Editor in Chief: Moh. Reza Huwaida Thursday, December 13th, 2018

Afghanistan: The Most Dangerous Place to Live


Afghanistan: The Most Dangerous Place to Live

Afghanistan is one of the most dangerous places in the world to live a healthy life. Due to poor quality health care services the wealthier choose to seek care in other countries but the poorer have to frequently die and suffer. According to reports, in Kabul one in five had travelled outside Afghanistan to seek the care they required, most of them heading to neighboring countries; While border provinces almost one in ten and one in twelve had gone abroad to seek treatment for an illness of someone in their household. The long distances people must travel to seek care not only delay the provision of urgently needed treatment, but also force them to undergo perilous and costly journeys. Nevertheless, there have been some achievements in past 15 years but it is not sufficient because one third of entire population still lack access to very basic healthcare services while others go abroad due to low quality services.
Beside war, insecurity and long distances, high costs are also an important barrier to access healthcare for many people in Afghanistan; travelling to distant, better health facilities often increase expenses, forcing families to become indebted to provide treatment for relatives. These include non-medical costs for transport to and from the health facility, accommodation and food, in addition to the actual medical costs. Despite the fact that healthcare should be free of charge, as promised under the national free care policy (article 52 of the national constitution) this is not the case in many public facilities. Instead, people must pay for drugs, doctor’s fees, laboratory tests and in-patient care. Overall, households in Afghanistan spent on average more than 9,000 Afghani on healthcare (around 150 USD). It is notable that urban households had a significantly higher level of expenditure than rural households, which is likely related to lower urban poverty levels and better access to health services. In a country where, according to the World Bank, more than one third of the people are living below the national poverty line of less than $1.25 USD per day, such expenditures can be crippling. People always complain about the poor quality of the public health system, including of staff and services; lack of appropriate drugs; and an improperly functioning referral system. It seems that public system is obsolete; patients often had to wait for a long time to be treated. For instance, in clinics those are open only in the mornings, women experiencing complications during labour at night or other times of the day or wounded patients who need immediate medical care are not cared for in time.
Corruptions such as Informal fees, low quality or smuggled medicine and are another worrying problems, considering that costs pose an important barrier to access healthcare. People often have to pay bribes in order to be seen by a doctor in a public clinic. Others spoke of doctors in public clinics pushing people to their after-hour private practice, saying that it was better equipped. People also regularly complained that public clinics in remote areas sold their drug supplies to pharmacies, so that patients had to buy them instead of receiving them free in the clinic. The importation of poor quality medicine is another serious issue. It is said that about 90% of Afghanistan’s pharmaceutical products are imported while 50% of them are illegally imported. As a result, the quality of public services is often perceived to be low, even if this is not always the case. For instance, assessment of the public clinics in certain provinces district showed that general primary healthcare provision appeared to be functioning well. At the time of the visits, all public health centres are open and providing consultations free of charge and seemed to have adequate levels of patient attendance. But distrust in the public health system causes many people to prefer private clinics and private doctors, who are perceived to be better in terms of quality. Yet, the quality in private system is not necessarily justified; many complain of overprescribing, misdiagnosing and even malpractice and medical mistakes by private practitioners. They also try benefit from the bad reputation of the public sector and ask high fees for their services.
More than half of Afghan girls and boys suffer damage to their minds and bodies that cannot be undone because they are poorly nourished in the crucial first two years of life. High levels of Malnutrition in Children is rate of stunting is around 60%, underweight rate is around 40%, Anemia rate is around 50% in children, High iodine deficiency: 72%(school age) and also the high levels of Malnutrition in Women is Iron deficiency: 48.4%, non-pregnant and Iodine deficiency 75% and high levels of chronic energy deficiency are 20.9% low BMI. There are about two million addicts in the country while the numbers are increasing due to lack of serious fight against opium products. Likewise, the figure of communicable disease especially HIV/AIDS are in increase because of boost in number of drug users, the number of injuries and disabled rising due to security condition in the country, the air-pollution, which is responsible for up to 70% disease of urban area, is also deteriorating.
As final points, having happy, healthy and well-talented lives depend to having quality health services and strategies; we must know that if we do not have sound body, we cannot have sound mind. We should realize that food and food experts play very important role in a society. We must understand that Pregnancy and infancy are important periods for the formation of the brain, laying the foundation for the devel­opment of cognitive, motor, and socio-emotional skills throughout childhood and adulthood. Children with restricted development of these skills during early life are at risk for later neuropsychologi­cal problems, poor school achievement, early school dropout, low-skilled employ­ment, and poor care of their own children, thus contributing to the intergenerational transmission of poverty.

Mohammad Zahir Akbari is the newly emerging writer of theDaily Outlook Afghanistan. He can be reached at mohammadzahirakbari@gmail.com

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