Poverty, vulnerability, and provision of healthcare in Afghanistan

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.

Health seeking behaviour and challenges in utilising health facilities in Wakiso district, Uganda

“…However, multiple factors are known to influence patient-health worker encounters such as the complexity of the condition, level of patient concern and trust between patient and health worker 41 . Although the frequency of seeking health care increased with income levels which compares with other studies 42,43 , some evidence suggests that the poor (and other vulnerable groups) visited health centres more frequently 44,45 due to higher burden of disease 7 . In addition, certain age groups such as children and the elderly 46 are known to be vulnerable to illnesses hence have regular visits for medical attention.…”

Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study

“…It is perhaps unsurprising that rural and remote postings were unpopular with many providers, yet as Petit and others note, the BPHS depends on rural health-staff for community-based services [14, 16, 24]. Lack of appropriate incentivisation, recruitment and retention – particularly of female staff – will likely challenge scale-up of BPHS services at both community and facility levels [39].…”

“…Among SRH service-users, out-of-pocket expenditures in non-BPHS areas were an important access barrier, suggesting the initial BPHS focus on under-served rural areas did increase access in Bamyan [24–26, 42]. Authors support the 2012 BPHS expansion to urban areas, including Kabul city, as a way to increase health equity.…”

“…Analysts reported that efforts to improve healthcare access in Afghanistan through the BPHS were constrained by inadequate infrastructure and transportation, restrictive cultural norms, lack of skilled female staff, high out-of-pocket expenditures, reduced access in remote areas and winter months, and inadequate quality of care [24–26]. …”

Capabilities, Perception of Well-being and Development Effort: Some Evidence from Afghanistan

“…Canfield (1977Canfield ( , 2011 argues that a reason for this lasting influence is that suffering in the country has been so severe that Afghans rely on the spiritual and emotional support provided by religious leaders. In cases of illness, for instance, Afghans continue to trust them for treatment (Trani et al, 2010). They also visit shrines where martyrs have been buried for miracle cures for various ailments.…”