With the defeat of the Taliban and the December 2002 establishment of the Transitional Islamic State of Afghanistan, a nation engulfed in war for over two decades officially became a postconflict country. The city of Kabul lay in ruins, the country's infrastructure had been destroyed and more than six million Afghans were living as refugees in neighboring Pakistan and Iran. When asked what the country needed, an observer at the scene replied, "Anything and everything you can think of."

Unfortunately, nothing is ever that simple.

Management Sciences for Health, which operates the USAID-funded REACH Program, knows that rebuilding a health system requires careful planning, the design and establishment of systems, and, above all, the human resources to do the job and sustain the results. As Joyce Smith, REACH Human Resources Advisor to the Afghanistan Ministry of Public Health (MOPH), explains, "People can't just rush in and build clinics and hospitals when there is no one to staff them."

In the aftermath of war, the Afghan Ministry of Public Health has had to identify, quantify, and assess existing human resources in Afghanistan—a difficult task in any postconflict country but perhaps doubly challenging in Afghanistan, where so many have been displaced for so long.

Among those who have returned to the country are Afghan health workers trained by NGOs who operated cross-border projects in Pakistan during the war years; out of necessity, many of these brave health providers expanded their roles beyond their training. Others claiming health worker status may have received training irrelevant to the job they hold. Some people may have had no formal training at all but nevertheless provided health care under dire circumstances.

Says Smith, "We knew that without a system to measure people against standards of competency, identifying the truly qualified in a pool of an estimated 20,000 potential health workers of such varied backgrounds, training levels, and experience would require the wisdom of Solomon."

To expedite this process, Smith has helped establish a Human Resources General Directorate within Afghanistan's Ministry of Public Health. The Directorate has the authority to set standards and systems for all areas of human resource development in Afghanistan, from policy and planning to finance, training, and management. "It's the first time," noted Smith, who has worked in a number of the world's recent war zones, "that a comprehensive approach to human resources has been used in a postconflict country."

All health providers in Afghanistan, including laboratory and pharmacy technicians, nurses, midwives, and community health workers, must not only meet international standards for years of training but also pass competency-based certification examinations. REACH oversees the Testing and Certification Board, which designs, administers, and maintains the integrity of the 100-question exams. Over 2,000 people have been tested so far; within five years, every Afghan health worker will have been able to take the exam, which will be offered three times a year.

Testing has also become a way to assess training needs. Results for health workers currently employed by NGOs, for example, can identify specific areas in which the employee needs further training, which the Afghan Ministry of Public Health then asks the NGO to supply. The MOPH can also make very specific requests of donors for funding for training and capacity building programs in the health sector.

REACH has also helped the Human Resources Directorate set up a database in which all Afghan health workers are being registered and assigned identification numbers. The database also includes each health worker's biodata and work history.

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