Afghans are finding it hard to meet their medical expenses even as unmet medical and humanitarian needs continue to soar in Afghanistan, according to a recent report from Médecins Sans Frontières (MSF).
In the report “Persistent barriers to accessing healthcare in Afghanistan: The ripple effects of a protracted crisis and a staggering economic situation”, the authors said that Afghans still struggle with access to healthcare due to a combination of increased widespread poverty, and a further weakened public health system.
The MSF said that healthcare delivery model in Afghanistan, which was already dysfunctional, suffered further in recent years from the effects of insufficient investment, inappropriate allocation of funds and short-term contracts.
The MSF report said that healthcare delivery model in Afghanistan has not been sustainable, remaining under-funded and under-resourced, lacking qualified personnel, equipment, medicines and medical supplies. The economic, banking and liquidity challenges are at the heart of the current humanitarian crisis in Afghanistan and greatly contribute to the difficulties people face in accessing and affording essential services, including healthcare, it said.
Highlighting the issues faced by women, the report said that women have been struggling with additional obstacles, such as the socio-cultural mobility constraints – like requiring male accompaniment to leave the house – impacting the access to proper and timely primary and secondary healthcare. And access to healthcare is compounded by a shortage of women health workers, that will only worsen after the authorities’ decisions at the end of 2022 to ban women from undertaking higher education or working for international or national non government organisations, it said.
As part of the study, MSF held a survey and pointed put that 97.5% respondents said that they have experienced financial challenges due to spending money on healthcare (20 percent more than in 2021), as they either had to borrow, dig into their savings, or sell properties and household items. About 95 % said they had difficulties in affording food in the past 12 months. The MSF also said that 91.2 % reported decreased income, 15.5 percent more than the 2021 survey. Meanwhile, 88 % respondents reported either delayed, suspended or forewent seeking medical care and treatments due to the reported barriers (14.3 percent more than in 2021), from which 52 percent believe their relative died due to lack or delayed access to healthcare. It further stated that 87.5 % of the respondents included costs as their main barrier to access healthcare, 18 percent more than in 2021. 62.5 % of the survey-respondents believe women face worse obstacles to accessing healthcare in comparison to men. An average of 45.4 percent of the respondents who have visited a public or a private facility at least once over the past year were not
satisfied with the service provided, similar to 2021 findings.
Recommendation to stakeholders, international donors, aid and development providers;
• The economic crisis needs to be urgently addressed. International actors must ensure clear communications and support to the banking system, aiming for solutions to alleviate the liquidity crisis, including in terms of the frozen Afghan assets abroad.
• Sanction exemptions for humanitarian assistance and development-related transactions should be clarified to private and public banks in Afghanistan. Financial transactions would not only facilitate the roll-out of humanitarian and development assistance, but also inject cash into the country.
• Organisations cannot remain as the de facto substitutes for the public health sector. While international organisations may have averted the collapse of the healthcare system, this is not a sustainable role for them to play. And the MoPH needs to be involved in identifying and working through the implementation of long-term solutions for the Afghan healthcare system.
To international donors and UN agencies:
• Increased and sustained funding is essential so that the Afghan healthcare system can benefit from sufficient and long-term planning. Durable solutions for existing medical needs should be prioritised.
• It’s urgent and of utmost importance to provide affordable and accessible healthcare to the people of Afghanistan and improve the ability of the healthcare system to both respond to emergencies and be capable of meeting the immediate medical needs of the population.
• Significant and urgent investment is needed to strength service delivery and improve the infrastructure of health facilities, especially at the primary level and in the districts. Donors and authorities should invest in technical support and regular monitoring of programmes and services, as well as being increasingly accountable for the outcomes and/or deficiencies.
To the Islamic Emirate of Afghanistan:
• The authorities should refrain from imposing restrictions that impede or delay people’s access to healthcare, or humanitarian and development aid. And continue to allow and facilitate timely and dignified access to healthcare, without conditionality. Women should be allowed to work in all areas of Afghan life. Women staff play a critical role in the provision of aid, including medical aid, and no organisation can assist local communities without them.
• Education should be available for everyone. it is vital in helping to ensure for example that there are enough skilled workers such as women medical staff.
• The authorities must ensure the proper allocation of funds for the health sector.