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SECTION 6 – RECONSTRUCTION AND DEVELOPMENT 6.1: GENERAL ASSESSMENT S<strong>in</strong>ce 2002, d<strong>on</strong>or fund<strong>in</strong>g has helped create nati<strong>on</strong>al health <strong>and</strong> educati<strong>on</strong> systems; built extensive transportati<strong>on</strong>, power, water, communicati<strong>on</strong>s, <strong>and</strong> border <strong>in</strong>frastructure; <strong>and</strong> strengthened ec<strong>on</strong>omic governance. Significant l<strong>on</strong>g-term assistance will c<strong>on</strong>t<strong>in</strong>ue to be required, however, to create c<strong>on</strong>diti<strong>on</strong>s for susta<strong>in</strong>able ec<strong>on</strong>omic growth. Short-term development <strong>in</strong>itiatives will focus <strong>on</strong> what is realistically achievable by the end of 2014 to stabilize the ec<strong>on</strong>omy <strong>and</strong> ensure that the Afghan Government can deliver basic social <strong>and</strong> development services to the Afghan populace. Development dur<strong>in</strong>g transiti<strong>on</strong> will be executed aga<strong>in</strong>st a backdrop of decl<strong>in</strong><strong>in</strong>g d<strong>on</strong>or fund<strong>in</strong>g, drawdown of coaliti<strong>on</strong> forces, a rapid decl<strong>in</strong>e <strong>in</strong> ISAF spend<strong>in</strong>g, grow<strong>in</strong>g unemployment, <strong>and</strong> likely ec<strong>on</strong>omic recessi<strong>on</strong>. Accord<strong>in</strong>g to the World Bank, Afghan GDP grew at the rate of 8 percent <strong>in</strong> 2010 <strong>and</strong> 7 percent <strong>in</strong> 2011. Future growth scenarios are highly c<strong>on</strong>t<strong>in</strong>gent <strong>on</strong> security, governance, the performance of the agriculture sector, <strong>and</strong> changes <strong>in</strong> aid levels. The base scenario projects growth to slow to 4-6 percent through 2018, then c<strong>on</strong>verge to 3- 4 percent a year. Improved governance <strong>and</strong> fully operati<strong>on</strong>al m<strong>in</strong>es would support a scenario of 6-7 percent average annual growth through 2025. However, should the key factors menti<strong>on</strong>ed above rapidly deteriorate, Afghanistan could experience negative growth of m<strong>in</strong>us 2 percent a year which would be difficult to recover from. 6.2: SOCIAL INFRASTRUCTURE HEALTH Afghanistan has made significant achievements <strong>in</strong> the health sector over the last 10 years, supported by external assistance from the <strong>United</strong> <strong>States</strong> <strong>and</strong> other d<strong>on</strong>ors. The <strong>in</strong>troducti<strong>on</strong> of the Basic Package of Health Services 31 (BPHS) <strong>in</strong> 2004 <strong>and</strong> the Essential Package of Hospital Services 32 (EPHS) <strong>in</strong> 2005 are largely resp<strong>on</strong>sible for the improvement <strong>in</strong> the quality <strong>and</strong> accessibility of health care <strong>in</strong> Afghanistan. Dur<strong>in</strong>g the current report<strong>in</strong>g period, 24 health facilities opened across Afghanistan, br<strong>in</strong>g<strong>in</strong>g the nati<strong>on</strong>wide total to 2136, up from 498 <strong>in</strong> 2002. Currently, the <strong>United</strong> <strong>States</strong> supports approximately 540 health facilities <strong>in</strong> Afghanistan, <strong>in</strong>clud<strong>in</strong>g five prov<strong>in</strong>cial hospitals. Additi<strong>on</strong>ally, 104 mobile health teams have been launched <strong>and</strong> more than 12,000 health posts have been stood up, supplement<strong>in</strong>g Afghanistan’s health system <strong>in</strong> more remote areas. Internet <strong>and</strong> communicati<strong>on</strong>s technology are also be<strong>in</strong>g used to a limited degree to enable access to health care through electr<strong>on</strong>ic health <strong>and</strong> telemedic<strong>in</strong>e <strong>in</strong>itiatives, <strong>in</strong>clud<strong>in</strong>g text-message rem<strong>in</strong>ders for vacc<strong>in</strong>ati<strong>on</strong>s <strong>and</strong> remote diagnostics. 31 The BPHS is designed to provide a st<strong>and</strong>ardized package of basic services that forms the core of service delivery for all primary care facilities, <strong>and</strong> to promote the redistributi<strong>on</strong> of health services by provid<strong>in</strong>g equitable access, especially <strong>in</strong> underserved areas. 32 The EPHS is designed to identify a st<strong>and</strong>ardized package of cl<strong>in</strong>ical, diagnostic, <strong>and</strong> adm<strong>in</strong>istrative services for prov<strong>in</strong>cial, regi<strong>on</strong>al, <strong>and</strong> nati<strong>on</strong>al hospitals; to provide guidance <strong>on</strong> how the hospital sector should be staffed, equipped, <strong>and</strong> provided with drugs for a def<strong>in</strong>ed set of services at each level; <strong>and</strong> to promote a health referral system which <strong>in</strong>tegrates the BPHS with hospitals. 84
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Cover Image: An Afghan National Arm
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2.6: FIELDED FORCE PARTNERING, OPER
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8.7: GULF COOPERATION COUNCIL STATE
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The relationship between ISAF and t
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lost territory and influence in the
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key elements of the insurgency rema
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Caldwell (US Army), who had been in
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Reconstruction Team (PRT) by the en
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Despite progress, the ANSF will con
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Figure 3: Ministry of Defense and G
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Figure 4: Ministry of Interior Capa
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2.3: INSTITUTIONAL TRAINER AND MENT
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ates fluctuated throughout the repo
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Figure 8: ANA Officer End-Strength
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and growth of a Special Operations
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AAF CAPACITY The NATO Air Training
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such as the Afghan National Civil O
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and NCOs will need to meet the need
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RC-N Regional Command North RC-S Re
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