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An independent evaluation of health services in Afghanistan carried out by Johns Hopkins University has shown that access to care and key health indicators have improved over the last three years.
Speaking at a press conference in Kabul last week to draw attention to the study, the country's minister of public health, Mohammad Amin Fatimi, said that the data provided “clear signs of health sector recovery.”
Further evidence of this recovery came from a conference on health research held earlier in the week to mark the opening of Afghanistan's first public health institute.
“This was a landmark event,” said Egbert Sondorp, senior lecturer at the London School of Hygiene and Tropical Medicine, who has been working in Afghanistan for several years. “It's the first time since 2001 that health researchers and others concerned with service provision have been able to come together to share results and exchange expertise.”
Among the many topics discussed at the conference was cutaneous leishmaniasis, which is common in Kabul and carries appreciable stigma. “The disease has the problem of being disfiguring but not deadly,” said Dr Sondorp. “And it's not something that can be treated at primary care level.” (Treatment entails repeated injections of expensive drugs.)
Dr Sondorp continued: “Therefore it's difficult to get it funded. Occasionally there is a donor that wants to give some money, but it [the funding] stops again after a few years. The disease just does not manage to become a priority.”
The conference also debated the smuggling of drugs. Currently brand name formulations of antibiotics and a range of basic drugs, including paracetamol, are being smuggled into the country illegally because obtaining them in generic formulations through the normal government channels is so slow and cumbersome.
One of the major challenges for Afghanistan's health sector is providing primary care services at a cost that poor people can afford. Currently, Dr Sondorp said, an estimated 30% of the population have to sell assets to pay for their medical care.
The establishment and roll-out of a basic package of health care in Afghanistan, delivered primarily by non-governmental organisations, began in 2004 (BMJ 2006;332:718-21 doi: 10.1136/bmj.332.7543.718).
The Johns Hopkins survey of 600 publicly financed health facilities between 2004 and 2006 shows that this package has improved access to care for most of the population but that it is still not reaching people in remote rural areas and provinces where security is poor. The survey found that infant mortality fell from 165 deaths per 1000 in 2001 to 135 in 2006; provision of antenatal care increased from 5% of women in 2003 to 30% in 2006; and the percentage of couples using modern contraception methods over the same period grew from 5% to 15%. Childhood immunisation rates have also increased. But despite these improvements, Afghan health statistics still compare unfavourably with south Asia as a whole.
The annual cost of providing primary healthcare services is estimated to be $5 (£2.50; €3.70) per person. For this care alone, therefore, Afghanistan needs $125m to $150m a year. With its economy still weak the country continues to depend on external donor aid. Major donors include the World Bank, the US Agency for International Development, and the European Union.
Last week the Ministry of Public Health pledged to establish health sub-centres and to run mobile clinics in underserved areas, as well as training and deploying more female health workers to encourage more women to use health services. But as Dr Fatimi emphasised, progress depends on “a firm commitment by the international community to increase and secure financing for the health sector.”