This article examines the health care system of Afghanistan and considers the health needs of the country, human resource development, public and private health system, availability and access to health services in Afghanistan.
In addition, it explains the health needs of Afghan people. This article will discuss reasons why people are travelling outside of the country to receive treatment, and the opportunities for developing internal and external partnerships for better health service delivery outside the country.
Health System
The management and structure of the Afghanistan health system is divided in to public, private and non-governmental organization sectors. The public health system in Afghanistan is organized into three levels of health care: primary, secondary and tertiary.
This structure has been defined by the Ministry of Public Health through two important strategies, the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services. The BPHS describes the service delivery at the primary level, while EPHS explains the services delivery at the secondary and tertiary level.1
According to the Ministry of Public health, at the primary level health care consists of Health Posts, Basic Health Centers and Comprehensive Health Centers while the secondary and tertiary levels include provincial, regional and specialized hospitals (teaching hospitals) that are located in the Capital of country, Kabul.2
A district hospital provides basic hospital services at the district level. Cases that cannot be treated at the district level should be refereed to higher level of health facilities. The provincial hospital provides more advanced services than district hospital and covers the provincial population as a whole. Cases that cannot be treated at the provincial hospital are referred to regional hospitals.
And, at the regional level, the regional hospital provides services that cannot be provided at the provincial hospital and covers provinces located in the respective region.3 Ideally there should be a referral system between all different levels of health facilities through which cases can be referred from one level of care provision to the next, where they can receive necessary treatment. In practice, this system is not working properly; patients may not always get what and where they want.
Capacity at Secondary and Tertiary Levels
The number of available beds in the hospitals in Afghanistan is not responsive to the need and number of patients at provincial and regional levels. Their capacity is far behind the need. Meanwhile the buildings and structures of the hospitals are not according to standards. Moreover, the teaching hospitals are used as a final referral point for the country.
The number of available beds in specialized hospitals is not enough to address the need of referred patients from provinces and regions. Although, the government claims to provide secondary and tertiary level health services in the country, due to other priorities, the government has not been capable of adjusting the number of beds to the number of patients in the country.
The current secondary and tertiary health provision system was designed for a population of 15,000,000, in the 1960s and 1970s. Unfortunately, the current bed capacity of Afghan hospitals is not responsive to the needs of the current population of 30,000,000. Therefore there is a need for the establishment of new hospitals with sufficient numbers of beds.
Human Resources
Afghanistan lost many health professionals during the 20 years of civil strife and conflict. The training facilities were destroyed and degraded; training with varying curricula, duration and teaching methodology was carried out within the country and across the borders, resulting in different standards of health workers. Worse yet, the human resource development situation in Afghanistan is complex and requires special attention.4
Presently there is a shortage of qualified health professionals in terms of numbers, gender, quality and distribution, at all levels of health service – especially nurses, midwives, pharmacists and environmental hygienists.5
The secondary and tertiary health care system is facing a serious shortage of human resources in term of number and qualification. The hospitals even with the current capacity do not have enough number of health professionals, especially at the provincial level.
Meanwhile the shortage or lack of qualified health professionals is another challenge that the Afghan health care system is dealing with. The limited number medical educational institutions are not capable of training more qualified professionals to meet the need for such services in Afghanistan.
Medical Technology
In today’s health care industry, use of advanced medical technology is a must to diagnose and treat complicated and complex health problems and diseases. In Afghanistan, the use of advanced medical technology by secondary and tertiary health service providers is limited.
It is partly due to the limit of available technology in the country and partly due to the lack of qualified professionals who can handle such technology. The MRI, CT-scan and Eco-cardio graph are new medical technologies in Afghanistan, but the quantity of such technologies is limited.
Health System Financing
The health system in Afghanistan is divided into publicly financed, non-governmental organization and private sectors. The publicly financed health system is supported by the Ministry of Public Health. It is a government owned system and is structured in the form of clinics and hospitals.
The private sector makes up a large part of the health system and is playing an important role in health services delivery. The private sector is structured in the form of hospitals, clinics and diagnostic centers. The private sector is financed by private contributions and out-of-pocket money. There is no accurate data available regarding how large this system is in Afghanistan.6
The non-governmental organization (NGO) sector is playing an important role in health service delivery in Afghanistan. This sector is providing primary health care services in rural and remote areas. This sector is financed by the government and international donor agencies.
Quality and Types of Services
Currently the secondary and tertiary levels of the health system provide limited numbers of health services, partly due to limited diagnostic technology and partly due to few qualified professionals. Meanwhile the quality of provided services is not acceptable.
The quality of service provision is very low in both public and private sectors. The health services delivery does not match the international standards and the quality is not acceptable. For instance, the surgical procedures are far behind the standards, and post-operative procedures are very weak. Post-operative infections and complications are common, due to unsatisfactory and weak nursing and the lack of a post-operative follow-up system.
The surgical procedures for orthopaedic services are at a basic level and hospitals are very limited in terms of diagnostics and treatment facilities for orthopaedic services. The current orthopaedic procedures are quite traditional and far from the internationally acceptable standards. More often these procedures are followed by post-operative infection.
The general surgical procedures are still carried out in a traditional way and provide limited options to patients and are executed infrequently.
Neural surgery is not an option for most of the cases and spinal cord operations are out of reach. Patients with neuronal diseases that need surgical procedures are automatically candidates for travel outside of the country.
Diagnostic and treatment facilities for those patients with cardiovascular diseases, especially those who need surgical procedures, are limited. There are no facilities in Afghanistan that perform heart surgery, hence all those patients who need surgical procedures for their heart problems need to travel outside of the country.
The case is the same for those patients with cancer and cancer related diseases. Most of the time, due to lack of diagnostic technology, lack of qualified professionals or misdiagnosis, it is too late for those patients to receive effective treatment.
Patients in need of cosmetic surgery have no viable choices in Afghanistan, as with people with endocrine diseases, diabetes or even infertility problems. They do not have access to standardized diagnostic and treatment facilities in Afghanistan.
The current health system in Afghanistan is far behind in comparison to its neighbouring countries.
Emergence of Medical Tourism
The Afghan health system is not responsive to the need of its people for advanced health expertise and sophisticated technology. So, people have started to look for better options outside the country, where they can get good quality services with a reasonable price. Hence, medical tourism is emerging as a new concept in the country.
People are travelling to neighbouring countries to get better outcomes but are still facing a lot of problems while travelling. Most of the time, they are unfamiliar with foreign cultures and do not have enough understanding of international languages to properly communicate.
In addition, since they do not have enough medical information and their health literacy is very low, they cannot make informed decisions about their health problems. There is a need for a professional body that possesses both medical expertise and business management ability – something that can provide Afghan patients with professional consultation and guide them where to go.
The people need someone to help them make an informed decision and give them professional advice. This aim can be achieved through making external and internal partnerships.
References:
1 WHO. Regional Health system Observatory. Retrieved March11,08, from
http://gis.emro.who.int/HealthSystemObservatory/PDF/Afghanistan/Health%20service%20delivery.pdf
2 Ministry of Public Health Afghanistan.(2005). Basic Package of Health Services Document. Retrieved
On March 11, 08, from http://www.msh.org/afghanistan/pdf/Afghanistan_BPHS_2005_1384.pdf
3 Ministry of Public health.(2005). Essential Package of Hospital Services Document
Retrieved on March 11, 08, from, http://www.moph.gov.af/
4 WHO. Regional Health system Observatory. Retrieved March11,08, from
http://gis.emro.who.int/HealthSystemObservatory/PDF/Afghanistan/Health%20service%20delivery.pdf
5 WHO. Regional Health system Observatory. Retrieved March11,08, from
http://gis.emro.who.int/HealthSystemObservatory/PDF/Afghanistan/Health%20service%20delivery.pdf
6 Ministry of Public Health Afghanistan.(2005-2006). National Health Policy. Retrieved March 11, 2008,
from, http://www.moph.gov.af
Dr. KHALIL AHMAD MOHMAND is President of Max Global Consulting Services in Afghanistan, a medical professional trained in the United States and assisting patients in seeking healthcare services outside of Afghanistan. For more information please contact info@medicaltourismassociation.com.
