Afghanistan is believed to have one of the highest infant and maternal mortality rates in the world. As a result of decades of war and civil unrest, Afghan women and children suffer from poor access to health services, harsh living conditions, and insufficient food and micronutrient security. To address the disproportionately high infant and maternal mortality rates in Afghanistan, the US Department of Health and Human Services pledged support to establish a maternal health facility and training center. Rabia Balkhi Hospital in Kabul, Afghanistan, was selected because this hospital admits approximately 36,000 patients and delivers more than 14,000 babies annually. This article reports the initial observations at Rabia Balkhi Hospital and describes factors that influenced women's access, the quality of care, and the evaluation health care services. This observational investigation examined areas of obstetric, laboratory and pharmacy, and ancillary services. The investigators concluded that profound changes were needed in the hospital's health care delivery system to make the hospital a safe and effective health care facility for Afghan women and children and an appropriate facility in which to establish an Afghan provider training program for updating obstetric skills and knowledge.