Primary Health Care in Afghanistan

Afghanistan is a landlocked and mountainous country, the country shares its border with six different countries, namely, Pakistan, Iran, Tajikistan, Uzbekistan, Turkmenistan, and China. The longest country to border Afghanistan is Pakistan (at 2,430 kilometers), whereas the smallest is China (at 76 kilometers) . The majority of the population lives in the most remote rural and mountainous areas. The primary health care system has similar problems to other civil sectors of the country due to the last three decades of war. Consequently, most people in the provinces of Afghanistan do not have access to primary health care due to lack of professional health care, hospitals, clinics, poverty, and finally lack of road infrastructure from one province to another province. The Afghan government tried to solve this problem by creating and implementing the Basic Package Health Service (BPHS) and later the Essential Package Health Service (EPHS) which were designed after the fall of Taliban regime in 2001. These programs represent important elements in the development of the health care system of Afghanistan in order to deliver primary health care services to Afghans in every part of the country. However, many obstacles exist that prevent the complete implementation of these programs throughout country. In the author’s experience as a medical student in 2008 in 10 hospitals in Kabul, there is lack of security, hospitals, medical equipment, and basic diagnostic and treatment services. In addition, the staffs are poorly managed and there is poor coordination between hospital systems, limited financial resources, and lack of professional personnel, especially female health care workers. In order to solve these problems, the Afghan government must build hospitals in remote areas and allocate enough funds for the health sector in rural areas. In addition, it should provide short-term and long-term training for women in nursing and midwifery in the provinces of rural areas, and provide management training for all new graduate doctors throughout the country. This training should be conducted by the Ministry of Public Health of Afghanistan with the help of national and international experts in health management and leadership. The long-term goal of quality primary health care for all Afghans requires the combination of specific factors including foreign aid, physician specialties, and time. Hiring and engaging more health care workers in remote areas will allow Afghan citizens in rural areas to have access to professional medical care. In addition, The Ministry of Public Health needs to identify problems that professional medical personnel are experiencing, and it needs to establish coordination between the hospitals and Non-Governmental Organizations (NGO). Development of good leadership and a management system for all the hospitals in the country is the solution to implement these programs successfully in urban and rural areas of Afghanistan