No abstract

This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The 'scaling-up process' is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation.

The objectives of the survey were to examine the extent to which (1) laypeople agree with conceptualizations of forgiveness encountered in literature, notably that forgiveness supposes the replacement of negative emotions toward the offender by positive emotions, (2) forgiveness is a process that can only take place between an offended and an offender who is known to the offended, and (3) forgiveness is not a process that devalues the forgiven but a process that encourages him/her to behave better in the future. It was also aimed at examining the extent to which parents and children share the same conceptualizations about forgiveness. A total of 343 students participated in the study as well as their mothers and fathers. Four conceptualization factors were identified: Change of Heart, More-Than-Dyadic Process, Encourages Repentance, and Immoral Behavior. Only a minority of participants agreed with the idea that forgiving supposes regaining affection or sympathy toward the offender (23%), and with the idea that forgiveness can encourage repentance from the forgiven (33%). More participants, however, agreed with the ideas that the forgiver can be somebody in close relationship with the offended and that the forgiven can be an unknown offender or an abstract institution (46%). Very few participants (4%) agreed with the idea that forgiveness is immoral. Parents and their children tended to conceptualize forgiveness similarly.