AFGHANISTAN HEALTH CARE SYSTEM (UNDERDEVELOPED)

Afghanistan’s healthcare system is on the brink of collapse, the World Health Organization warned in
early February 2022. After four decades of war, a persistent severe drought, the COVID-19 pandemic,
and the Taliban takeover in August 2021, the number of Afghans suffering from acute poverty and poor
health has increased substantially. Without funds to pay doctors and purchase medical supplies, the
remaining physicians and hospitals are unable to respond to the growing demand for medical services.
The International Rescue Committee (IRC) predicts over 90% of the country’s health clinics are expected
to shut down without adequate funding. In response to the crisis, the United States has revised its
sanction policy on the Taliban to allow the transfer of money to aid groups in Afghanistan (Reuters).

Ayesha, 29, is a midwife in a rural health facility in Afghanistan. She graduated from the provincial
midwifery school supported by the government’s Sehatmandi programme, which provides essential
primary care services including for maternal, newborn and child health.

“I was born in a very remote district where health facilities were not available. I witnessed many
pregnant mothers dying because there was no health care facility at my village or on the way to
hospitals, located more than 50 km away. I decided to become a midwife and serve the women and
children in the villages. I love my job and attend numerous institutional deliveries, and have contributed
to the reduction of maternal mortality,” said Ayesha.

However, these vital health services that save the lives of many in the community have come under
severe threat. The Sehatmandi programme is the backbone of Afghanistan’s health system, providing
care for millions of people through 2 331 health facilities. Since the Taliban gained power, major funding
for the programme has been withdrawn. As of 15 January 2022, the country has received funding to help
cover immediate needs for the early part of the year. More funds are needed to urgently fill remaining
gaps and to support the country’s health system in sustaining the delivery of essential services.

The primary care facility in the village is vital, serving 58 000 people including 13 340 women of
childbearing age and 11 600 children under-five. Importantly, it provides emergency obstetric care,
including Caesarean section services. Without this, women would have to travel far, and put themselves
and their babies at risk.

Due to a lack of funding, staff in the health facility have not received their salaries for months, the clinic
is faced with shortages of medicine and supplies, and patients are not able to access the essential health
services they need. If this facility closes down, increasing ill health and mortality is inevitable. The
facility’s struggles are not unique.
Primary health care under threat

The situation is replicated across the country because the Sehatmandi programme is no longer able to
receive appropriate financial support due to the change in Afghanistan’s government. In August 2021,
when the Taliban took over Kabul, donors found it impossible to provide financing through the new
regime, and major funding was withdrawn. Previously funded by the World Bank, the European
Commission, and USAID, there are now serious challenges to continuing these vital primary health care
services.

The population Is also suffering due to a recent drought that has affected crops and livestock. This,
combined with rising food prices and the collapse of public services, led to acute food insecurity for
nearly 19 million people in September and October 2021.

Urgent call for international support

For two decades in Afghanistan, life expectancy has risen, and maternal, newborn and child deaths have
dramatically decreased. Today, the population’s health is seriously under threat. All the progress in
health outcomes may be lost. WHO is urgently calling for international donors to step up and find an
alternative funding mechanism for this crucial primary health care initiative.

“The recent funding pause by key donors to the country’s biggest health programme (Sehatmandi) will
cause the majority of the public health facilities to close. As a result, more mothers, infants and children
will die of reduced access to essential health care. WHO is determined to work with partners in
identifying a sustainable solution with the support of donors to maintain and scale up the lifesaving
interventions when needed in the country,” said Dr Luo Dapeng, WHO Representative in Afghanistan

While it may be challenging to find alternative and innovative ways to support the Sehatmandi
programme, it is essential for the health and lives of the population of one of the poorest countries in
the world and for health security globally.

KABUL CRISES

Echoing that message from the Afghan capital, Kabul, WHO Director-General Tedros Adhanom
Ghebreyesus said that international funding cuts had forced health providers to decide “who to save and
who to let die”.

After meeting senior Taliban figures, medical professionals and patients, Tedros explained that a lack of
financial support for the country’s largest health project, Sehetmandi, had left thousands of facilities
unable to buy medical supplies and pay salaries.
Fewer than one in five of the country’s Sehetmandi facilities remained open, the WHO chief explained,
although he said that access to all communities was “no longer impeded”.

Medicine shortages

“This breakdown in health services is having a rippling effect on the availability of basic and essential
health care, as well as on emergency response, polio eradication, and COVID-19 vaccination efforts,”
Tedros said, amid reports that cold chain medical storage has been compromised.

COVID-19 risk

The WHO chief also noted that nine of 37 COVID-19 hospitals have already closed, and that “all aspects”
of the country’s COVID-19 response have dropped off, from surveillance to testing and vaccination.

• No child or mother should suffer and die from preventable causes. Yet, Afghanistan remains one of the
most dangerous places in the world to be a baby, a child or a mother, and access to a hospital or health
facility is beyond the reach of most. The country has one of the highest infant mortality rates in the
world and thousands of Afghan women die every year from pregnancy-related causes, a majority of
which can be easily preventable.

Although present conditions are improving, and many more children are living past infancy, in 2018, 4
out of 10 Afghan children died before their first birthday. While this is a significant drop since 1990, far
too many families are unnecessarily losing their children, especially during the neonatal period. The
majority of these deaths can be prevented with timely and adequate care, and treatment, as well as
healthy beahviours.

Children and mothers need access to quality community-based healthcare and comprehensive
emergency obstetric and newborn care at district and provincial hospitals. This is critical in the first days
of a child’s life and during a mother’s labour and delivery, particularly for women who have complicated
pregnancies. Up to the age of five, and especially in the first weeks and months of a child’s life,
protection against preventable illnesses is critical. Low immunization levels among poor and
marginalized children compromise gains made in all other areas of maternal and child health

Adolescents (ages 10-19), who make up 40 per cent of the population in Afghanistan, face tremendous
challenges in meeting their sexual reproductive health needs. Despite advances in gender equality over
the last decade, and according to the 2020 Human Development Report, Afghanistan ranks 169 on the
Gender Inequality Index (GII) – among the least favorable scores, reflecting high levels of inequality in
reproductive health, women’s empowerment, and economic activity. This affects their ability to reach
their full potential and contributes to the high maternal mortality ratio of 638 per 100,000 live births.

MAJOR DISEASE
Cancer

Around 15,000 Afghans die annually from various types of cancer.

Congenital heart defect

As of early 2023, as much as 11,000 Afghan children are said to be affected by the treatable disease
known as congenital heart defect, which is commonly referred to as hole in the heart.

Crimean–Congo hemorrhagic fever (or simply Congo fever) has been reported in the country in recent
years.

Hepatitis A

Sanitation issues place the Afghanistan population at risk of contracting hepatitis A through the
consumption of food and water that has been contaminated by fecal material. Hepatitis A works by
inhibiting the liver from functioning properly. Symptoms generally include jaundice, fatigue, loss of
appetite, while some victims may experience diarrhea. Furthermore, symptoms will appear 2–6 weeks
after an individual has come into contact with the hepatitis A virus.

Hepatitis C

Hepatitis C virus (HCV) is a blood-borne pathogen associated with several morbidities and mortality.The
state of the infection remains poorly understood in most MENA countries including Afghanistan.

HIV

The prevalence of HIV in Afghanistan is 0.04%. According to Afghanistan’s National Aids Control Program
(NACP), 504 cases of HIV/AIDS were documented in late 2008.By the end of 2012, the numbers reached
1,327. Afghanistan’s healthy ministry stated that most of the HIV patients were among intravenous drug
users and that 70% of them were men, 25% women, and the remaining 5% children.

Time People with HIV

1990 600

1995 1300

2000 1900

2005 2000
2011 5800

Leishmaniasis

Leishmaniasis is estimated to cause the ninth largest disease burden among infectious diseases
worldwide and it is not preventable by vaccination or chemoprophylaxis, but only by personal protective
measures preventing bites of infectious arthropod vectors.

Leprosy

Despite anti-leprosy initiatives by Leprosy Control (LEPCO) dating to 1984, leprosy is present in
Afghanistan, with 231 cases reported in the 2001-2007 period. Just over three-quarters of the cases
were the MB-type, with the rest PB-type

Malnutrition

More than half of Afghan girls and boys experience permanent mental and physical damage because
they are poorly nourished in the crucial first two years of life. High levels of malnutrition in Children is
rate of stunting 60.5%, One third of children (33.7%) underweight, Anaemia 50% in children 6–24
months, 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.

Maternal Mortality

Afghanistan has long been one of the countries that deal with high maternal mortality cases.initially,
having one of the highest maternal mortality rates in the world at 1640 per 100,000 in 1980 to 400 per
100,000 in 2013.

Time Maternal Mortality

1980 1640

1988 1280

1996 1180

2004 792

2013 400

2017 638

Measles

Measles killed over 380 children in Afghanistan in 2022.Approximately 75,000 people suffer from the
disease. Vaccinations against the disease is ongoing.
•Among its operations in Afghanistan, WHO supports an extensive trauma programme that includes
training, the provision of supplies and equipment for 130 hospitals and 67 blood banks.

COVID-19 vaccine challenge

Data from WHO indicated that before the Taliban takeover on 15 August, 2.2 million people had been
vaccinated against the new coronavirus in Afghanistan.

“In recent weeks, vaccination rates have decreased rapidly while 1.8 million COVID-19 vaccine doses in
country remain unused,” Tedros said. “Swift action is needed to use these doses in the coming weeks
and work towards reaching the goal of vaccinating at least 20 per cent of the population by the end of
the year.”

The WHO top official also urged renewed action to eradicate polio in Afghanistan – one of two countries
where the disease remains endemic.

Measles is also spreading, the WHO Director-General warned, but he said that access to all communities
was now possible. “With only one case of wild poliovirus reported so far this year, compared to 56 in
2020, there has never been a better time to eradicate polio,” Tedros said. “However, the polio
programme will struggle to respond if the basic immunization infrastructure begins to collapse around
it.”

This meant that WHO and partners can begin a country-wide house-to-house polio vaccination
campaign, combining measles and COVID vaccination too, he explained.

95 per cent of Afghan families going hungry

Rising job losses, lack of cash and soaring prices are creating a new class of hungry in Afghanistan, the
United Nations World Food Programme (WFP) warned on Wednesday, with urban residents suffering
from food insecurity at similar rates to rural communities, for the first time.