Newly appointed Health Minister Firozuddin Feroz has promised to turn around public health services in 100 days. The job at hand is daunting to say the least. Killid conducted interviews to compile a wish-list.
Patients thronging Kabul’s Noor Eye Hospital, Indira Gandhi Childrens’ Hospital and Rabia Balkhi Women’s Hospital request the Ministry of Public Health (MoPH) to make available free drugs. Poor patients cannot afford to pay for health services, they plead.
Mohammad Alam has brought his 3-year-old daughter to the Indira Gandhi Childrens’ Hospital. He says not even a syringe is free. “We take our sick children for treatment and hospitals make us pay for even the syringe. A syringe costs 15 Afs (a quarter USD),” he says.
Nothing is free in hospitals. Everything from the registration card to consultation has a price. While at Rabia Balkhi the registration card costs 50 Afs (83 US cents), there is a separate charge for appointments. Ali Ahmed who has brought his mother to the hospital says, “We have to pay whatever they ask.”
At the Noor Eye Hospital, Sayida says she paid 20 Afs (33 cents) for the stamp on her card, which confirms her appointment.
The MoPH has permitted hospitals to charge patients for drugs and equipment. The ministry had sought the assistance of the parliamentary health commission to amend Article 2 of the health law to charge a fee for some services – diagnosis of illness and surgery. The amendment was approved last month. It is awaiting the green signal from the president.
Wahid Mayar, spokesperson for MoPH says a fee will make the services better and prevent corruption in the guise of gifts. “Patients can openly pay for the services instead of being at the mercy of the corrupt. Also, the salaries of medical professionals would increase, and they would deliver better services,” he says.
People, however, are not sure. They fear the fee money will go into the pockets of the corrupt. Also, according to Salim Khurami, a Kabul resident, in a situation where people barely survive, demanding money for health services will have more negative than positive impact. Saboor Nezami, a resident of Mazar-e-Sharif says, “If you have to pay for health services in government hospitals, the wealthy will go abroad for treatment. The poor may not be able to afford medicines and care, and will be left on the road.”
According to MoPH information, basic health services and check-up, mother and child health services including vaccinations would remain free in government hospitals.
The MoPH spokesperson sought to justify the decision to charge patients saying international aid accounted for only 23 percent of the health service budget. Article 52 of the Constitution states the government must ensure the means of prevention and treatment of diseases as well as health facilities are free for all citizens under the law.
Paktia
Health services do not reach remote areas of the province. While there are buildings for hospitals or clinics in 13 districts, there is no delivery and patients have to travel to the government hospital in Gardez. Sardar Khil is a resident of Aryoob Zazi district. “There are clinics in our district and also doctors, but they don’t attend to patients because there is anarchy,” he says.
Arif Khan who is from Zurmat district also complains about the lack of health services. “We go to the district hospital only to be told there is no treatment here. In the case of female patients who are about to deliver we have to take them to Gardez on roads that are very bad. Often the patient dies,” he says.
Badakhshan
It is one of 10 provinces where health services are scanty. Khair Mohammad’s house is only 3 kms from Faizabad, the provincial capital, yet his 28-year-old wife died while they were taking her to the hospital in the city for treatment. “If there was a clinic nearer to our home, my wife would not have passed away.”
Maliha is a midwife at the Baharak health centre. She knows of a case of a pregnant woman who was being taken on the back of donkey to a health centre for delivery but lost her baby due to excessive bleeding. This is a routine problem in districts like Baharak, Arghanch Khwah, Yamagan and Keran Menjan, according to Maliha. “People in some villages have to travel two days to get to health centres – many infants and women have died on the way,” she says.
Conflict
Authorities in MoPH say health services in provinces such as Kunduz and Helmand have been affected by the lack of security. Mayar, the spokesperson says, “Unfortunately the latest fighting in Kunduz province caused the closing of one health centre and a basic clinic in Tapa Borida area of Chardara district.”
Elsewhere, a CHC (comprehensive health centre) in Musa Qala district, a health centre each in Sangin and Nawzad (Helmand) were similarly closed. However, residents believe that is not the reason they shut; even when open they did not have medicines.
Hashmatullah from Chardara district says, “These were no health centres! Yes, a clinic was built but there was neither medicines nor doctors. How can the government cheat itself and us?”
Mujib, a resident of Helmand appeals to the government to re-open the clinics and protect the lives of citizens.
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