Editor in Chief: Moh. Reza Huwaida Monday, May 27th, 2019

Difference between Words and Reality: Access to Health Care and Its limitations in Afghanistan

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Difference between Words and Reality: Access to Health Care and Its limitations in Afghanistan

Last Saturday April 20, 2019, Afghanistan and Pakistan jointly inaugurated a 200-bed, hospital in Kabul, one of three major health care facilities being built and funded by Islamabad as its contribution to reconstruction efforts in Afghanistan. Named “Muhammad Ali Jinnah Hospital” under name of Pakistani founder and it took 12 years to finish at a cost of more than $24 million. As reflected in media reports, Officials of both countries cited deteriorating Afghan security, continued mutual political acrimony and institutional as well as bureaucratic inefficiencies for the delay in the completion of the second-largest hospital in Afghanistan.
Second vice President Sarwar Danesh, Minister of Public Health Dr. Feroz, Pakistani minister of state for parliamentary affairs Ali Mohammad Khan, Pakistani ambassador to Kabul Zahid Nasrullah Khan, a number of lawmakers and elders participated in the ceremony. Danesh on behalf of the government and people of Afghanistan thanked the government and people of Pakistan.  Pointing to Pakistan’s part in key infrastructural projects in Afghanistan, he said Afghanistan government hoped Pakistan government would also play constructive role in maintaining security and peace in Afghanistan and the region.  Pakistani minister of state for parliamentary affairs Ali Mohammad Khan also spoke and considered completion of Jinnah Hospital as an effective step towards sympathy between the people of the two countries. He recalled of completion of other hospitals in Logar and Jalalabad by Pakistan, stressing that Pakistan was making efforts to help Afghanistan in security, stability and lasting peace.
The Second Vice-President criticized the related ministries for failure to provide equal and quality healthcare services to all people of Afghanistan. “Today health for all, justice for all and education for all are the motto of all of us, but in action, we’re facing with serious obstacles to implement such mottos,” Danesh said, stressing on balanced development in health sector as Ministry of Public Pealth is provided with considerable national budget. He said that most of people even in areas like west of capital Kabul were deprived of proper health services as the people preferred to visit private hospitals for treatment, but their health services’ quality was also very low.
He also called for national participation in the public administrations and termed lack of national participation as one of the key causes of the gap between the government and the people in the country. He pledged that the NUG would take all the necessary measures to ensure national participation in the public administration. West of Kabul is unfortunately deprived of most of proper city services and has been sidelined,” Danesh said, adding that central institutions including municipality, education and water supply companies have failed to act upon their commitments, which caused distance the people and government.
As voiced by the second vice president, there are many objections in social media networks indicating huge differences between words and reality in terms of providing public services both in terms of inclusion and quality. As to health quality issues, people mostly choose to go the neighboring countries for serious health problems.  They normally choose to visit Pakistan and India for better medical facilities.  Few days ago, Tolonews showed a man from Balkh province taken a patient to Pakistan for treatment and kissed hand of Imran khan imploring to build a hospital in Afghanistan. In fact, it is big shame for the related ministries as their citizens are compelled to beg healthcare services from the neighbors.
Going abroad may be convenient for the ones who are financially strong or have a strong talent of begging, but others remain untreated and mostly neglected. It is really tragic for them as their own country cannot provide them even their basic rights. It can be said that from each five resident of Kabul at least one had travelled outside Afghanistan to seek the healthcare service they required.

However, both quality and quantity of healthcare services have improved in nearly last two decades but people expect as we could do better within this long period of time.  Specifically, they are not satisfied about the poor quality of public health system, including staff and services; lack of appropriate drugs; and an improperly functioning referral system. They reported that often they had to wait a long time to be treated or that health facilities were open during hours that did not correspond to medical needs.
Women and girls face more barriers to accessing proper and timely health services, both for themselves and their children. These include, due to low literacy rates, a lack of knowledge of health problems and practices and restrictions of their movement and their access to money. Usually Women need to be accompanied by a male, which doubles travel costs and makes the financial burden of accessing health services larger for women than for men.
Informal fees or corruption are another worrying problem, considering that costs pose an important barrier to access healthcare. People reported that they 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.
Consequently, the quality of public services is often distrusted, even if this is not always the case. Therefore, many people prefer private clinics, private doctors and eventually going abroad that are perceived to be better in terms of quality. While there are also reports of overprescribing, multiple price, misdiagnosing and even malpractice and medical mistakes by private practitioners. Many private providers seek to benefit from the bad reputation of the public sector and ask high fees for their services. It is therefore essential that public health facilities offer quality care as an accessible and affordable alternative.

Mohammad Zahir Akbari is the permanent writer of the Daily Outlook Afghanistan. He can be reached at mohammadzahirakbari@gmail.com

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