A community-based approach to reshaping health services

10 Dec 2018
A community-based approach to reshaping health services

Wahidullah Azizi & Saida Azimi, Integrity Watch Afghanistan

Decades of war in Afghanistan have destroyed much of its already fragile infrastructure, including the provision of medical services which are a precious commodity for the health of citizens and society as a whole.

Whilst the past one and a half decade have brought some upgrades to the country’s healthcare system, nonetheless, a growing population and the demand for quality services require more substantial transformation — one that involves the public in overseeing the delivery of these services and the health sector responding to the needs of the people who should be the ultimate beneficiaries.

There is a famous saying, “your health is your wealth”. With quality health services so scarce in this impoverished country, the fortunate often go abroad for treatment. But the large number of Afghans living under the poverty line either do not have the financial means to avail of better healthcare services or do not have access to the few facilities within the country.

Around three percent of the Afghan population suffer from disabilities need medical care. Women and children are particularly prone to common curable diseases. Four out of 10 (41%) children under age of five years suffer from stunting, a chronic sign of malnutrition, at an early age, leaving them with crippling effects. While the material mortality rate has declined over the years, it is still above the global average.

Mismanagement and rampant corruption in the government, is retarding every sector and have frustrated attempts at enhancing the quality of health services in Afghanistan. A study published in Lancet Global Health, which contained findings from 2005 and 2013 household surveys in 13 provinces, concludes that vulnerable groups, including those people suffering from disabilities, are symptomatic of the dismally low levels of access to health services. The findings like this and others questions the impact of international investments in the healthcare sector during the past one and half decade.

Another survey of 183 healthcare facilities indicated that the misuse of authority and graft have resulted in the lowering of the standards of service delivery. Of the health facilities surveyed, 45 percent were in poor hygiene and sanitation condition. Overall two-thirds of the health centres remained in bad condition, with more than half (53%) needing urgent care.

Efforts by the government to provide the Basic Pack of Health Services (BPHS) across Afghanistan are commendable. Despite their shabby quality and dysfunctional nature, health facilities remain central to people’s lives as for many they are the only services they can access.

The engagement of the communities in the oversight and monitoring of healthcare can be very effective. Recently, Integrity Watch Afghanistan, a civil society organization combating corruption and other forms of abuse, launched a pilot programme seeking to make the public health system more effective, and this has produced promising results.

Only three months after its launch, the initiative has enabled local residents to solve 34 percent of the issues they identified. In a rare act of courage, community members prevented the theft of medicines by a medic who was the head of a clinic on the outskirts of Kabul. The medical professional’s attempt to steal drugs worth $5000 was thwarted, an intervention that rarely happens.

To improve the status of healthcare in the country, cooperation between locals and the health officials who are providing the services remains an important factor. An important objective behind this should be to provide a platform for engaging the community in the healthcare system – not just as clients but to oversee the quality and delivery of the services there.

Ensuring sustainable, affordable and easy-to-access healthcare services should be a priority for the government and the international community. The latter should not shy away from investing in long-term strategies and planning to boost the system. While investments in the sector are vital to improved services, there is also a need for greater oversight over how funds are spent. Corruption and mismanagement delays much-needed reforms in the sector.