Poor quality drug imports and an acute shortage of medical professionals and facilities are the bane of health care in Afghanistan.
More than 60,000 people travel out of the country for medical treatment every year spending some 3 million USD.
At the inauguration of an emergency ward in Jamhoriat Hospital, Kabul, Minister of Public Health Ferozuddin Feroz admitted people were suspicious of the quality of health care available in the country. He said 70 percent of CT scans and MRIs in “government and non-governmental” facilities were unreliable.
A rough calculation of expenditure in the health sector reveals that the government pays barely 6 percent of the cost of people’s treatment. While 21 percent is from international aid, patients pay the remaining 73 percent.
There are all kinds of reasons why people go abroad for treatment. Take Shrullah from Nangarhar province who has taken his father for treatment to Pakistan. He says doctors had correctly diagnosed his father’s condition in Nangarhar but the medicines that were available in Afghanistan were not effective. “Doctors told me the medicines imported by Afghanistan were of poor quality, and the same drug bought in Pakistan would make my father feel well,” he says.
Dr Haidar Niazai at the pharmacy faculty in Kabul University says provinces on the border like Nangarhar are the worst affected by spurious drugs. Smuggling in expired medicines is rampant along the porous borders. Doctors in remote areas, where there are no checks, are involved in supplying patients with expired and poor quality medicines, according to Dr Niazai. “They earn a lot of money because people don’t know that the doctor cheated them and sealed poor quality medicines in plastic bags,” he says.
He urges the government to set up a laboratory for drug testing. Minister Feroz has promised to make it a priority. In fact, the minister has promised to reform the health sector. He is strongly disapproving of foreign assistance for health care. The money goes mainly in paying the salaries of expatriate advisors, he avers.
He is also hoping to sign a memorandum of understanding with his Pakistani counterpart on the quality of drugs being exported to Afghanistan. There are an estimated 300 pharmaceuticals companies selling in Afghanistan.
A look at the situation in some provinces.
The district of Zazi Maidan in Khost province is on the border with Pakistan. While there are no complaints about the security situation, people suffer from lack of access to health facilities. There is only one small clinic, which cannot meet anything but basic needs, and patients have to be taken across the border to hospitals in Parschenar and Korma in Pakistan. People in the district complain there has been no improvement in health care in the last 14 years.
Padshamir, a tribal leader in the district, says the provincial government has not kept the promise to build a 50-bed hospital in the district. According to him, people who go to Pakistan face numerous problems. “The local police bother us without any reason,” he says. “Any pretext is enough to harass us, and we are tired of the situation,” he adds.
Akbar, a village headman in the district, says there isn’t a single female doctor.
Health centres are few and far between in the province. People told Killid reporter Esmail Larwai that there are not enough female community health workers. The province has only four female doctors and 40 midwives.
People in Ahmad Abad and Zurmat districts remember three cases of women dying in child birth because there were no mid-wives in health centres. “They would have lived had there been midwives,” says Gulab Khan from Zurmat district. He believes many midwives may be registered but they do not attend to their duties.
Meanwhile, Ahmadullah from Ahmad Abad district says female health workers are an absolute necessity in health centres.
Midwives are present at the time of delivery nearly everywhere in the province, says Killid reporter Mohammad Eshaq Akrami. Aziza Ahmadi, acting director in the women’s affairs directorate says the districts of Saighan, Kahmard, Waras and Charborj of Yakawlang are covered. There are 99 health centers in Bamyan, one provincial hospital and three district hospitals. However, there are no female doctors attending many of the health centres.
Mohammad Aref Noori, Killid reporter, says people in the province have many complaints against doctors in public hospitals. Take Gulab Khan from Waghaz district. He says he took his ill brother to Ghazni provincial hospital but had to wait for more than one month for a surgery. Hasanullah from Qarabagh district says that his son was bitten by a rabid dog. When he rushed him to the government hospital, doctors kept him waiting for many hours and he was forced to go to a private hospital for anti-rabies treatment.
Hospital authorities in Ghazni and other districts reject these complaints and say the staff are doing their best under very trying circumstances.
Abdul Qader Akhundzada, formerly a lecturer in the medical faculty of Nangarhar University says there is a crisis in health care; there is a shortage of staff and equipment while accessibility is an issue in remote areas. “People die of treatable illnesses like tuberculosis, asthma and pneumonia,” he says. “Polio has not been eradicated and stress is also a killer.”
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