In the rugged and often overlooked terrains of Afghanistan, a silent epidemic challenges the nation’s already fragile health infrastructure: non-communicable diseases (NCDs). A groundbreaking study recently published in the International Journal of Equity in Health sheds light on the intricate financial mechanisms underpinning the management and treatment of these chronic illnesses in Afghanistan. The research by Neyazi, Mosadeghrad, Tajvar, and colleagues unveils the complexities and gaps in funding that hinder effective response to NCDs—a hurdle not unique to Afghanistan but emblematic of many low- and middle-income countries grappling with an evolving disease burden.
Non-communicable diseases, encompassing ailments such as cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes, constitute a growing proportion of the global disease burden. Afghanistan is no exception. Once overshadowed predominantly by communicable diseases and acute conditions related to conflict and poverty, the epidemiological transition in this country now demands urgent attention to chronic disease management. Yet, what stands out starkly in the study is the glaring disparity between the escalating health care needs for NCDs and the financial frameworks allocated to address them.
The Afghan health system’s financing of NCDs is marred by inadequate resource mobilization coupled with fragmented funding streams. The authors meticulously dissect fiscal flows within public, private, and international aid sectors, revealing a mosaic of inconsistencies and inefficiencies. Afghanistan’s dependence on donor funding for health programs appears to disproportionately favor communicable diseases and maternal-child health initiatives, leaving NCD programs underfunded and without sustainable support. This financial imbalance threatens to exacerbate health disparities, particularly among marginalized populations living in rural, underserved regions.
One of the study’s pivotal findings highlights the insufficient integration of NCD financing within Afghanistan’s national health budgeting processes. Despite the growing prevalence of these ailments, the incorporation of their financing into long-term strategic health plans remains nascent. Health expenditure analysis indicates that only a meager portion of the total health budget addresses NCD prevention and care. This underinvestment reflects systemic prioritization challenges where acute health emergencies routinely overshadow chronic care requirements in policy discussions and budget allocations.
The authors emphasize the role of innovative financing mechanisms as potential game-changers in mitigating funding shortages. Domestic revenue generation through taxation on tobacco, alcohol, and sugary products offers a dual benefit, acting both as a deterrent to NCD risk factors and as a source of earmarked funds. However, such fiscal policies remain underutilized in Afghanistan due to socio-political constraints and administrative hurdles. The research outlines the feasibility and impact of such ‘sin taxes’ as underexploited tools within the broader financial landscape.
Compounding the financing gaps, the study delves into the burden of out-of-pocket expenditures on Afghan households managing chronic diseases. Patients and their families frequently bear catastrophic health costs, pushing them further into poverty. This direct financial burden manifests in reduced medication adherence, delayed treatments, and reliance on informal healthcare providers. The vicious cycle of impoverishment and poor health outcomes underscores the need for robust risk-pooling mechanisms, such as community-based health insurance schemes, which are still in embryonic stages in Afghanistan.
International aid, while critical, presents a paradox of both alleviating and complicating financing landscapes. The study critiques the donor-driven programs’ design and sustainability, noting that external funding is often vertical in nature—targeting specific diseases or interventions rather than supporting integrated primary care infrastructure. Fragmented funding leads to duplication of efforts, inefficiencies, and challenges in creating a cohesive national NCD response. The authors advocate for harmonization of international contributions through coordinated funding frameworks aligned with national priorities.
In the context of health systems strengthening, the paper evaluates the minimal budgetary allocation for workforce development in NCD management. Specialist training, continuous medical education, and retention incentives for healthcare providers remain underfunded. Given that effective NCD care relies heavily on multidisciplinary teams including doctors, nurses, nutritionists, and counselors, investment in human resources emerges as a critical lever for improving outcomes. Without adequate support, the existing clinical workforce remains ill-equipped to address the multifaceted needs of chronic patients.
Technology and digital health innovations appear as underexplored frontiers in the paper’s financial analysis. Afghanistan’s constrained infrastructure limits widespread deployment of electronic health records, telemedicine, and mobile health interventions that could reduce costs and increase access. Yet, pilot projects show promise in enhancing disease surveillance and patient follow-up. The study proposes targeted investments to scale up such technologies, potentially transforming the cost-effectiveness and reach of NCD services, especially in remote areas.
Furthermore, the research highlights the intersection of sociopolitical instability and health financing challenges. Decades of conflict have eroded institutional capacities, governance structures, and economic stability, directly impacting resource allocation and financial planning in health sectors. The resultant unpredictability undermines long-term commitments to NCD financing and complicates donor coordination. Addressing these structural vulnerabilities is essential for establishing resilient funding environments capable of sustaining chronic disease interventions.
Gender and equity considerations permeate the authors’ discussion on financing frameworks. Women and vulnerable populations often face amplified barriers to healthcare access, including financial constraints compounded by sociocultural norms. The study underscores the absence of gender-responsive budgeting in NCD programs, leading to inequitable service utilization. Incorporating equity-focused financial planning is vital to ensuring that investments translate into inclusive health gains rather than widening disparities.
The research employs a methodical approach combining quantitative financial data analysis with qualitative insights from key stakeholders across government, NGOs, and donor agencies. This mixed-methods perspective enriches understanding of the systemic bottlenecks and political economy influencing NCD financing in Afghanistan. The nuanced findings illuminate the divergence between policy rhetoric and implementation realities, a gap all too familiar in health systems worldwide yet particularly acute in fragile states.
Ultimately, Neyazi and colleagues call for a paradigm shift in Afghanistan’s health financing strategies—one that elevates non-communicable diseases as a public health priority requiring dedicated, sustainable, and equitable financial commitments. They envision a multi-sectoral approach linking fiscal policies, health sector reforms, and community engagement to forge a resilient framework capable of confronting the rising NCD tide. The implications extend far beyond Afghanistan, offering lessons for countries at similar crossroads navigating the complex interplay of chronic disease burden and constrained resources.
In an increasingly interconnected world, the Afghan experience as detailed offers a sobering yet informative case study. The vaccination campaigns and infectious disease control programs of the past century are giving way to a new era where chronic illnesses dominate health agendas. Financial innovations and strategic investments tailored to this shift will determine health outcomes for millions. The paper concludes with a call to international partners and national policymakers alike: without urgent and coordinated action to rectify financing deficits for NCDs, the social and economic costs will escalate, undermining decades of health gains and development progress in Afghanistan.
Subject of Research: Financing mechanisms for non-communicable diseases in Afghanistan
Article Title: Financing of non-communicable diseases in Afghanistan
Article References:
Neyazi, N., Mosadeghrad, A.M., Tajvar, M. et al. Financing of non-communicable diseases in Afghanistan. Int J Equity Health 24, 99 (2025). https://doi.org/10.1186/s12939-025-02423-4
Image Credits: AI Generated
