The reconstruction of the health institutions is exceedingly considered by the policy makers, decision makers as well as the globally operational NGOs and non-profit establishments which are working for more than a decade for the country. A huge population decided to move outside the country, and a considerably vast migration took place which affected the international economy and completely halted many international trades due to the war and unsustainable conditions of the country. There are many challenges which were the barriers for the creation of the efficient and sustainable system of health care in respect to the primary care in the war based Afghanistan. The prominent factors which are being addressed by this research were the lack of security, infrastructure, economics, coordination, facilities, suitable hospital conditions, trained staff and women in the field. Due to the frequent policy shifts of the NGOs and the governments, the clauses between the policies are coming many ties which end up in losing the health care service from many regions. The working government, as well as non-government organizations under discussion, are ANA, ANP, UN, USAID, WHO and direct international helps. It was required to understand that there is the huge population which is not getting the proper health care because of the war, religion and other local and social issues and the requirement of enhancement of the knowledge of the local community to protect them from diseases and other health issues.
Keywords: healthcare, Afghanistan, war, instability.
Shortage of Physician Care in Afghanistan
Afghanistan is suffering from the war since sixteen years, and the regulation of the life is destroyed. There was a considerably vast migration seen which affected the economy of the country as well as the economy of all over the world including Pakistan, Tajikistan, Iran, Iraq, Kazakhstan, United States and the United Kingdom. The sudden start of the war has completely changed the living conditions of the country. The health sector is also wholly disturbed. In an overview of the country, only three health institutes are operating in the country for the education of the medical staff and doctors which are not meeting the international standards because of the corruption and many other local influences. The rebuilding of the health institutes is highly considered by the policy makers, decision makers as well as the internationally working NGOs and non-profit organizations which are working for more than a decade for the country. The best-known non-Government Organizations which are currently under discussion on the international forums like the WHO, UN, and British Council. It was required to understand that there is the huge population which is not getting the proper health care because of the war, religion and other local and social issues and the requirement of enhancement of the knowledge of the local community to protect them from diseases and other health issues. The main aim of the paper is to discuss the policies improvement as well as to deliver a white paper which would help in understand the shortage of the physician care in Afghanistan because of the war and religion.
The most highlighting points which are essential to consider before discussing the policies and the problems which are causing the shortage of the medical care and physicians. Due to the influence of Russia and northern trade disturbance, Afghanistan was unable to develop that much accurately than comparatively the Iran, Pakistan and other neighboring countries. As the Russian influence was over, Afghanistan was entirely under the pity of the international world because of lack of modern resources and workforce which would help him to cover his expenses and development upon its resources (Tadjbakhsh, & Schoiswohl, 2008). In the meanwhile, the Taliban issue was highlighted in the international community, and this caused United States to interfere as international police and the emergency of War and this interference of US officially declared in the country (Trani et al., 2009). A considerable population decided to move outside the country, and a considerably vast migration took place which affected the international economy and completely halted many international trades. Many departments if the country were also destroyed and a good, loyal and peaceful community was replaced by the soldiers, Taliban’s and defenders of the nation. The US, UN and UNO camps for the treatment of the patients, first aid work, food and necessity supply and emergency management staff was only to provide the services. The internal staff was completely missing and in very few regions like Kabul and borders where the healthcare staff was available.
After a decade, the war was over, and the reestablishment and reconstruction of the country are adequately initiated but still the influence of the war as well as the massive gap of the population missing in the country as well as the soldier’s influence has profoundly affected the area. The health sector has to be started entirely from the scratch which means that there are no currently working institutes which are working in the production of the qualified staff with capabilities as the international healthcare staff (Stewart & Brieger, 2009). The Ministry of Public Health (MoPH) also started to build the institutes, hospitals, medical staff training centers and other departments to give necessary training to the local community as well as to register the considerable number of students. It will help in reestablishing the healthcare and fulfill the needs of the country as per required today and in the future. The current healthcare educational institutes for the education of the health workers and not only doctors but the staff as well are built in corruption and are not complete enough to provide the necessary facilities to fulfill the needs of the country.
If concluded the facts and figures which are entirely vanishing the way of progress of the healthcare and education are the government, political influence and the prebuild policies which are implemented forcefully on the healthcare which are hindering the flow of development and the primary strategy of overcoming the shortage of the local healthcare providence in the country.
Afghanistan is a landlocked state, and there is no way that any international water could serve in providing the necessity of healthcare as per required on the emergency as it is practiced in Somalia, Palestine, and Syria in uncertain internal war conditions (Riddle et al., 2005). Moreover Bangladesh, Thailand, Malaysia, Indonesia, Philippines, and India at the time of the high Tsunami in the recent past. The MoPH have an aim to expand its own rebuilt and working educational institutes of medicine, but there are examples which explain that due to the political influence, Afghanistan is on the path of 14 years of progress, but the outcome is less than the expected one (Windle, 2011). The international NGOs fulfill the requirements and there, is no way that the country could replace them from their infrastructure. That’s why it is highlighted much time in the UN conferences by Afghanistan and the WHO’s representatives that the need of reestablishment is essential and the main problem which is limiting the actions is the lack of policies.
Challenges to Overcome the Problems
A research was conducted by John R. Acerra and its affiliates in June 2009 under the International Journal of Emergency Medicine which was addressing the rebuilding of the healthcare and hospitals in Afghanistan for the emergency as well as primary care services. The research had focused on many challenges which were the barriers for the creation of the efficient and sustainable system of health care in respect to the primary care in the war based country, Afghanistan. The prominent factors which are being addressed by this research were the lack of security, infrastructure, economics, coordination, facilities, suitable hospital conditions, trained staff and women in the field (Acerra et al., 2009).
Lack of Security
One of the main insecurity of the lack of the international support for providing the health care to Afghanistan as the security. It is known that the safety is the central figure to be considered for any work being started. The conflicts among the soldiers, Taliban, and the native community as well as the religion was the highest problem in the country. There were many districts and regions where the access was limited because of the untouched mines laid by Russians and US soldiers in the initial times of wars. The UN missions broadly covered most of the central Afghanistan of approximately 45% of the region only. Many NGOs refused initially to work in the area because of killings of the foreign health workers because of the conflicts among the locals and soldiers. This violence has caused up to a half million deaths of the workers. Lack of security also become a cause to the women and children who wish for a health care service but are behind the doors because of the local authorities and religious communities (Mashal et al., 2008). The result of this problem caused millions of deaths in Afghanistan in which local community, soldiers, health care workers and research workers who focused on their jobs but still were targeted because of misunderstandings and misconceptions.
The policies are required to make necessary actions for the providence of the security in the region. Absence of security is highly considered by the stakeholders who are willing to initiate the medical schools for the training purposes of the doctors, physicians and health care staff.
In the middle of 20th century and before that time, Kabul was considered as one of the most beautiful, modernized and well-structured city of Asia and it was known that if this progress would be smoothened this city and the surroundings would be the center of land trade of Central Asian countries with China and South Asian Countries. The war was a true disaster to the area and completely ruined the area. In the targeted bombing, all the government buildings, schools, hospitals and complete towns were vanished which caused a huge loss of lives as well as the disturbance of the manifestation of area in many different ways. The absence of the roadways is one of the great problem for the international health care providers to access to the areas which are away from the camps. In 2005, a report by one of the UN worker was published that they didn’t have the certainty of returning from the same path through which they approached the problem areas (Mahmoodi, 2008). Only satellite phones were available for the communication purpose. The railway was also absent in the areas where the workers and doctors were unable to travel through roads in the winters.
If infrastructure problem is considered in the view of the formal education than it would not be wrong to say that infrastructure is essential for the education purposes. The way of communication, internet, roadways, railway, buildings, vehicles, staff and equipment is highly required and requested for years in the medical field. The policies are highly requested to make some string actions for this purpose. Since the basic necessity is not available for the emergency usage, therefore the education purpose is hardly accomplished. In many ways, infrastructure absence counts one of the main issue in the building of the local medical staff and physician’s availability.
Lack of Stable Economy
Afghanistan is seemed to be a place where many soldiers from different countries are available for many purposes. The soldiers accomplish NGOs, protection, local community, the supply of goods and many other functions (Lipson & Omidian, 1992). The economy is volatile, there is no stock exchange working stably, and no industry is available which is accurately operating according to the international standards. It is known that the funds are the only source for the improvement of the health care system and the salary of the physician and health worker. These resources are mostly coming from outside the country. Initiated from the US, UK, UNO, WHO, CARE, Danish Refugee Council, Action Aid and Afghan Health and Development Services. They are all based outside the country. The inside sources are not enough even after the start of the development and the end of the war. Still ANA, ANP and other Afghan-Iran, Afghan-Pakistan and Afghan-Iraq administrations had worked for the health services but they are negligible and only specified to some specific regions (Fogarty et al., 2014). Due to the frequent policy shifts of the NGOs and the governments, the clauses between the policies are coming many ties which end up in losing the health care service from many regions. The highlighted effected of these issues are upon the economy of the country and the overall health care department of the area.
It is highly required that the policies must be made according to the current situation of the country, the requirement of the community and the healthcare providers so that the work would be stabilized. Also with the help of this change in the policies would improve the internal as well as external funding sources (Fogarty et al., 2014). The health sector must be enhanced by the scope of at least next ten years so that a good number of local staff and the physicians would be produced to work in their own country.
In another critical research conducted about Afghanistan’s population was held in 2013 and under the Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, United States of America. In this research, it is explained clearly that the local community has the insecurity of the job satisfaction in their own country which resulted in their permanent immigration towards different developed nations like Canada, Turkey, and the UK. Since the destruction have wholly vanished all the basic as well as other necessities of the local community, therefore there is genuinely no job security (Fogarty et al., 2014).
It is known that the crises of quality human resource have affected completely the region and the stakeholders are very rarely interested in making investments on the war zone. All over the country is surviving on the UN, WHO and other non-government as well as the government ones. The people from all over the world as well as the local community is not willing in making any kind of commitment related to Afghanistan or any Afghanistan’s organization because of terrible background and uncertain future of the country’s economics and the development sector (Fluri, 2011).
There is a requirement of the reconstruction and reestablishment of the country’s main systems and the policy makers are requested to rethink about the issues because of which the technical health care staff would find the job satisfaction and a good intention of staying in the field as well.
Lack of Women
The healthcare department in Afghanistan highly require female staff for the operational purposes (Cutler, 1950). There are very less physicians and health care staff which would help in the regulation of providing the healthcare services to the 50% community of the country which are the women and waiting for international world to and the local authorities to make prominent steps for helping the local female students to enroll in the medical schools as well as an awareness of religious strictness which is not allowing male physicians for diagnosis and health care facilities.
Steps taken so far for the building and sustaining health care system in Afghanistan
The Afghan National Security Forces (ANSF), included the Afghan National Army (ANA) and the Afghan National Police (ANP), give some medicinal services, quite a bit of which is tertiary care; be that as it may, proceeded with global help for the ANSF is pivotal for its upkeep. The majority of the tertiary administrations gave by the ANSF are in Kabul, with provincial healing facilities in Kandahar, Gardez, Mazar-e Sharif, and Herat. At present 82% of the whole populace lives in regions where essential care administrations are furnished by NGOs under contracts with the Ministry of Public Health of Afghanistan or through gifts. Much cash and exertion has been put into building up tertiary care doctor’s facilities, however a planned social insurance framework has not yet been created in this nation. Subsequently, numerous are as yet living without access to essential social insurance. An expected 70% of therapeutic projects in the nation have been executed by help associations. In spite of the fact that these associations are to some degree effective, access to social insurance remains an issue. There is a noteworthy deficiency of a social insurance workforce in Afghanistan. World Health Organization information demonstrate that there are just 6,000 doctors and 14,000 attendants for a populace of 28 million individuals (Acerra et al., 2009).
Fundamental Package of Health Services
In a statistical view it can be explained that, in March 2002, the Afghan Ministry of Public Health built up the Basic Package of Health Services (BPHS) as a guide for the wellbeing administrations that the Afghan government would resolve to accommodate every Afghan native. Administrations were recognized that would have the best effect on significant medical issues, be achievable given the confinements in framework, be financially savvy, and give level with access to medicinal services in both rustic and urban regions. Center territories included maternal and infant wellbeing, youngster wellbeing and vaccinations, sustenance, transmittable maladies, emotional wellness, inability, and pharmaceutical supply. The cost of conveying these BPHS was hard to decide as human services was and still is given by different gatherings, including the Afghan government, givers, and NGOs. Beginning WHO gauges put the cost at around US $40 per individual to begin a revamping program in Afghanistan. After cautious thought of the BPHS, a few NGOs later assessed the cost of giving these administrations to 80% of the populace at US $4.30– $5.12 per capita. Six years prior just 9% of Afghanistan’s populace of 28 million individuals had fundamental well being scope. Today about 85% of the populace approaches (inside a 2-h stroll) to fundamental social insurance. The objective for 2010 is 90% (Acerra et al., 2009).
Future of Healthcare in Afghanistan
It is a challenge to establish a functional care system and in the era of 2001 to 2009 there was not a certainty of the life and a huge number of doctors, physicians and health specialists have resigned from their designations in the country because of uncertain deaths of their colleagues (Ayyoubi et al., 2010). The loss for the NGOs was great and they didn’t focused on Afghanistan at all and stepped back from the country. Since, US-Afghanistan war was the first most advance and over attempted war by US and there was no returning point of any decision.
Now the war is completely over and the development is being started so it is highly required that the policy makers and the decision makers to make some appropriate decisions and policies for the country’s health care service providers and the future of this field so that the loss would be managed and lessened (Acerra et al., 2009). The corruption should be considered as the highlighted figure to discuss while making the policies because already the only three medical school’s output is observably below the international standards. The long term goal of the quality health care for all people including men, women, rich, and poor will only be met by the combination of the goal oriented projects as well as the external aid and domestic duty.
In a nutshell, it can be explained that the war states always have lack of internal support from the local community, industry, agriculture, and healthcare. Afghanistan is developing country on very initial stages. The health services are not correctly installed, and vast population is affecting by many health issues. The women are the most attacked by this problem, and the lack of female staff in the medical field in Afghanistan is the most prominent problem of not providing the 50% of the community, the healthcare services. The shortage of Female staff, doctors, and physicians is causing the religious leaders and the Taliban movements having a claim of being illegal camping in the area. The future of the country’s health services is still dark, and there is no reliable move inside the region by the local community which would help in the rebuilding of the healthcare units, un-corrupt educational institutes and the departments without any domestic or international influence for the medical education and training. In conclusion, it should also be added that the steps must be taken by the policy makers and decision makers of the country. It would at least stabilize the healthcare service unit for a healthy community of Afghanistan.
Acerra, J. R., Iskyan, K., Qureshi, Z. A., & Sharma, R. K. (2009). Rebuilding the health care system in Afghanistan: an overview of primary care and emergency services. International journal of emergency medicine, 2(2), 77-82.
Ayyoubi, M. T., Konstenius, T., McCullough, J. C., Eastlund, T., Clay, M., Bowman, R., … & McCullough, J. (2010). BLOOD DONORS AND BLOOD COLLECTION: Status of blood banking and the blood supply in Afghanistan. Transfusion, 50(3), 566-574.
Baird, C. P. (2012). Review of the Institute of Medicine report: long-term health consequences of exposure to burn pits in Iraq and Afghanistan. ARMY PUBLIC HEALTH COMMAND ABERDEEN PROVING GROUND MD.
Brinkerhoff, J. M. (2004). Digital diasporas and international development: Afghan‐Americans and the reconstruction of Afghanistan. Public Administration and Development, 24(5), 397-413.
Cutler, J. C. (1950). Survey of venereal diseases in Afghanistan. Bulletin of the World Health Organization, 2(4), 689.
Fluri, J. (2011). Armored peacocks and proxy bodies: gender geopolitics in aid/development spaces of Afghanistan. Gender, Place & Culture, 18(4), 519-536.
Fogarty, L., Kim, Y. M., Juon, H. S., Tappis, H., Noh, J. W., Zainullah, P., & Rozario, A. (2014). Job satisfaction and retention of health-care providers in Afghanistan and Malawi. Human resources for health, 12(1), 11.
Lipson, J. G., & Omidian, P. A. (1992). Health issues of Afghan refugees in California. Western Journal of Medicine, 157(3), 271.
Mahmoodi, S. M. (2008). Integrated water resources management for rural development and environmental protection in Afghanistan. Journal of Developments in Sustainable Agriculture, 3(1), 9-19.
Mashal, T., Takano, T., Nakamura, K., Kizuki, M., Hemat, S., Watanabe, M., & Seino, K. (2008). Factors associated with the health and nutritional status of children under 5 years of age in Afghanistan: family behaviour related to women and past experience of war-related hardships. BMC public health, 8(1), 301.
Riddle, M. S., Tribble, D. R., Jobanputra, N. K., Jones, J. J., Putnam, S. D., Frenck, R. W., & Sanders, J. W. (2005). Knowledge, attitudes, and practices regarding epidemiology and management of travelers’ diarrhea: a survey of front-line providers in Iraq and Afghanistan. Military medicine, 170(6), 492-495.
Stewart, C. C., & Brieger, W. R. (2009). Community views on cutaneous leishmaniasis in Istalif, Afghanistan: implications for treatment and prevention. International quarterly of community health education, 29(2), 123-142.
Tadjbakhsh, S., & Schoiswohl, M. (2008). Playing with fire? The international community’s democratization experiment in Afghanistan. International Peacekeeping, 15(2), 252-267.
Trani, J. F., Bakhshi, P., Noor, A. A., & Mashkoor, A. (2009). Lack of a will or of a way? Taking a capability approach for analysing disability policy shortcomings and ensuring programme impact in Afghanistan. The European Journal of Development Research, 21(2), 297-319.
Windle, J. (2011). Poppies for medicine in Afghanistan: Lessons from India and Turkey. Journal of Asian and African studies, 46(6), 663-677.