The total estimated population of Afghanistan for 2021-22 is 33.6 million (National Statistics and Information Authority), with 17.1 million men and 16.5 million women. Of this population, 70.8% reside in rural areas, 24.7% in urban areas, and 4.5% are nomadic. Afghanistan is administratively divided into 34 provinces, which are further subdivided into 422 districts (364 original districts, 24 temporary districts, and 34 provincial centers). According to the Afghanistan Living Condition Survey (ALCS 2017), 54.5% of the population lives below the poverty line. The country faces multiple challenges, including political transition, the COVID-19 pandemic, drought, harsh winter seasons, prevalent poverty, high dependency ratios, and large numbers of returnees and internally displaced persons (IDPs). These challenges have led to multiple crises, increasing the vulnerability of the Afghan population and affecting their access to health services.

Low vaccination rates have made Afghanistan especially vulnerable to COVID-19, with several waves impacting the country, including in 2022. The clinical case mortality rate exceeded 3%, with a significant increase among patients over 80 years old, according to WHO. Since the change of government in mid-August 2021, the COVID-19 response from the de facto authorities has been weak, relying on a fully funded health system and implementing partners. From 3 January 2020 to 31 May 2023, there were 221,332 confirmed cases of COVID-19 and 7,914 deaths reported to WHO. As of 21 May 2023, a total of 17,479,379 vaccine doses had been administered in a country with a population above 41 million. Approximately 36% of the population received at least one dose, well below the WHO global target of 70% COVID-19 immunization coverage by mid-2022, with some provinces performing much lower than the national average.

The initial funding for this Intervention was EUR 15 million, which was then topped up with an additional EUR 10 million as part of the overall EUR 1 billion support package announced by the President of the European Commission in October 2021. This package included EUR 227 million in humanitarian funding for lifesaving and life-sustaining emergency humanitarian assistance in sectors such as food and nutrition, shelter, water and hygiene-related activities, medical care, education, and protection. At the start of the pandemic, the EU mobilized EUR 70 million to address the immediate health crisis and provide humanitarian assistance to people in need. The EU response to COVID-19 included this WHO intervention and two other interventions implemented by UNICEF and a consortium led by the Aga Khan Foundation (AKF).

The Intervention subject to this Results-Oriented Monitoring (ROM) review is implemented by the World Health Organization (WHO) Country Office (CO) in Kabul, under a Contribution Agreement funded by the EU’s Development Cooperation Instrument through an addendum to the Multiannual Indicative Programme (MIP) between the EU and Afghanistan for the period 2014-2020. With an EU contribution of EUR 25 million and EUR 1,070,000.20 from other sources, the Intervention started on 31 December 2020, for an expected duration of nearly 36 months until 16 December 2023.