The people of Afghanistan continue to face challenges in primary health care despite the expenditure of over $92 billion on humanitarian assistance. Therefore, using the Afghanistan experience as a model, what interventions by the United States Army are optimal in the development of host-nation health systems during counterinsurgency (COIN) operations? To answer this, statistical analysis evaluated 14 countries with an insurgency against 42 non-insurgency countries that spanned diverse economic, geographic, and cultural backgrounds. Analysis showed that high-income nations were better than insurgent countries in every category that achieved statistical significance. As such, COIN goals should not include healthcare expectations similar to those in high-income nations. In addition, it appears that insurgency imposes an opportunity cost on the overall health of a society, which serves to exacerbate conditions more than a simple economic classification would suggest. Finally, stability operations within COIN should consider childhood malnutrition rates and the access to improved water sources as good examples of potential measures of effectiveness (MOEs) that may positively influence broad segments of the host-nation populace. These findings grant insight in defining the role that the Army should provide in facilitating primary health care within the context of a broader COIN strategy in coordination with unified action partners.

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