Access to Care in Afghanistan: Perspectives from Afghan People in 10 Provinces
Afghan people are facing major socio-economic barriers to care, as well as a healthcare system affected by chronic challenges and underinvestment. EMERGENCY and CRIMEDIM, a research centre from the Università del Piemonte Orientale, have released a new report that explores access to care across 10 Afghan provinces based on data and testimony from over 1,800 Afghans. The findings show the extreme difficulties for Afghans to access and afford care in the country, with more than one in every five respondents having lost at least one family member or friend in the last year due to the inaccessibility of care. The report concludes with 12 key recommendations on how to address the issues exposed.
Patients in Afghanistan
Visitors to 20 EMERGENCY hospitals and First Aid Posts, covering 10 provinces, were surveyed about their experiences accessing care in a range of settings from different providers, including the state, private facilities, and EMERGENCY.
Respondents have generally felt safer reaching health facilities, more informed about health information and more able to reach care since August 2021. The major barriers have been ongoing violence, despite the end of the war, and a decreased ability to pay.
Of the people we spoke to, one out of every two cannot buy the medicines they need. Over half have sacrificed buying food or clothing to pay for health services in the past year, and more than 85 per cent have been forced to borrow money to make these payments.
Healthcare Workers in Afghanistan
Healthcare workers were interviewed at EMERGENCY’s facilities as well as hospitals run by the Afghan Ministry of Public Health. They expressed the desire to make the Afghan public health system more robust, in both its facilities and its training programmes, to increase its long-term sustainability and ease the burden on existing workers.
At one Provincial Hospital, a staff member said, “Our hospital has 10 times more beds than it was built for, and it is still not enough because the demand is so high. There was a corridor in the previous plan, now they use it for the maternity ward.”
As part of EMERGENCY’S long-term outlook in the country, we offer residency programmes in surgery, anaesthesia and resuscitation, gynaecology and paediatrics in our hospitals, but the report makes clear that large-scale investment across the country is required to improve the availability and quality of health education and capacity-building programmes.
Women in Afghanistan
Like male respondents, women generally felt safer and more able to access care since August 2021. However, they were four times as likely to say their sense of safety had decreased. They were also disproportionately affected by the burden of cost: nearly two-thirds said their ability to pay for care had decreased in the last year, compared to less than 40 per cent of men.
Barriers continue to be significantly higher for pregnant women, and the report highlights that the poor management of maternal health conditions leads to preventable deaths. A Kabul hospital conducting around 200 consultations daily has just one ultrasound machine. Pregnant women may be forced to wait hours for an emergency caesarean section due to lack of space or skilled worker availability. Cases were reported of women dying in labour en route to healthcare facilities, and many pregnant women do not receive any antenatal support whatsoever.
While education and employment are being restricted for women and girls across Afghanistan, EMERGENCY’s female staff continue to work in the country. At the end of 2022, 365 of our Afghan colleagues were women, making up 21% of our staff. By supporting our female colleagues, we provide economic and social empowerment and continue to ensure that the women of Afghanistan have the best possible care available to them.
The Changing Landscape
With the conclusion of most hostilities in August 2021, the health needs of Afghans have changed. The admission criteria of EMERGENCY facilities (particularly the Surgical Centre in Lashkar-Gah, located in a former hub of fighting) expanded to treat civilian trauma, which is among the main needs of patients.
Nevertheless, EMERGENCY treated more than 13,700 patients in its Kabul Surgical Centre during 2022, totalling more than 2,700 admissions and over 5,000 surgical operations. Of the latter, 99 per cent involved wounds from gunshots, stabs and explosions. These figures show that despite the conclusion of the conflict, thousands of Afghans are still victims of violence every day, especially in the capital.
Healthcare workers tell us that, increasingly, patients are turning to EMERGENCY for assistance because of the public health system’s barriers of cost and inadequate facilities and care. Respondents used EMERGENCY’s facilities most often for:
Key Recommendations
Access to Care in Afghanistan: Perspectives from Afghan People in 10 Provinces concludes with 12 recommendations developed from the input of the more than 1,800 participants, including:
- Secure multi-year funding from the international community focused on capacity-building programmes;
- Reform and strengthen the existing Afghan health system, from the pharmaceutical supply chain to an adequate ambulance and referral system; and,
- Invest in health as a priority for economic and social sustainability, including the meaningful participation of women and girls.
EMERGENCY has been committed to improving care in Afghanistan since 1999. We operate two surgical hospitals in Kabul and Lashkar-Gah; a Surgical and Paediatric Centre in Anabah; a Maternity Centre in Anabah; and a network of over 42 First Aid Posts and Primary Healthcare Centres connected by a 24/7 ambulance service. In 2022, EMERGENCY’s hospitals admitted over 20,000 people.
Since the U.S. withdrawal in August 2021, Afghanistan has lost significant international focus. We began this research with CRIMEDIM to bring attention back to the country and highlight ongoing humanitarian needs in the health sector. EMERGENCY’s work in the country has always focused on training local staff and capacity-building. We firmly believe the international community need to keep Afghanistan at the forefront of its humanitarian and political focus, particularly developing and supporting the healthcare system, without which a sustainable medical and economic foundation is not possible.
Every day, millions of Afghans are being forced to decide whether to treat their conditions or to eat; a decision that is unsustainable for them, and unconscionable for the international community.