Afghanistan’s economy is hugely dependent on the international humanitarian aid with small contribution from general domestic revenue. The national domestic revenue is largely reliant on agricultural products. Dry fruit, carpet, and handicraft are among the key export products.

The war and conflict has always affected the health system and health service provision. Before war, Afghanistan had a relatively effective system of health provision. The public sector was responsible for both curative and preventive services at all levels of health service provision. The private sector was restricted to private clinics of doctors. During the soviet occupation of Afghanistan (1978–1988), the services inside the communist regime territory continued to rely heavily on government support focused mostly on urban hospitals and clinics. At the same period, the health services were provide to rural Afghanistan by Mujahedeen health services supported financially by international NGOs such as MSH, MSF, Swedish Committee for Afghanistan, and so forth. These services were mostly preventive and emergency. Health system during the rule of Mujahedeen (1992–1995) and Taliban (1995–2001) weakened to the state of collapse. The role of female health workers reduced and even during the Taliban government reduced to zero. It was at this period that slowly the private sector started to emerge, and it was later institutionalized and strengthened after the fall of Taliban government (2002) [2].

Current health system led by the Ministry of Public Health (MoPH) has a better coverage than before (60 % coverage in comparison to 9 % in 2002) [3]. The focus of the current health system is on provision of the basic health needs of the people through implementing Basic Package of Health Services (BPHS) and Essential Package of Health Services (EPHS). Both of these packages funded by the main donors (USAID, EU, and the World Bank) are contracted out to the non-governmental organizations, but the management and oversight is with the Ministry of Public Health [2].

The private sector has seen a tremendous surge in the past decade in the country. Ministry of Public Health developed a private sector policy and thereafter established the Private Sector Support Directorate in the framework of the ministry. Afghanistan National Development Strategy (ANDS) supports the free economy system and thus supporting the private sector in all aspects of life has been one of the government’s priorities [4]. The health sector has benefited the most from it, and thus private hospitals, diagnostic centers, and medicinal stores have seen a huge development. The issue of a transparent and good oversight over the private sector though remains an area to be improved [5].

In response to the above developmental challenges facing the country, a very positive development has been the preparation of a 5-year Afghanistan National Development Strategy (ANDS) for 2008–2013 [4]. It provides a road map for transition towards stability, self-sustaining growth, and human development. It is a Millennium Development Goals (MDGs)-based plan that serves as Afghanistan’s Poverty Reduction Strategy Paper (PRSP). As an integral component of this strategic plan, the MoPH has formulated the Health and Nutrition Sector Strategy (HNSS ) 2008–2013 (updated in September 2009) as Health and Nutrition Strategy 2010–2013—NPNPS [6] that provides strategic directions for reducing morbidity and mortality and for institutional development. Furthermore, based on the identified need for an overall organizing framework for the MoPH, and building on the achievements of the past decade and lessons learned, the Ministry has developed the Strategic Health Plan (2011–2015) [4] with support from international donors. It is designed to enable further health gain for the Afghan people(s) and to strengthen the MoPH itself as an organization, over the next 5 years. This Plan is underpinned by a Population Health Promotion Model developed in 1970s and successfully implemented by the Public Health Agency of Canada and now universally adopted [7].

TheStrategic Health Plan identifies ten Strategic Directions:

Strategic objectives and priority interventions are identified for each of the above Strategic Direction for the next 5 years. Some of the key priorities identified are:

In implementing this Plan, the government has recognized that a number of causes of death, illness, and disability in Afghanistan are preventable. International data show that preventing ill health and promoting positive health saves the health care system a lot of money. This also reduces unnecessary suffering and enables people to be more productive and to live longer, happier, and more fulfilling lives.

The formulation of these strategic documents has gone a long way in ensuring that all the stakeholders in the health sector align their priorities and programs with those of the government. The well-defined goals, priorities, and monitoring framework of the ANDS (2008–2013), the Health and Nutrition Strategy (2008–2013), the Strategic Health Plan (2011–2015), and the National Health and Nutrition Policy (2012–2020) ensure that international assistance is in alignment with and contributes to these goals and strategic directions. This is particularly important for the development of any new project to strengthen the national health care system to prevent and control the emerging chronic diseases such as cancer, which is clearly mentioned under the health service delivery of National Health and Nutrition Policy of 2012–2020 (prevent cancer through avoiding or reducing exposure to risk factors, screening of high-risk groups, early detection, diagnosis and treatment of cancer, and improving quality of life of those affected by cancer through public and professional education programs and improvement of services; and encourage and support private sector to invest in the establishment of specialized facilities for this purpose).

For the above reasons, and in line with the World Health Assembly (WHA) resolutions, the MoPH in Afghanistan has established a non-communicable disease (NCD) unit in order to develop the relevant policies and strategies to combat NCDs and cancer. A draft NCD strategy was developed in 2012 and is approved by the MOPH as the national strategy currently under review by the World Health Organization (WHO). Moreover, in line with the provisions of Afghanistan’s Strategic Health Plan 2011–2015, the MoPH has initiated an action plan to develop a national cancer strategy within the scope of the NCD strategy.

Chronic NCDs and mental health remain an important problem in the country. It is estimated that over two million Afghans suffer from mental health problems such as depression, anxiety, schizophrenia, and bipolar disorder. Due to the long period of civil war and conflict, it is estimated that most Afghans suffer from some levels of stress disorder. Mental diseases have not been addressed over the last decades in Afghanistan and little is known about the disease pattern in Afghan society. A study in 2000 compared the mental health status of women living in Taliban controlled versus non-Taliban controlled areas. Major depression among women living in Taliban-controlled areas was recorded at 78 % as against 28 % among women living in non-Taliban controlled areas. Suicidal ideation was alarmingly high—65 % in Taliban-controlled area versus 18 % in the control area and actual suicidal attempts 16 % in the Taliban-controlled area versus 9 % in the non-Taliban controlled area. There has been no demonstrable improvement in the mental health status of the population in the post-Taliban years. A nationwide survey conducted in the first year after the US-led invasion found high levels of depression symptoms (male 59.1 %, female 73.4 %), anxiety symptoms (male 59.3 %, female 83.5 %) and post-traumatic stress disorder (male 32.1 %, female 48.3 %) and confirmed by others. There is a clear correlation between the number of traumatic events and the likelihood of developing psychopathology.

Anecdotal evidence indicates that cardiovascular diseases, and cancer are being diagnosed with increasing frequency, but reliable estimates are not available about their incidence and of the prevalence of related risk factors in the general population (except for cancer data estimated by the International Agency for Research on Cancer as mentioned below).

Among the chronic NCDs, cancer is rapidly becoming a serious burden for the populations and health authorities in all low- and middle-income countries (LMICs). There is no country in the world where cancer does not occur [8], and Afghanistan is no exception. According to the latest WHO statistics, cancer causes around 7.9 million deaths worldwide each year. Of these deaths, around 70 %, that means 5.5 million, are now occurring in LMICs. If no action is taken, deaths from cancer in the developing world are forecast to grow to 6.7 million in 2015 and 8.9 million in 2030. Throughout LMICs, most health systems are designed to cope with episodes of infectious disease. Most LMICs do not have the financial resources, facilities, equipment, technology, infrastructure, staff, or training to cope with chronic care for cancers.

The matter has been given even a higher urgency following the 2012 World Health Assembly’s decision to set a global target of 25 % reduction of premature mortality from NCDs by 2025 as a key target, among other targets, for the implementation of the above UN resolution [9].

The situation concerning cancer in Afghanistan is not different from the global cancer scene. Afghanistan a low-income country of nearly 30 million people is typical of many areas of the developing world. Modest increases in life expectancy have led to a subsequent rise in the number of cancer cases. At the same time, changes in lifestyle and eating habits, due to growing urbanization, are causing a surge in cancer and other NCDs. Cancer is already becoming a serious public health issue.

According to International Agency for Research on Cancer (IARC) GLOBOCAN 2008 [9], the cancer incidence in Afghanistan was around 14,355 per year in 2008, of which 11,539 died giving an incidence to mortality rate of over 80 %. Based on the same GLOBOCAN estimates, in 2012 there were around 16,300 new cases of cancer in the country. As there is no proper cancer registry in Afghanistan, the real numbers are not known, although based on experience elsewhere these estimates are close enough for planning purposes. In terms of incidence and mortality, the six most frequent cancers for men are stomach, oesophagus, lung, bladder, colorectal, and leukemia, and for women are breast, stomach, oesophagus, colorectum, cervix uteri, and leukemia. The top six cancers for both genders are: Breast, stomach, oesophagus, lung, colorectum, and cervix uteri.

Among the chronic NCDs, cancer is rapidly becoming a serious burden for the populations and health authorities in all low- and middle-income countries (LMICs). There is no country in the world where cancer does not occur [10], and Afghanistan is no exception. According to the latest WHO statistics, cancer causes around 7.9 million deaths worldwide each year. Of these deaths, around 70 %, that means 5.5 million, are now occurring in LMICs. If no action is taken, deaths from cancer in the developing world are forecast to grow to 6.7 million in 2015 and 8.9 million in 2030. Throughout LMICs, most health systems are designed to cope with episodes of infectious disease. Most LMICs do not have the financial resources, facilities, equipment, technology, infrastructure, staff, or training to cope with chronic care for cancers.