A Critical Review of the Public Health Policy of Afghanistan

According to article 52 chapter 2 of the Afghanistan Constitution,  under the term ‘Fundamental Rights’: “the state is obliged to provide free access to preventive health care and medical treatment, and proper health facilities to all citizens of Afghanistan in accordance with the law”. The state encourages and protects the establishment and expansion of private medical services and health centers.

The 2011-15 strategic plan for Ministry of Public Health (MoPH) has been developed through a highly participatory process. In addition, many stakeholders, such as the Director General Policy and Planning and Director of Health Economics and Finance were involved in consultations with the new planning team at the strategic planning department. Inputs were also invited and consensus built at a national workshop held in Kabul on December 2012 from which 10 strategic directions emerged. 1- Improve the nutritional status of the Afghan population, 2- Strengthen human resource management and development, 3- Increase equitable access to quality health services, 4- Strengthen the stewardship role of MoPH and governance in the health sector, 5-  Improve health financing, 6- Enhance evidence-based decision making by establishing a culture that uses data for improvement, 7- Support regulation and standardization of the private sector to provide quality health services, 8- Support health promotion and community empowerment, 9- Advocate for and promote healthy environments, and 10- Create an enabling environment for the production and availability of quality pharmaceuticals (www.moph.gov.af).

The national health policy of Afghanistan has been struggling for a long time. The importance of health policy has been avoided due to poor infrastructure, weak processes and lack of expertise in policymaking. Most of the citizens do not have access to health facilities in the rural areas. Health care workers and advanced medical equipment are also necessary for an effective health care system; unfortunately, Afghans do not have access. Afghanistan’s status in terms of health indicators is quite alarming. The health expenditure is 0.5% of the GDP and represents 6.1% of the current expenditure since 2002. There are only 7.26 doctors, nurses and midwives per 10,000 people since 2006. Based on planning, the expected increase was only 9 doctors, nurses, and midwives over 5 years. Tuberculosis, an acute respiratory infection, and malaria are the most severe diseases, causing high levels of causalities. Improved drinking water sources show a positive scenario, but sanitation facilities have not improved since the last decade, which shows only 5% improvement from 2000 to 2015.

Acute respiratory infection was one of the leading causes of death during 2012, claiming 28,000 lives. Afghanistan needs to have a contingency policy whereby the state apparatus can tackle this situation and ensure citizens have effective health care. Cases of diabetes almost doubled from 2000 to 2012 in both genders, but it’s quite surprising that female ratio in this regard is quite higher than male. It is ironic that policy makers have not responded in a positive way to reduce the risk of diabetes. Afghanistan has the second highest mortality rate in the world for children under the age of 5 years. This means that 101 deaths occur per 1000 births. Approximately one in 50 women in Afghanistan has a lifetime risk of dying due to pregnancy-related causes (UNICEF). Availability of qualified midwives and lady doctors are one of the key issues of Afghanistan.

However, diabetes, TB, malaria, and respiratory infections are the significant issues which need to be addressed with an effective solutions-oriented policy. Policymakers need to study the causes of incidence of diabetes that is on the rise throughout the country. What could be the possible way to resolve the problem? Should the government, go for public awareness or for nutrition policy? The government of Afghanistan is not mature, but at least it can align the private sector with the public sector so that they both work together to resolve these issues. There is a severe shortage of medical technicians such as laboratory technicians, ultrasound technicians, diagnostic technologists, and radiologists. The state should spend more on health and education which will not only enhance the education sector but positively influence the health sector.

The Afghan government doesn’t examine and predict what would be the situation if those doctors or technicians leave citizens in these critical situations. They haven’t designed effective, strong retention policies. Most of the medical experts migrate to developing countries due to social and political instability. The current policymakers seldom engage local communities, interest groups, and civil societies for consultation. If these interest groups are made part of policy making, they will help in achieving the objectives of the policy. If a small number of people are involved in the policymaking process, the outcome would be vague and unacceptable to many. Currently, strategic policymakers need to involve academia as well in order to come up with innovative solutions.

Public policies vary from one country to another, but it requires regulatory measures. Afghan policymakers set very lofty goals, but the objective should begin with meeting people rather than focusing on strategic goals. Afghanistan is in a state of war, but we can’t blame the war for every ill. In fact, lack of expertise, ineffective execution, and poor work ethic are the indicators of failure. Afghans blame foreign involvement as the main cause of the problem, but what about internal policies which have failed? In fact, it shows our lack of commitment, accountability, and widespread corruption.

Accurate public reforms are needed for Afghanistan, targeting the issues of corruption, violence related conflict, poor planning, and almost no execution. It is amazing to know that International Transparency declared Afghanistan as the world’s second most corrupt state. This is food for thought for the bureaucrats and technocrats. Even if 5% of the budget was utilized properly for healthcare, citizens would refrain from going neighboring countries for medical treatment. Unfortunately, our people are not responsible citizens because they have been gone through a prolonged war. Therefore, their engagement in such policies is not so attentive.

The government has many challenges in the country. It is not serious about the most important issues such as healthcare and education. It has been more than 15 years now that the health sector is struggling to achieve its objectives. Every five years they set strategic plans, but fail to achieve them. Every citizen has the right to get an education and access to health facilities.

The Ministry of Public Health is facing two main issues; first, is rampant corruption. The second is the gap between strategy formulation and strategy implementation processes. The Ministry makes policies for healthcare but fails to execute them properly. The MoPH demands international help to conduct a rapid review of the current health policies. When the policies are followed haphazardly and are not executed efficiently, nothing changes and the people continue to suffer. When the right person for the right job does not get selected due to nepotism, the quality of public service will never improve. Corruption is a curse, and it needs to be eradicated in order to lead the country to prosperity. Those Afghans who are part of strategy-making but are not competent to do their job should be removed in favor of those who are dedicated, committed, passionate, experienced and have the potential to work for the best interest of their people.

General Directorate of Pharmaceutical Affairs (GDPA) is another aspect of health policy, which is vital for the state, but the government never encourages investors to invest in this sector. Medicines that are imported from other countries by local businessmen and are of poor quality and expensive. The foreign experts and knowledgeable workers should be welcomed to train and develop Afghan capabilities in different fields, then Afghans can further train other people, multiplying capabilities.

 

WaheedUllah Aziz is a freelance writer and writes about social, health and other issues of Afghanistan.

He can be reached at waheedullah99@ymail.com 

Twitter: https://twitter.com/exotickhann

 

The Afghan Tribune | WaheedUllah Aziz | Published: March 07, 2017, 09:17 AM

 

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