Health in Afghanistan

Opening ceremony at a public health institute in Kandahar, Afghanistan.

Health in Afghanistan is in need of improvement due to the country being in a state of civil war for the last three decades. According to the Human Development Index, Afghanistan is the 15th least developed country in the world. The Ministry of Public Health deals with matters concerning the health of Afghanistan's population.

After Operation Enduring Freedom in late 2001, when the United Nations began focusing on the situation in Afghanistan, improvement slowly began in the health care system of the country.^[1] According to USAID, infant mortality rate has decreased by 22% and child mortality has dropped by 26% since 2003. It was reported in 2006 that nearly 60% of the population lives within two hours walking distance of the nearest health facility, up from nine percent in 2002.^[2] According to the World Health Organization (WHO), the average life expectancy at birth is reported at around 60 years for both sexes.^[3][4][5] In 2013, Harvard Medical school and NATO published a report on the impact of the conflict on the Afghan health system.^[6]

History

Inside a regional military-run hospital in the Paktia Province of Afghanistan.

Beginning in 1979, military conflict destroyed the health system of Afghanistan. Most medical professionals left the country by 1992, and all medical training programs ceased. In 2003, there were 11 physicians and 18 nurses per 100,000 population, and the per capita health expenditure was $28 US dollars. The nation had one medical facility for every 27,000 people in 2004, and some centers were responsible for as many as 300,000 people. An estimated one-quarter of the population had no access to health care. The international organizations provided a large share of medical care. The drought of 1999–2002 exacerbated these conditions. An estimated 800,000 Afghans are disabled.^[7]

Afghan men inside a U.S.-run hospital at Bagram Air Base in the Parwan Province of Afghanistan.

Infant, child, and maternal mortality rates in Afghanistan reached the highest in the world, by some estimates as high as 275 per 1,000. In rural areas, one in six children die before reaching age five. This is because of poor sanitation and insufficient potable water supply, infectious and parasitic diseases such as malaria and diarrhea are very common. Malnutrition and poor nutrition also are pervasive.

User fees have been a major deterrent to accessing health care. Various interventions have been devised to improve uptake of health care services, including the distribution of waiver cards to very poor and female-headed households^[8] and the introduction of community-based health insurance.^[9]

Following the national user fee ban in 2008, a pilot study conducted by the Future Health Systems consortium found a 400% increase in utilization of services that had previously charged fees for services and medicine.^[10] The government's strategy to collaborate with non-governmental organisations^[11] has led to higher primary health outcomes among the poor,^[12] with relatively high levels of perceived health care quality reported by clients in a recent study of primary care services.^[13]

The physical and psychological effects of war have substantially increased the need for medical care. In the last decade a number of new hospitals were established, with the most advanced treatments being available in Kabul. The French Medical Institute for Children and Indira Gandhi Childrens Hospital in Kabul are the leading children's hospitals in the country. Some of the other main hospitals in Kabul include the 350-bed Jamhuriat Hospital, the Sardar Mohammad Daud Khan Hospital,^[14] and the Jinnah Hospital, which is still under construction. There are also a number of well-equipped military controlled hospitals in different regions of the country. 2011 surveys show that 57 percent of Afghans say they have good or very good access to clinics or hospitals,^[15] and Afghans themselves pay approximately 75% of health care costs directly.^[16]

Diseases

Tuberculosis

Tuberculosis is endemic in Afghanistan, with over 76,000 cases reported per year. The United States Agency for International Development is engaged in promulgating DOTS (directly observed therapy, short course) treatments, as well as TB awareness and prevention.^[17]

BRAC is a development organisation that focuses on the alleviation of poverty through the empowerment of the poor to improve their lives. BRAC Afghanistan is involved in assisting Ministry of Public Health (MoPH) of Islamic Republic of Afghanistan in the implementation of the Basic Package of Health Services (BPHS) in Kabul, Badghis, Balkh and Nimroz. This implementation is mainly funded by the World Bank and the USAID-REACH (United States Agency for International Development - Rural Expansion of Afghanistan Community-based Healthcare).

Tuberculosis is a serious public health problem in Afghanistan. In 2007, 8,200 people in the country died from tuberculosis and, in the WHO’s Global Tuberculosis Control Report 2009, an annual estimated figure of 46,000 new cases of tuberculosis were in Afghanistan. As such, Afghanistan is ranked 22nd in amongst highly affected Tuberculosis countries.^[18]

To help control tuberculosis, BRAC Afghanistan started the community based TB DOTS (Directly Observed Therapy – Short Course – a relatively cheap and highly effective treatment for TB; identified and recognized by the World Bank) under the Fund for Innovative DOTS Expansion through Local Initiatives to Stop TB (FIDELIS) project in 2006. In the first phase of this programme, diagnostic facilities for tuberculosis were expanded through the setting up of 50 TB microscopy centres. This phase lasted from January 2006 and up to March 2007. Over the next two years, facilities were further expanded and 92 more Tuberculosis Microscopy Centres were set up under the FIDELIS programme.^[19]

The Tuberculosis Control Assistance Programme (TB CAP) is another project taken up between BRAC Afghanistan, World Health Organization (WHO) and Management Sciences for Health (MSH) in a bid to fight TB in Afghanistan. In this project, BRAC Afghanistan supports the BPHS (Basic Package of Health Services) project by replicating the CB-DOTS model into health systems of four provinces: Baghlan, Jawzjan, Badakshan and Herat. BRAC Afghanistan was selected as Principal Recipient (PR) for malaria and TB components of the Global Fund 8.^[20]

In 2009, 2,143,354 patients received treatment under the health programs mentioned. As of August 2010, BRAC Afghanistan had covered 388 districts and 25 million of the total population are under the BRAC Afghanistan Health Program. Health facilities also include six District Hospitals, 26 Comprehensive Health Centres, 53 Basic Health Centres, 18 Sub Health Centres as well as 533 Mobile Clinics every month.^[21]

HIV

According to Soraya Dalil, Minister of Public Health, "the fastest method of HIV and AIDS spread is the use and sharing of injections by drug addicts. A recent data shows a 7.1 percent HIV/AIDS prevalence rate in three urban centers, where 85 percent of drug users share needles."

According to reliable scientific studies, the prevalence of HIV in Afghanistan is much lower, i.e., less than 1% (Todd CS, 2012 and 2008).^[22]

^[23] In 2006 the United Nations Development Programme estimated that an HIV/acquired immune deficiency syndrome (AIDS) epidemic could occur in Afghanistan because of the high incidence of intravenous drug use, unsafe blood transfusion procedures, massive refugee repatriation, poor health facilities, and illiteracy.^[7] According to Afghanistan's National Aids Control Program (NACP), 504 cases of HIV/AIDS were documented in late 2008.^[24] By 2011 the numbers reached 1,250. Health officials estimate that between 2,000 to 3,000 people may be living with the virus.^[23][25] About 11 people, most of them drugs addicts, have died in Afghanistan from AIDS.^[23]

Polio

Afghan Ministry of Public Health along with WHO and UNICEF are engaged in a campaign to eliminate polio in the country. Wild poliovirus is present in Afghanistan, though in limited areas. Reported cases were on the decline, from 63 in 1999 to 17 in 2007, until increased violence in 2008 impeded vaccination efforts, causing cases to climb to 20 for the first nine months of 2009.^[26] However, for the first 7 months in 2013 there were no polio cases reported in the country according to WHO.

Leprosy

Despite anti-leprosy initiatives by Leprosy Control (LEPCO) dating to 1984, leprosy is present in Afghanistan, with 231 cases reported in the 2001-2007 period. Just over three-quarters of the cases were the MB-type, with the rest PB-type. Leprosy has been reported in the central Hindu Kush mountain area of the country. Mainly in the provinces of Bamyan, Ghazni, Balkh.^[27]

Typhoid fever

Being the 15th least developed country in the world, Afghanistan faces difficulties in sanitation. In urban areas 40% of the population have unimproved access to sanitation facilities. Because of this many Afghanistan natives are forced to combat typhoid fever. Typhoid fever is one of Afghanistan's major infectious diseases in terms of food/waterborne diseases. This infectious disease occurs when fecal material comes into contact with food or water. Symptoms vary from case to case but often mild fever is present and if left untreated death may occur.^[28]

Hepatitis A

Sanitation issues place the Afghanistan population at risk of contracting hepatitis A through the consumption of food and water that has been contaminated by fecal material. Hepatitis A works by inhibiting the liver from functioning properly. Symptoms generally include jaundice, fatigue, loss of appetite, while some victims may experience diarrhea. Furthermore, symptoms will appear 2–6 weeks after an individual has come into contact with the hepatitis A virus.^[28]

Leishmaniasis

Visceral leishmaniasis infections are often recognised by fever, swelling of the liver and spleen, and anemia. They are known by many local names, of which the most common is probably Kala azar,.^[29][30] A total of 21 cases of VL acquired in Afghanistan, all in the 1980s according to CDC reporting.^[31]

Maternal and child health care

Mothers and infants receiving health care at a hospital in Kabul.

An improvement in child health services in 500 - 600 health facilities was noted in 2006; the improvement correlates with the presence of clinical guidelines and the frequency of supervision of health care providers.^[32] A 2008 study by Future Health Systems and the Johns Hopkins Bloomberg School of Public Health indicated that only 13% of respondents had used skilled birth attendants.^[33] By 2010, the maternal mortality rate per 100,000 births for Afghanistan was 1,400. The under 5 mortality rate, per 1,000 births was 201 and the neonatal mortality as a percentage of under 5's mortality was 27. The aim of this report was to highlight ways in which the Millennium Development Goals can be achieved, particularly Goal 4 – Reduce child mortality and Goal 5 – improve maternal death.^[34]

In June 2011, the United Nations Population Fund released a report, which contained new data on the midwifery workforce and policies relating to newborn and maternal mortality for 58 countries.^[35] Afghanistan has more than 3,000 midwives with an additional 300 to 400 being trained each year. According to Afghanistan's Ministry of Health about 1 in 50 women die while giving birth and the number of children who died before the age of 5 is about 1 in 10. According to Sima Ayubi, a maternity doctor in Kabul who advocates hospital births, explains: "Now pregnant women have more information about health. This mortality rate is still a problem. There's just a decrease. The problem is not completely eliminated or under control."^[15]

According to a 2012 report by Save the Children, improved healthcare and the rise of females attending school have made Afghanistan climb up from its position as the worst place on earth to be a mother."More mothers are surviving and fewer children are dying and this is something we need to be celebrating," said Rachel Maranto, Advocacy and Mobilisation senior Manager at Save the Children in Kabul. Despite the better healthcare, about 275 children die every day in the country of 30 million.^[36]

See also

• Ministry of Public Health (Afghanistan)
• Water supply in Afghanistan
• Environmental issues in Afghanistan

References

External links

Wikimedia Commons has media related to Health in Afghanistan.

• Pajhwok Afghan News - Health
• The State Of The World's Midwifery - Afghanistan Country Profile
• Harvard Medical School/NATO Healthcare project - Afghanistan Case Study