Sayed Ikram Afzali, Executive Director of Integrity Watch, stated, “There are some bright spots in the Afghan public health sector including all health centers reported as being open. However, the quality of health care services suffers from limited resources and weak oversight.” He proposed that, “the full potential of the Afghan public health sector could be realized if meaningful community engagement in the budget and monitoring process at grassroots level is coupled with robust and rigorous oversight by the Ministry of Public Health from Kabul and the provinces.”
Staff credentials are found to be relatively good with only 7% of doctors reported as not certified for delivery of the required services. The annual performance appraisal of health professionals – a tool of personnel management – covers around 80% of the health facilities, with 83% of health personnel’s behavior with patients reported as being satisfactory; and yet, operation and maintenance and safety standards of the facility buildings fall short. For example, 39% of health facilities do not have clean running water, 51% do not have a wheel chair ramp for patients, only 22% have fire alarms and only 2% have emergency exit doors. Heating and cooling systems are often not available in facilities located in areas of extreme weather conditions. Half of toilets are reported as not being clean and hygienic. There are ambulances at most of the health facilities and yet some facilities have none or only an inadequate number, not meeting the existing demand. Of the provincial hospitals covered in this report, 25% reported as not having ambulances with 11% district hospitals and 13% basic health facilities encounter this problem.
Dr. Nipa Banerjee, the author of this report and the lead analyst of the survey data collected by researchers of Integrity Watch, comments that some quantitative findings of the study put the health facilities in a satisfactory light. For instance, plumbing systems were found in a large majority of the facilities surveyed- a finding that is commendable. However, there was no plumbing system found in a small number of facilities which indicates lack of satisfactory health care services in those centers. The analyst concludes that the absence of required equipment and materials and adequate stocks and supplies of medicines; and necessary transport infrastructure (well-equipped ambulance services for the sick, access routes etc.,) are basic requirements for quality delivery of health care services; and weaknesses in such areas, even in a lesser number of facilities, must be remedied, as the first order of business. Further, absence of functional and well maintained electrical and plumbing systems, the latter ensuring operation of toilets, consistent supply of clean running water and operation of hand-washing stations, impact quality care delivery adversely.
The overarching recommendation of the report is to put in place a regime of systemic and regular consultation with stakeholders by the Ministry of Public Health. The Ministry should enhance its oversight of the operations of the facilities. Supervision Teams from the Ministry must make elaborate maintenance plans for the facilities and ensure their implementation by the health facility-based management teams. Introduction of a “Performance Measurement Framework”, with concrete indicators to monitor progress, must be drawn up and used at the time of the scheduled monitoring visits by the Health Ministry’s Supervision Team. The Cabinet and the Ministry of Finance should provide an additional budget for travel, for securing technical assistance and expert advice and training of staff to the Ministry of Public Health to implement these recommendations.
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