the question about the reasons for not attending school for children in the school age who did not attend school. A consistent pattern is revealed, implying that for rural and Kuchi children access to
school is importantly prohibited by distance to the school. Financial reasons – including the requirement for children to work or help in the household – are other important barriers. They are mentioned much more often for boys than
for girls, probably because for girls the overriding obstacle is formed by cultural considerations. For them, exclusion from education because the family did not allow going to school was, after ‘distance’, the single most important reason
mentioned.
Table 7.3 School-age children not attending school, by sex, school age, and by residence, reason for non-attendance in percentages
Residence, reason for non-attendance
Sex, school age Boys
Girls Both sexes
7-12 13-15
16-18 Total
7-12 13-15
16-18 Total
7-12 13-15
16-18 Total
Urban
Distance access 14
19 6
12 17
9 9
12 16
12 7
12 Financial reasons
12 35
54 31
4 6
5 5
7 14
24 15
Cultural reasons 12
15 9
11 31
61 61
49 23
48 40
35 Security reasons
5 4
3 4
4 4
8 5
4 4
6 5
Other reasons 57
28 28
42 44
20 18
29 49
22 22
34
Total 100
100 100
100 100
100 100
100 100
100 100
100 Rural
Distance access 43
34 34
41 39
36 35
37 41
39 35
39 Financial reasons
13 27
37 21
6 8
6 6
9 16
18 13
Cultural reasons 7
6 6
7 28
38 39
33 19
25 25
22 Security reasons
4 5
7 5
6 6
8 6
5 6
7 6
Other reasons 32
19 19
26 22
12 12
17 26
15 15
21
Total 100
100 100
100 100
100 100
100 100
100 100
100 Kuchi
Distance access 61
66 55
61 60
59 49
58 60
63 52
59 Financial reasons
12 16
20 14
6 7
10 7
9 12
16 11
Cultural reasons 2
2 1
2 15
24 29
19 8
10 14
10 Security reasons
2 1
2 3
6 3
2 10
3 2
Other reasons 24
17 23
22 17
8 6
13 20
13 15
18
Total 100
100 100
100 100
100 100
100 100
100 100
100 National
Distance access 43
44 31
40 39
34 31
36 40
38 31
38 Financial reasons
13 26
36 22
5 8
6 6
9 15
19 13
Cultural reasons 7
6 6
7 27
40 42
34 18
26 27
22 Security reasons
4 4
6 4
5 6
8 6
5 5
7 5
Other reasons 34
19 21
27 24
13 13
18 28
15 16
22
Total 100
100 100
100 100
100 100
100 100
100 100
100
Education
71
7.4 Educational attainment
Educational attainment is used as an indicator of the stock and quality of human capital within a country. As such, it also reflects the structure and performance of the education system. It is measured by the percentage distribution of the adult
population – here those age 15 and older – by the number of years or highest level of schooling attended, or completed. The NRVA provided information about highest attendance as reflected in
Table 7.4. The typical patterns for Afghanistan can be observed, revealing large gender and urban-ruralKuchi differences. In the
latter populations, women are almost totally without schooling, whereas among their urban sisters only one-quarter ever attended any form of education. Around one-quarter is also the share of all men with any level of schooling. The relatively
high share of persons with high school attendance – especially among urban men – is somewhat surprising and may need further investigation. One line of understanding would be that it indicates that once children start secondary school,
relatively many continue to the highest level. Also the 11 percent urban males having attended at least university level is unexpected and should be treated with caution.
Table 7.4 Population age 25 years and over, by sex, residence, and by highest educational attendance in percentages
Highest level of education attended
Sex, residece Boys
Girls Both sexes
Urban Rural
Kuchi Total
Urban Rural
Kuchi Total
Urban Rural
Kuchi Total
No education 43
78 91
72 76
98 100
94 60
88 95
83 Primary school
14 10
4 10
8 1
3 11
6 2
6 Middle school
9 5
3 5
4 1
6 3
2 5
High school 21
6 2
9 7
2 14
3 1
3 Teacher college
3 1
1 3
1 3
1 University Post-graduate
11 1
3 2
6 2
Total 100
100 100
100 100
100 100
100 100
100 100
100
7.5 Conclusions
Afghanistan is faced with a huge challenge to meet the human right of children to receive at least primary education. This should provide them with necessary skills for life and provide the country with the human capital required to make
progress to the goals it has set for development. Past performance of the education sector has resulted in a very poor overall adult literacy rate of 26 percent and a very low educational attainment level, as only 17 percent of the total
population aged 25 and over has attended any type of formal education. In addition, the difficult access to education for girls is reflected in large gender gaps and even worse female education indicators.
MDG Indicator 3.1: Ratio of girls to boys in primary, secondary and tertiary education
This indicator relates to the number of female students enrolled at primary, secondary and tertiary levels in public and private schools to the number of
male students, regardless of age. The indicator of equality of educational opportunity, measured in terms of
school enrolment, is a measure of both fairness and efficiency. It is used to measure progress to achieving MDG 3 – Promote gender equality and
empower women. Eliminating gender disparity at all levels of education would help to increase the status and capabilities of women. Female education is
also an important determinant of economic development.
The ratios for primary, secondary and tertiary education are, respectively, 69, 49 and 28 percent, indicating a large inequality of access to education that is
increasing with educational level.
Education
72
Present enrolment figures are still among the worst in the world – net primary and secondary enrolment rates are, respectively, 52 and 16 percent – but in comparison with the NRVA 2005 they show a significant improvement. Also age-
specific literacy rates indicate that in recent years primary school-age children have been much better served: 62 percent of boys around age 14 are literate, compared to only 30 percent of the 26-year old men; female literacy in corresponding
ages rises from below 10 to 37 percent. These figures also imply a narrowing gender gap, especially in urban areas where the literacy rate of girls at the end of primary school age is nearly 80 percent of that of their male age peers.
It is the task of the Afghan government to maintain this momentum and further expand educational opportunities for the new generations. This will become increasingly hard since underserved areas – especially rural areas – are usually the
ones that are more difficult to penetrate with development programmes. In addition, the very high population growth will provide ever larger numbers of school-age children in the near future.
Besides a focus on rural and Kuchi populations, education policy needs to further emphasize learning opportunities for girls. Not only because of equity principles, but also to be able to tap their potential for national development. Policy
and programme development should take notice of the reasons mentioned for not attending schools. Distance and access issues, as well as financial obstacles should be addressed, but also cultural barriers for girls. Leveling the latter
would imply building support in the communities and, for instance, training more female teachers. A more detailed analysis of reasons for not attending school among targeted sub-populations is recommended to focus future education
programmes.
Health
73
8 Health
SUMMARY.
The NRVA analysis paints a stark picture of the present performance of Afghanistan’s health sector and its implications for the health status of the population. On most internationally comparable health indicators,
Afghanistan is among the most poorly performing countries. Decades of conlict and social conservatism have left a health structure that is particularly adverse to the reproductive health needs of women. The results
are relected in the NRVA indings of poor accessibility of health facilities, low contraceptive prevalence, continuous high fertility, and low levels of antenatal care and skilled birth attendance. It was also found that,
invariantly, improvement of health facilities ranked among the top priorities for community development, regardless of gender perspective.
Despite its very weak state, the health system is now experiencing reconstruction and delivering some results. Although caution for methodological discrepancies is warranted, comparison with previous surveys
suggest that use of skilled birth attendance has improved from 16 percent in 2005 to 24 percent in the 2007- 08 period of the NRVA. In addition, the overall contraceptive prevalence increased from 10 percent in 2003
to 23 percent, and a current total fertility rate of 6.3 is found to be nearly one live birth below the fertility level experienced by women aged 40-49. Also, a declining trend was observed for the share of women marrying
before age 20, which exposes fewer to the risk of early pregnancy complications. With regard to child health care, improvements seem to have been made, with the notable exception of
measles immunization. For the vaccinations included in the Expanded Program on Immunization EPI – BCG against tuberculosis, OPV3 against polio, DTP3 against diphtheria, pertussis and tetanus, and
Measles – the estimated immunization rates of the children aged 12-23 months were, respectively 74, 71, 43 and 56 percent. Full immunization is only received by 37 percent of the children, whereas 15 percent
have never been vaccinated. Immunization against neonatal tetanus was received by only 33 percent of eligible women. Furthermore, 69 percent of children aged 6-59 months received vitamin-A supplements
against infections and 61 percent of households used iodized salt, which helps to prevent goiter and brain damage in children. Finally, with a prevalence of 78 percent, exclusive breastfeeding of children aged 0-6
months seems to be relatively high. However, when information about additional liquids in the irst days is included, the overall exclusive breastfeeding rate drops to only 35 percent.
The NRVA reported 406 thousand disabled in Afghanistan, implying a disability prevalence of 1.6 percent. The prevalence rate increases with age, adding to the vulnerable position of the elderly. However, younger disabled
persons also face negative consequences: school attendance of disabled children of primary school age and labour force participation of people of working age are only half of that of their non-disabled counterparts.
8.1 Introduction
The health system of Afghanistan is recovering from a collapse in the recent decades of conflict. Many of the country’s main health outcome indicators – although improving – remain at the very bottom of the international rankings. The poor
general health conditions in Afghanistan are directly related to many factors such as nutrition, access to safe drinking water and adequate sanitation. Yet one of the main causes for these poor health outcomes not being overcome is the
inadequate availability, access and quality of health care services.
The 20078 NRVA covered several issues related to health. Other parts of this report deal with fertility and mortality Section 3.4, and access to drinking water and sanitation Section 9.3.1. This chapter specifically focuses on aspects
of access to health care Section 8.2, child health – in particular child immunization and breastfeeding practices Section 8.3, reproductive health Section 8.4 and disability Section 8.5. Information on the latter subjects directly
relate to components of the
Basic Package of Health Services BPHS in Afghanistan: maternal and newborn health, immunization and disability.
8.2 Access to health services
Access to health services is a multi-dimensional concept. It does not only relate to the physical distance to health facilities or the travel time involved, but also involves the costs of travel and services, as well as opportunity costs,
cultural responsiveness to clients’ needs, mobility of women, and even the ‘value’ attached to the health and survival of
