3 Oct 2017
Writer: Hasibullah Noori

Universal health care is critical need

Basic health care remains a challenge with access and a severe shortage of health workers being twin problems.

The World Health Organisation (WHO) recommends at least 23 health workers for 10,000 people. But Afghanistan which should have 671,000 health workers on the rolls has only 37,000 – a shortage of roughly 94 percent.

On paper, of course, the Ministry of Public Health has 57 percent of the Afghan population covered for health care. There are 4,500 registered doctors in both the government and non-governmental sectors. The figures from the CSO (Central Statistics Organisation) are nearly double at 9,842 doctors, which would translate as three doctors and five beds for every 10,000 people.
While AISA or Afghanistan Investment Support Agency, which was tasked with monitoring investments, has been merged with the Ministry of Commerce and Industries, authorities in the latter ministry say 35 million USD was invested by the private sector in 482 health centres over the past 17 years. The health centres gave jobs to 8,597 individuals.
A 2016 survey of the health sector commissioned by CSO found there were 9,842 doctors, 21,502 trained staff, 1,658 governmental and 2,000 non-governmental pharmacists, 3,302 midwives and 120 dentists working in public and private health care. WHO figures that were given to Killid are much lower. The Ministry of Public Health (MoPH) has employed 14,000 in its health centres. Some 15,000 are working in private health care.
WHO programme head Najibullah Safi says, "The numbers include ordinary and non-professional staff of ministry and private companies too." He adds, "Considering these numbers, Afghanistan needs to train many more health workers." The population of Afghanistan is an estimated 29.2 million people.

Uneven spread
Insecurity, bad roads and remote locations far from cities and towns are some of the factors inhibiting universal access to health care. WHO's Dr Safi, observes, "There are enough doctors in cities but not enough in rural areas, and this is a big problem. The Ministry of Public Health should pay attention." MoPH has designated areas without access to health care as "white areas".
The CSO survey also revealed there were more active doctors in provinces like Kabul, Kandahar, Herat and Nangarhar, also in the Balkh capital Mazar-e-Sharif.
Kabul had nearly 4,000 doctors while there were 437 doctors in Balkh, 491 in Herat, 450 in Nangarhar and 330 in Kandahar. Some 4,240 doctors are spread across the remaining 29 provinces. Mountainous Kunduz has the smallest number of health professionals.
Wahid Majroh, spokesperson for the public health ministry, rues the inequity. "That the spread of doctors is so uneven can be blamed on the problems in the health sector," he said. But the ministry has plans to resolve the shortage of doctors. Some 1,500 doctors will be trained in different specialisations, he said. "They would be sent abroad or trained inside the country and posted to areas poorly covered by health care," he told Killid.
However, not everyone shares his opinion. Dr. Safi says training will not help but ensuring there are working health facilities, professionally managed, in places that are not covered by the health care system will.
At present the majority of people travel to Kabul mainly to access medical care, or they go abroad for treatment.
Confusing figures
MoPH says there are 2,607 health centres with 8,424 beds in Afghanistan. Spokesperson Wahid Majroh claims the health centre is only one hour away for 57 percent of Afghans and two hours for 87 percent. He blames the shortage of beds in hospitals and clinics on the country's economic and financial problems.
The CSO figures reveal there are only five beds for 10,000 people, which by all standards including the WHO's is very low.
WHO's Dr Safi points out that while the problem of beds is now solved in the big cities of Afghanistan the situation is bleak in "remote areas as well as in small provinces". "Serious attention must be paid (to solving it)," he urges the government.
Doctors in hospitals in Kabul, for instance, are overworked as a result of the uneven spread of medical care. A conscientious doctor at the Kabul Child Health hospital says 900 children visit the hospital daily. "The number of beds in the hospital is not comparable at all with the capacity of the hospital. We have two even two and half times more beds than the capacity of the hospital."
Clearly, the health care sector needs more facilities and doctors. But nobody in the Ministry of Commerce and Industries was willing to speak to Killid.
Meanwhile, maternal and infant mortality figures have improved. "A number of 257 out of 1000 children were dying in 2001 and 2002. The number has since decreased to 55 children." Half the deliveries take place in primary health centres and hospitals.
Dr Safi also said there has been a decrease in contagious illnesses. "Earlier Afghanistan was one of 22 countries that disease like tuberculosis was widespread. Now Afghanistan is not on that list anymore."

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