The Battle For Healthcare In Afghanistan: A Nation's Struggle For Basic Human Rights

Afghanistan's healthcare system has been steadily improving over the last two decades, after decades of war left the country with almost non-existent medical services. In 2001, the United Nations began working to rebuild Afghanistan and resolve its political issues, and since then, the country has seen significant progress in healthcare. In 2018, there were over 3,000 health facilities in Afghanistan, with 3,135 functional health facilities ensuring access to almost 87% of the population within a two-hour distance.

Despite these improvements, Afghanistan's healthcare system still faces many challenges and remains poor when compared to its neighbouring countries. The country continues to struggle with issues such as inadequate facilities, insecurity, ongoing conflicts, and a lack of trained healthcare workers, especially women.

The impact of war on healthcare

Afghanistan's healthcare system has been in a state of disarray due to decades of war and conflict. The war has had a detrimental impact on the country's healthcare infrastructure, access to healthcare services, and the overall health of the population. Here are four to six paragraphs detailing the impact of war on healthcare in Afghanistan:

Infrastructure and Service Delivery:

The war has led to the destruction of healthcare facilities and a lack of investment in the sector. Afghanistan has faced challenges related to poor infrastructure, including inadequate roads, transportation, and basic medical equipment. The lack of infrastructure, particularly in rural areas, has made it difficult for people to access healthcare services. The country also suffers from a shortage of healthcare professionals, especially in rural and conflict-affected areas. The insecurity and instability caused by the war have further hindered the delivery of healthcare services, with many healthcare workers facing threats and violence.

Access to Healthcare:

The war has disrupted the provision of basic healthcare services and made it difficult for people to access medical care. The destruction of healthcare facilities, lack of transportation, and insecurity have all contributed to limited access. Additionally, the economic impact of the war, including poverty and unemployment, has made it challenging for people to afford healthcare services and medications. This has resulted in a high proportion of the population lacking access to primary healthcare.

Healthcare Workers:

The war has had a significant impact on the availability and well-being of healthcare workers. Many healthcare professionals have fled the country due to security concerns and a lack of economic opportunities. Those who remain often face challenges such as low salaries, inadequate working conditions, and a lack of necessary medical supplies. The shortage of healthcare workers, especially female healthcare providers, has further limited access to healthcare services, particularly for women and girls.

Maternal and Child Health:

Maternal and child health indicators, such as maternal and infant mortality rates, have been severely affected by the war. The lack of access to healthcare services, inadequate nutrition, and limited access to clean water and sanitation facilities have contributed to high mortality rates. The war has also disrupted immunization programs and other public health initiatives, further exacerbating the situation.

Mental Health:

The war and ongoing conflict have had a profound impact on the mental health of the population. Trauma, psychological distress, and anxiety are common among Afghans, particularly those who have experienced displacement, violence, or loss. The limited availability of mental health services and the stigma associated with mental illness further compound the issue.

Economic Impact:

The war has severely impacted Afghanistan's economy, which has, in turn, affected the healthcare sector. The country relies heavily on foreign aid and donations to fund its healthcare system. The economic instability and lack of sustainable domestic funding have hindered the development and improvement of healthcare services.

Maternal and child healthcare

Afghanistan has made significant improvements in maternal and child healthcare over the last decade. However, it remains one of the most dangerous places in the world to be a mother, newborn, or child, and access to hospitals or healthcare facilities is beyond the reach of most.

Maternal Healthcare

Maternal mortality rates in Afghanistan have reduced by 50% since 2001, from 1450 deaths per 100,000 live births in 2000 to 638 deaths per 100,000 live births in 2017. However, the maternal mortality ratio is still high at 638 per 100,000 live births, and thousands of Afghan women die every year from pregnancy-related causes, most of which are preventable.

In 2018, the World Health Organization (WHO) introduced the concept of a maternal and child health home-based handbook to Afghanistan. The handbook is a collection of evidence-based essential health information that helps pregnant women keep track of their health and that of their babies. It can be used to monitor the health and growth of both mother and child before and after pregnancy and even in early childhood development. The handbook also serves as a de facto birth certificate, with trained service providers and community health workers recording the health and growth conditions of mothers and infants, including a log of vaccinations.

Child Healthcare

Afghanistan has also seen improvements in child healthcare, with infant mortality reducing from 88 deaths per 1,000 live births in 2001 to 45 deaths per 1,000 live births in 2020. However, Afghanistan still has one of the highest infant mortality rates in the world, and in 2018, 4 out of 10 Afghan children died before their first birthday.

Low immunization levels among poor and marginalized children compromise gains made in all other areas of maternal and child health. UNICEF works with Afghanistan's Ministry of Public Health to improve services and ensure quality reproductive, maternal, newborn, child, and adolescent health (RMNCAH) care.

Healthcare access

Despite these improvements, various factors continue to hinder healthcare access in Afghanistan. One of the main challenges is the lack of infrastructure, particularly in rural and mountainous areas where the majority of the population lives. The country's road network is inadequate, making some rural areas inaccessible during heavy winter snowfalls. Additionally, there is a limited number of vehicles, making ambulance access difficult for civilians. The lack of infrastructure also extends to basic utilities such as reliable electricity and safe drinking water, which are unavailable to a large portion of the population.

Economic instability is another significant barrier to healthcare access. Afghanistan is a low-income country, with nearly 70% of its population living in extreme poverty and a high unemployment rate of 32%. Healthcare funding relies heavily on external sources such as the European Commission, the World Bank, and USAID. While domestic health care spending is crucial, it is currently a low priority, with per capita spending on health care at only 0.6% of the country's gross domestic product (GDP).

Security concerns also play a significant role in limiting healthcare access. Violence and conflict have plagued the country, with healthcare facilities and workers often being targets of attacks. In 2019, there were 34 reported terrorist attacks on healthcare facilities, resulting in closures and loss of life. The security situation remains unpredictable, with threats such as suicide bombers, narcotics trade, and kidnapping. These issues not only affect the operation of healthcare facilities but also impact the safety of those seeking medical care.

Furthermore, the shortage of healthcare workers, especially women, is a critical challenge. The Taliban regime forbade women from attending school, resulting in a lack of female doctors and nurses. Cultural norms dictate that only women can provide medical care for other women, further exacerbating the issue. While there has been some progress, with approximately 60% of healthcare facilities now having at least one female healthcare provider, more efforts are needed to address this disparity.

The COVID-19 pandemic has further strained the healthcare system, with an influx of migrants and insufficient testing capacity. Additionally, healthcare workers have paid a high price due to a lack of personal protective equipment, with a significant number of infections and deaths reported among medical staff.

To address these challenges and improve healthcare access in Afghanistan, a combination of specific goal-oriented projects, foreign aid, and domestic responsibility is necessary. The development of good leadership and a management system for hospitals, along with increased coordination between government, healthcare providers, and NGOs, is essential. Additionally, improving security, investing in infrastructure, and prioritising domestic health care spending will contribute to enhancing healthcare access in Afghanistan.

Healthcare quality

In 2003, there were 11 physicians and 18 nurses per 100,000 people, and the per capita health expenditure was $28. The nation had one medical facility for every 27,000 people in 2004, and some centres were responsible for as many as 300,000 people. An estimated quarter of the population had no access to healthcare. International organisations provided a large share of medical care.

In 2006, it was reported that an estimated 800,000 Afghans are disabled. Infant, child, and maternal mortality rates in Afghanistan were the highest in the world, with one in six children dying before reaching age five in rural areas. This is due to poor sanitation, insufficient potable water supply, and the prevalence of infectious and parasitic diseases such as malaria and diarrhea. Malnutrition and poor nutrition are also pervasive.

In 2008, a national user fee ban was implemented, leading to a 400% increase in the utilisation of services that had previously charged fees. The government's strategy to collaborate with non-governmental organisations has led to higher primary health outcomes among the poor, with relatively high levels of perceived healthcare quality reported by clients in a recent study of primary care services.

As of 2020, Afghanistan had 172 hospitals and four doctors per 10,000 people, according to a government report. Around a third of the 37 million population has no access to a functional health centre within a two-hour radius of their home.

The COVID-19 pandemic has put an additional strain on Afghanistan's weak healthcare system, with healthcare workers paying a high price for battling the pandemic with inadequate equipment and facilities. The ongoing conflict and violence in the country have also severely weakened healthcare structures.

Healthcare funding

Afghanistan's healthcare system has been almost non-existent due to decades of war. The country's healthcare system is slowly improving, but it remains poor when compared to its neighbouring countries. The system is heavily reliant on funding from international donors, and there is a lack of adequate domestic funding.

Afghanistan's healthcare system is primarily funded by international donors such as the World Health Organization (WHO), the World Bank, and the European Union (EU). These organizations provide financial support for the development and implementation of healthcare programs and policies. For example, the WHO has been working with the Afghan government to implement the National Health Policy 2015-2020, which aims to improve access to health services and reduce maternal and child mortality rates. The EU and the World Bank previously funded the country's healthcare system directly until 2014, after which funding was centralized through the Afghan Reconstruction Trust Fund (ARTF), managed by the World Bank. However, in recent years, there has been a decline in donor support, and the World Bank has frozen all funding towards Afghanistan. This has led to a lack of funding for essential medical supplies, infrastructure, and staff salaries, threatening the collapse of the healthcare system.

The Afghan government has also played a role in funding healthcare. The Ministry of Public Health (MoPH) developed and implemented the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services (EPHS). These programs aimed to improve access to primary healthcare services and enhance the quality of care. However, the government's contribution to the public healthcare system has been relatively small compared to international donors. The previous government's expenditure on health was negligible, and the current Taliban regime has allocated little funding towards public health. Instead, they have relied heavily on donors to fill the gap in healthcare funding.

Non-governmental organizations (NGOs) have also been crucial in funding and delivering healthcare services in Afghanistan. Organizations such as USAID, HealthNet TPO, and Médecins Sans Frontières (MSF) have provided significant support. USAID has played a lead role in decreasing maternal and child deaths by funding basic health services and providing mentorship and training to healthcare providers. HealthNet TPO has been providing healthcare services in Afghanistan since 1994 and has implemented the BPHS/EPHS in several provinces. MSF has also provided essential medical care, particularly in underserved areas. However, many NGOs have faced challenges due to funding cuts and security concerns, leading to the closure of some health facilities.

Overall, the funding for Afghanistan's healthcare system has been inadequate, and the country continues to struggle with providing accessible and quality healthcare services to its citizens. The heavy reliance on international donors and the lack of sufficient domestic funding have contributed to the fragility of the healthcare system.

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