Amidst Afghanistan’s many rebuilding challenges, Afghanistan’s health sector is considered one of the worst development cases in the world. While the health sector has made great strides in recent years it calls for a new innovative method for a more inclusive, thoughtful and transparent health care system.
A healthy population is necessary for the economic development and social stability of the country. The recent US invasion of Afghanistan has brought on an increase in violence further increasing the barriers towards social services. Those suffering the most from these circumstances are the women and children of Afghanistan.
Facts:
- Afghanistan has one of the highest mortality rates in the world.[1] While progress has been made, The UN Children's Fund (UNICEF) ranked Afghanistan the worst of 202 countries in terms of maternal, infant and child mortality last year. [2]UNICEF considered it the worst place to be born.
- 1 in 8 Afghan women faced a lifetime risk of death from causes related to pregnancy and childbirth in 2009 which, according to the report, has improved to 1 in 11.[3]
- Maternal deaths have fallen from 1,600 per 100,000 live births in 2001 to 1,400 in 2010, still the second highest in the world.[4]
- “Communicable disease accounts for 60-80% of all curative outpatient visits and over half of all deaths in Afghanistan“[5]. Consequently, control of communicable disease is one of the highest priorities for the Ministry of Public Health.
- Plagued by war and land mines, a significant portion of Afghanis live as amputees who are often ostracized or overlooked by the government. Having been directly incapacitated by the incessant violence, many of them are unable to contribute to family income.
- The lack of infrastructure has diminished access to health facilities and services.
Women and Health
There have been great strides made in the attempts to make reproductive health and family planning services more widely available in Afghanistan. It is imperative that these efforts
be continued and expanded upon because a key to empowering women is to give them the ability to choose when and with whom they want to have children. Many organizations have encountered difficulties in dealing with the cultural components that make giving women access to these services so difficult. Traditional gender roles deny women control over their own sexual decisions, and can compel some men to undertake risky sexual behavior that puts both him and his partner's at risk for STDs. Comprehensive programs need to include the education of both the man and the woman on the benefits of sexual health services, ranging from STD protection to the spacing of births of children.
Since Afghanistan is the second highest for maternal deaths and women face particular difficulty in having access to health services, this is the area most deserving of attention. In order to address the problem of women’s health, efforts must be targeted at all levels. Traditional beliefs do not allow for women to visit male doctors so the training of women personnel is imperative.
Islamic Relief USA does work to improve maternal health in developing countries with a cultural sensitivity to local customs; this is essential in the case of Afghanistan in order for the citizens not to feel threatened. We will work to provide workshops in order to train women in basic education of hygiene, nutrition, reproductive and maternal health practices. Support will also be given to women who wish to pursue occupations in the health fields. Essential to this operation is the community involvement. While Afghani women will be trained by women themselves, male workers from this NGO will also be needed in promoting Afghani men to support womens empowerment since women will be required to step out of their traditional roles.
We will also work to utilize mechanisms created by Afghans that are already in place. For example, the Revolutionary Association of the Women of Afghanistan (RAWA) runs mobile health teams in 8 provinces of Afghanistan. The mobile teams mainly treat those women who cannot go to the doctors because of their financial problems. They also run first aide courses for young girls and literate women. Last year the teams successfully carried out the polio vaccination program in their concerned areas. By providing local organizations such as this with access to larger amounts of funds so that they can expand their already successful programs, development stays in the hands of the Afghan people. These women are much more likely to be trusted than teams of foreign internationals. Men are also much more likely to allow their wives and daughters to be treated by an Afghan woman rather than a foreigner.
Women's health clinics provide a safe space for all women, that general clinics sometimes lack. At least one women's health clinic should be in each province, preferably two or three.
Other strategies include:
- Coordinate and support national immunization days. As previously mentioned, Afghanistan has one of the highest rates for communicable diseases. Many of the deaths caused by disease are preventable and those who suffer the most from them are children. This method is used in Afghanistan today and should continue. We will work to reach out to isolated that continue to be . We will fully involve the provincial authorities.
- Reach out to rural areas. In order to reach out to areas that are isolated, we will like to use buses to travel and provide basic health services and medicine. Our personnel will work to diagnose patients and should they need further treatment, provide transportation to the nearest health facility.
- Work with donors to make medicines more affordable and accessible and if possible, free.
- Provide basic education on hygiene and sanitation practices for youth, especially since many are illiterate through workshops given in the communities.
- We will work to develop a multi-sectoral approach in providing clean water. Afghanistan’s water sources have been severely impacted by drought and armed conflict effecting not only the population’s health but agriculture as well. This issue requires institutional reform, the adoption and enforcement of irrigation and water management policies as well as the creation of a proper water-development plan. Effort needs to be placed on developing strategic water supplies. We will work alongside the Ministry of Energy and Water, UNDP and OBO Water & Energy Engineering, a contracting firm based in Afghanistan, to create quality standards of safe drinking water and ensuring they are met.
- In order to promote a culture of preventative medicine, we will work on providing proper funding for research facilities. This will help to bring in better jobs to civil society and encourage higher education.
Due to the violence and Afghanistan’s history of clannish intermarriage, the nation is home to thousands of disabled citizens. Incapacitated by their circumstances, they are unable to provide for themselves and family. The government has failed to make them a priority. To help with their situation we will work with donors to provide prosthetic devices and other orthopedic services.
In order to prevent an uncoordinated effort by a proliferation of NGOs, Afghanistan's government and donors should jointly contract NGOs to provide a Basic Package of Health Services (BPHS). This will be done through a bidding process where national and international NGOs will compete for a service contract to provide the package in a province selected by the government and donors.[6]
Health sector reform strategies have been developed and proposed by non-native experts on the developing world. Although some of these experts produce technically and scientifically sound guidelines, a lack of cultural and local competence to fully understand the system problems has been a source of ultimate failure so we will do all that is possible to avoid this.
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1.Nebehay, Stephanie. “Afghanistan is the World’s Worst Place to be Born.” Reuters. 20 Nov 2009. http://www.rawa.org/temp/runews/2009/11/20/afghanistan-is-world-s-worst-place-to-be-born-u-n.html
2. http://www.reliefweb.int/rw/rwb.nsf/db900SID/JALR-89QHDU?OpenDocument
3. http://www.unicef.org/sowc09/docs/SOWC09-FullReport-EN.pdf
4. http://www.rawa.org/temp/runews/2010/09/28/afghanistan-limited-progress-on-maternal-health.html
5. afghanistan.usaid.gov/en/Activity.135.aspx
6. Roberts, B, S Guy, E Sondorp, and L Lee-Jones. "A Basic Package of Health Services for Post-Conflict Countries: Implications for Sexual and Reproductive Health Services." Reproductive Health Matters. 16.31 (2008): 57-64. Print.
