The Complex Web Of Afghanistan's Medical Enclaves

Afghanistan has a large number of medical facilities, with over 3,000 health facilities across the country. This includes over 100 government-run and private or internationally-administered hospitals. Healthcare in Afghanistan has been steadily improving over the last two decades, with life expectancy increasing from 56 to 64 years and maternal mortality rates halving. However, the country's health system still faces challenges, including a shortage of healthcare workers and limited access to healthcare for many Afghans, particularly in rural areas.

Maternal and child healthcare

Afghanistan has long faced challenges in providing adequate maternal and child healthcare. The country's healthcare system has been in disarray due to ongoing conflict, resulting in limited access to hospitals and health facilities for most. While conditions are improving, Afghanistan remains one of the most dangerous places globally to be a mother or child.

The country has one of the highest infant mortality rates, with 4 out of 10 Afghan children dying before their first birthday in 2018. Additionally, thousands of Afghan women die annually from preventable pregnancy-related causes. To address these issues, access to quality community-based healthcare and comprehensive emergency obstetric and newborn care is critical.

The World Health Organization (WHO) has played a pivotal role in promoting maternal and child health in Afghanistan. In 2015, WHO introduced the concept of a maternal and child health home-based handbook, which serves as a valuable tool for pregnant women to monitor their health and that of their babies. This handbook has been well-received and is aimed at improving the linkage between healthcare providers, women, families, and communities.

Despite improvements, Afghanistan continues to grapple with challenges in maternal and child health. The Taliban takeover in 2021 exacerbated the situation, bringing economic sanctions, a collapse in the healthcare system, and restrictions on women's freedom. This has resulted in decreased availability of maternal and child care, negatively impacting the ability to provide quality care.

To address the crisis, international pressure on the Taliban to respect women's and children's rights to essential health services is crucial. Additionally, sustained donor support and investments in the healthcare system are vital to improving maternal and child healthcare in Afghanistan.

Mental health services

Afghanistan has been devastated by decades of war, political violence, instability, and poverty, resulting in a population with exceedingly high rates of mental illness. In 2004, the country's Ministry of Public Health (MoPH) declared mental health a top priority, and the National Strategy for Mental Health (NSMH) was established to address the issue through a multifaceted approach. Despite these efforts, mental health services remain scarce across the country, and the ongoing crisis has further deteriorated access to these services.

The Impact of War and Political Violence on Mental Health

The decades of violent civil war and political unrest have taken a significant toll on the mental health of Afghans. Successive generations have been exposed to systemic violence, resulting in widespread human rights violations and mass displacement. The constant state of conflict and instability has left many with psychological scars and trauma. Post-traumatic stress disorder (PTSD) is prevalent among Afghans due to their high exposure to traumatic events, with 86% of respondents having personally experienced or witnessed at least one traumatic event in their lives.

The Impact of Poverty and Displacement

In addition to the direct effects of war and violence, poverty and displacement have also contributed to the mental health crisis in Afghanistan. Many Afghans have lost their homes, possessions, and loved ones due to the ongoing crisis, leading to uncertainty and a loss of a way of life. The current political situation, displacement of people, and unemployment have all impacted the mental health and psychosocial well-being of Afghans.

Addressing Mental Health

The integration of mental health services into primary healthcare is a crucial step in improving access to mental healthcare in Afghanistan. Through the support of donors like the European Union, progress has been made in ensuring that mental health disorders and psychosocial problems are recognized and addressed by healthcare workers. Training of healthcare workers on mental health assistance has been a crucial aspect, with over 260 doctors and 265 midwives and nurses now able to identify mental health issues and provide support or referrals.

However, there is still a need for additional mental health professionals, including psychiatrists, psychiatric nurses, psychosocial counsellors, and social workers, to improve access to services. Inadequate financing of mental health interventions, increasing substance abuse among the youth, limited monitoring of services, and poor community mental health awareness all impact the ability to access treatment. Stigma associated with mental health, cultural and structural barriers, gender discrimination, and ongoing conflict also hinder people from seeking help.

The Way Forward

To improve mental health services in Afghanistan, the government and international donors need to increase their efforts and investment. Public awareness campaigns are necessary to inform people about mental health, reduce stigma, and highlight available services. The government should also focus on providing longer and more comprehensive trainings for mental health professionals, ensuring that counseling psychology is included in university curricula, and encouraging the deployment and retention of more psychosocial counsellors, especially in rural areas.

Medical education

Afghanistan's healthcare system has been steadily improving over the last two decades, with increasing coverage of health services throughout the country. In 2018, there were 3,135 health facilities in operation, providing access to healthcare for almost 87% of the population within a two-hour distance. Despite these improvements, Afghanistan's healthcare system remains poor when compared to its neighbouring countries.

The country's health services are defined by the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services (EPHS). The scope of these services includes preventative healthcare, treatment of diseases, and access to medical facilities. However, access to healthcare remains a challenge for many Afghans, especially in rural areas.

One of the main issues is the shortage of healthcare workers, which is partly due to the migration of medical professionals seeking better opportunities and a higher standard of living in other countries. This "brain drain" has left Afghanistan with only 9.4 healthcare workers per 10,000 patients, far below the World Health Organization's recommended number of 22.8 workers.

The lack of female healthcare providers is particularly concerning and affects the provision of life-saving services for women and children. Cultural and socio-economic barriers, as well as gender and geographic imbalances, contribute to the shortage of female healthcare workers.

To address these challenges, Afghanistan has been working with international organizations such as the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) to strengthen its health system. Efforts have been made to improve access to healthcare, particularly for women and children, and to enhance the quality of care.

The Afghan government has also implemented various strategies, such as banning user fees for health services and collaborating with non-governmental organizations, which have led to improved health outcomes, especially among the poor.

Investing in education, particularly for girls, is crucial for ensuring an adequate number of healthcare professionals in the future. However, under the Taliban, girls are not allowed to receive secondary education, which will have direct and indirect impacts on the health of Afghans in the long term.

Overall, while Afghanistan has made significant progress in improving its healthcare system, there are still challenges to be addressed, including the shortage of healthcare workers, limited access to healthcare, and the need to invest in education to ensure a sustainable future for the country's health system.

Healthcare access

The Afghan healthcare system has been plagued by decades of war and poverty, which have resulted in a lack of investment in education and infrastructure. The country has a severe shortage of healthcare workers, with a ratio of 4.6 medical doctors, nurses, and midwives per 10,000 people, far below the critical threshold of 23 health care professionals per 10,000. This shortage is more pronounced in rural areas, as many healthcare workers prefer to work in urban areas, particularly in Kabul, due to better standards of living and career opportunities.

The lack of female healthcare providers is a significant issue in Afghanistan, impacting access and comfort for female patients. Cultural and socio-economic barriers, as well as gender and geographic imbalances, contribute to the overall shortage of female healthcare workers. The shortage of female providers also affects the quality of care for women, as female providers may be more attuned to the needs of female patients, and adult females can interact freely with each other without the constraints faced by sex-discordant adults.

Despite the challenges, there have been some improvements in healthcare access. From 2001 to 2021, life expectancy in Afghanistan increased from 56 to 64 years, and the maternal mortality rate was reduced by half. Additionally, access to clean water has improved, with 89% of residents in cities having access in 2021 compared to only 16% in 2001.

The Ministry of Public Health (MoPH) oversees all matters related to the health of Afghanistan's residents and has implemented various initiatives to improve healthcare access. The World Health Organization (WHO) and other international organizations have also provided support and technical assistance to strengthen the country's health system.

However, user fees have been a major deterrent to accessing healthcare in Afghanistan. To address this issue, interventions such as waiver cards for very poor and female-headed households and community-based health insurance have been introduced. The national user fee ban in 2008 resulted in a 400% increase in the utilization of services, demonstrating the effectiveness of such initiatives.

While healthcare access has improved in Afghanistan, significant gaps remain, especially in rural and insecure areas. The security situation, economic factors, and limitations on women's freedom continue to impact access to healthcare services, and further efforts are needed to ensure that all Afghans have equal access to quality healthcare.

Healthcare funding

Afghanistan's healthcare system has been steadily improving over the last two decades, with increasing coverage of health services throughout the country. However, the system remains poor when compared to its neighbouring countries. The country's health system has been negatively affected by decades of war and the nation's environmental issues.

In 2003, Afghanistan's Ministry of Public Health (MoPH) began implementing the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS). These frameworks specified health services at the provincial level, the type of facilities, quality of services, staffing, and a uniform salary system. The countrywide healthcare system was directly funded by USAID, the European Union (EU), and the World Bank (WB) until 2014. From then on, funding was centralised in the Afghan Reconstruction Trust Fund (ARTF), managed by the WB.

The implementation of BPHS and EPHS resulted in a significant increase in access to healthcare and drastic improvements in health indicators. Despite these improvements, Afghanistan's healthcare system still faces critical underfunding, with the WHO calling for greater investment in 2023. The organisation warned that without sufficient funding, 8 million Afghans would lose access to essential and potentially life-saving healthcare.

The sharp reduction in financial and technical development support for Afghanistan's public health system since the Taliban takeover in 2021 has severely harmed the country's healthcare infrastructure. The lack of sufficient healthcare services has undermined the right to health for millions of Afghans, leaving them vulnerable to disease and other consequences of inadequate medical care. Women and girls have been disproportionately affected by the healthcare crisis due to the Taliban's restrictions on their freedom of movement, education, and employment.

The collapse of the Afghan economy and the loss of hundreds of thousands of jobs after the Taliban takeover drove many Afghans into extreme poverty, leaving them unable to pay for medical expenses. The result has been life-threatening for many, including millions of children suffering from malnutrition.

To address the health emergency in Afghanistan, humanitarian efforts are targeting 14 million people, including 7.5 million children and 3.1 million women. However, inadequate funding remains a critical issue, threatening to exacerbate the existing humanitarian crisis in the country.

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