Overview
Articles 52, 53, and 54 of the Afghan Constitution lay out the basic mandates and fundamental basis for health and related rights and services for the population of the country. The Ministry of Public Health (MoPH) is the lead state institution responsible for the health of the entire population. The MoPH structure at the central level currently has three deputy ministers, seven general directorates, and a number of directorates, departments, sections, and units. A number of other government ministries and agencies also implement activities that either directly or indirectly impact the health of the people. Development partners, non-governmental organizations (NGOs), professional associations, regulatory bodies, and the private sector are also key stakeholders in health.
To ensure rapid expansion of basic health services for the underserved and badly affected population after the collapse of the Taliban in 2001, the MoPH developed packages of basic services, called the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS). The comprehensive approach was intended to lay the foundations of a health sector that had the health of the people at its core. Out of the nearly 2,300 health facilities that comprise the core of the BPHS and EPHS strategy, all but the 34 hospitals in provincial capitals are BPHS facilities.
Aside from the public health sector, there is a large private sector. Given the very high out-of-pocket expenditure of 74 percent, private health providers are most common. Nonetheless, this sector is largely unregulated and informal. Despite past efforts, there is still a long way to go before sufficient regulations are enforced and synergies between the government and private sector are secured through effective public-private partnerships.
What happens if you need to see a doctor?
When you need to see a doctor, you have a choice of either going to a public or private hospital/clinic. Though we have public health facilities that provides free consultation, 60% of the health care load is taken up by the private hospitals. This is mainly due to lack of capacity and quality assurance, uncomfortable environment, and low quality health services in the public health sector. You need to pay for your medications in public hospitals, but there is a very low fee for diagnostic investigations and doctor consultation in public hospitals. Whenever you decide to go to a private hospital the patient needs to pay a high cost for all the services and medications.
Who decides what medicines a doctor can prescribe?
National medicine and health products regulatory authority, working under Ministry of Public Health, has the control over deciding what drugs can be prescribed by the doctors. However, there are national guidelines on when and how to prescribe specific drugs. It is largely based on the trainings that the doctors receive during their studies or otherwise.
Practically, what is it like to live with type 1 diabetes in Afghanistan?
Practically, there are many problems. Firstly, there is a lack of a comprehensive health facility which can treat diabetes and teach self-management. Because in Afghanistan, the public health system did not integrate non-communicable diseases. The ministry of health has launched a new package by the name of integrated health system in which diabetes is also included. Many people with type 1 diabetes really do not understand how to manage their day to day challenges. There are no well-funded support groups and no camping programs at community level.
In Afghanistan. 54% of peoples live under the poverty line and they do not have money for their three meals. The cost of insulin per vial may range from between $7 to $35. Therefore a lot of people cannot afford it. On average, if you want to use modern therapies with frequent blood glucose monitoring, you need to spend around $80 USD on insulin and an added $30 USD for blood glucose testing. For most people, this means that they will hardly have anything left to put towards food if they spend money on insulin and supplies. Most type 1s would likely only check their blood glucose every two months, or not at all. It is also extremely hard for the poor to get any healthy snacks or meals. Mostly they depend on on sugared tea to keep them going through the day.
What about getting admitted to hospital?
If you’re going to a public hospital, there is not enough beds and you will face a long wait time and other problems to get admitted. When you get admitted, the public hospitals will provide you some basic medications for free, but for other necessary medications you have to pay from your pocket. If you go to a private hospital where they have beds available at any time you will need to pay for your bed and all medications and other diagnostic interventions.
How does diabetes care vary throughout Afghanistan?
In Afghanistan we do not have any special treatment system and guideline for treatment of diabetes. Only in specialized and regional public hospitals can you find some basic treatments for diabetes. In primary health care we do not have any intervention for diabetes as described above. The other main problems is that in rural areas there are even less facilities and there are no female doctors in the public sector setting due to security problems.
All the above information is provided by Afghanistan NCD Alliance General Director Dr.M.Musa Shukoor. For further more information you can contact them at Afghanistan.ncd.Alliance@gmail.com.