Over the past 25 years, Afghanistan has been through various difficult, but different periods. The intensity of the conflict has varied as has the degree of central control over the country, the interest of the central authorities in social service delivery, the engagement of the international community and the access of the international community to the various parts of the country. The different periods, therefore, show different ‘difficult environments’ and, with the advantage of hindsight, it seems worthwhile to look at these different periods to assess if some currently useful lessons could be drawn and to retrospectively assess if different approaches towards service delivery could have made a difference. With a focus on the health sector this case study will attempt to achieve this analysis. Special attention will be paid to the changes during the current transition period from a largely project based approach to a more system based approach.
