Healthcare collapse in Afghanistan due to political crises, natural catastrophes, and dearth of international aid post-COVID

"It's different here" Afghan refugee maternal health experiences in the United States

BACKGROUND

The number of Afghan families in the US has grown over the past two decades, yet there is a paucity of research focused on their maternal healthcare experiences. Afghan families have one of the highest fertility rates in the world and typically have large families. As the US faces rising maternal mortality rates, it is crucial to understand factors that affect health outcomes for culturally distinct groups. We aimed to better understand Afghan women's maternal health experiences in South Texas as a step toward designing culturally sensitive care.

METHODS

Using a qualitative descriptive design, twenty Afghan women who gave birth in the US within the past 2 years participated in audio-recorded interviews. The first and second authors conducted each interview using a semi-structured interview guide. The authors used an in vivo coding method and qualitative content analysis of the transcribed narrative data.

RESULTS

We identified three broad categories with corresponding sub-categories: 1) Maternal Healthcare Experiences: pregnancy, birthing, and postpartum, 2) Communication: language barrier, relationship with husband, and health information seeking, 3) Access to Care: transportation and financing healthcare. The participants expressed perspectives of gratefulness and positive experiences, yet some described stories of poor birth outcomes that led to attitudes of mistrust and disappointment. Distinct cultural preferences were shared, providing invaluable insights for healthcare providers.

CONCLUSIONS

The fact that the Afghan culture is strikingly different than the US mainstream culture can lead to stereotypical assumptions, poor communication, and poor health outcomes. The voices of Afghan women should guide healthcare providers in delivering patient-centered, culturally sensitive maternity care that promotes healthy families and communities.

Exploring barriers to access to care following the 2021 socio-political changes in Afghanistan: a qualitative study

BACKGROUND

Following the change of government in August 2021, the social and economic landscape of Afghanistan deteriorated into an economic and humanitarian crisis. Afghans continue to struggle to access basic healthcare services, making Universal Health Coverage (UHC) in the country a major challenge. The aim of this study was to perform a qualitative investigation into the main access to care challenges in Afghanistan and whether these challenges have been influenced by the recent socio-political developments, by examining the perspectives of health professionals and hospital directors working in the country.

METHODS

Health professionals working in facilities run by an international non-government organisation, which has maintained continuous operations since 1999 and has become a key health reference point for the population, alongside the public health system, and hospital directors working in government hospitals were recruited to participate in an in-depth qualitative study using semi-structured interviews.

RESULTS

A total of 43 participants from ten provinces were interviewed in this study. Four issues were identified as critical barriers to achieving UHC in Afghanistan: (1) the lack of quality human resources; (2) the suboptimal management of chronic diseases and trauma; (3) the inaccessibility of necessary health services due to financial hardship; (4) the unequal accessibility of care for different demographic groups.

CONCLUSIONS

Health professionals and hospital directors shed light on weaknesses in the Afghan health system highlighting chronic issues and issues that have deteriorated as a result of the 2021 socio-political changes. In order to improve access to care, future healthcare system reforms should consider the perspectives of Afghan professionals working in the country, who are in close contact with Afghan patients and communities.

Access to care in Afghanistan after august 2021: a cross-sectional study exploring Afghans' perspectives in 10 provinces

BACKGROUND

The Taliban takeover in August 2021 ended a decades-long conflict in Afghanistan. Yet, along with improved security, there have been collateral changes, such as the exacerbation of the economic crisis and brain drain. Although these changes have altered the lives of Afghans in many ways, it is unclear whether they have affected access to care. This study aimed to analyse Afghans' access to care and how this access has changed after August 2021.

METHODS

The study relied on the collaboration with the non-governmental organisation EMERGENCY, running a network of three hospitals and 41 First Aid Posts in 10 Afghan provinces. A 67-item questionnaire about access to care changes after August 2021 was developed and disseminated at EMERGENCY facilities. Ordinal logistic regression was used to evaluate whether access to care changes were associated with participants' characteristics.

RESULTS

In total, 1807 valid responses were returned. Most respondents (54.34%) reported improved security when visiting healthcare facilities, while the ability to reach facilities has remained stable for the majority of them (50.28%). Care is less affordable for the majority of respondents (45.82%). Female respondents, those who are unmarried and not engaged, and patients in the Panjshir province were less likely to perceive improvements in access to care.

CONCLUSIONS

Findings outline which dimensions of access to care need resource allocation. The inability to pay for care is the most relevant barrier to access care after August 2021 and must therefore be prioritised. Women and people from the Panjshir province may require ad hoc interventions to improve their access to care.

Primary healthcare system and provider responses to the Taliban takeover in Afghanistan

INTRODUCTION

Existing health system challenges in Afghanistan were amplified by the Taliban's August 2021 government takeover during which the country faced an evolving security situation, border closures, banking interruptions, donor funding disruptions and international staff evacuations. We investigated factors that influenced health sector and health service delivery following the takeover.

METHODS

We purposively sampled individuals knowledgeable about Afghanistan's health sector and health professionals working in underserved areas of the country. We identified codes and themes of the data using framework analysis.

RESULTS

Factors identified as supporting continued health service delivery following August 2021 include external funding and operational flexibilities, ongoing care provision by local implementers and providers, health worker motivation, flexible contracting out arrangements and improved security. Factors identified as contributing to disruptions include damaged infrastructure, limited supplies, ineffective government implementation efforts and changes in government leadership and policies resulting in new coordination and capacity challenges. There were mixed views on the role pay-for-performance schemes played. Participants also shared concerns about the new working environment. These included loss of qualified health professionals and the associated impact on quality of care, continued dependency on external funding, women's inability to finish their studies or take on any leadership positions, various impacts of the Mahram policy, mental stress, the future of care provision for female patients and widespread economic hardship which impacts nearly every aspect of Afghan life.

CONCLUSION

Afghanistan's health sector presents a compelling case of adaptability in the face of crisis. Despite the anticipated and reported total collapse due to the country's power shift, various factors enabled health services to continue in some settings while others acted as barriers. The potential role of these factors should be considered in the context of future service delivery in Afghanistan and other settings at risk of political and societal disruption.

Contents of antenatal care services in Afghanistan: findings from the national health survey 2018

BACKGROUND

Maternal and newborn mortality is a public health concern in low- and middle-income countries (LMICs), including Afghanistan, where the evolving socio-political circumstances have added new complexities to healthcare service delivery. Birth outcomes for both pregnant women and their newborns are improved if women receive benefits of quality antenatal care (ANC).

OBJECTIVES

This study aimed to assess the contents of ANC services and identify predictors of utilization of services by pregnant women during ANC visits to health facilities in Afghanistan.

METHODS

In this cross-sectional study, we used data from the Afghanistan Health Survey 2018 (AHS2018). We included a total of 6,627 ever-married women, aged 14-49 years, who had given birth in the past 2 years or were pregnant at the time of survey and had consulted a health worker for ANC services in a health facility. The outcome was defined as 1-4 services and 5-8 services that a pregnant woman received during an ANC visit. The services were (i) taking a pregnant woman's blood pressure, (ii) weighing her, (iii) testing her blood, (iv) testing her urine, (v) providing advice on nutrition, (vi) advising about complicated pregnancy, (vii) advising about the availability of health services, and (viii) giving her at least one dose of Tetanus Toxoid (TT) vaccine. The binary outcome (1-4 services versus 5-8 services) was used in a multivariable logistic regression model.

RESULTS

Of all 6,627 women, 31.4% (2,083) received 5-8 services during ANC visits. Only 1.3% (86) received all 8 services, with 98.7% (6,541) receiving between 1 and 7 services, and 71.6% (4,745) women had their blood pressure measured during ANC visits. The likelihood (adOR = Adjusted Odds Ratio) of receiving 5-8 services was higher in women who could read and write (adOR = 1.33: 1.15-1.54), in women whose husbands could read and write (adOR = 1.14: 1.00-1.28), in primipara women (adOR = 1.42: 1.02-1.98), in women who knew one danger sign (adOR = 5.38: 4.50-6.45), those who knew 2 danger signs (adOR = 8.51: 7.12-10.19) and those who knew ≥ 3 danger signs (adOR = 13.19: 10.67-16.29) of complicated pregnancy, and in women who had almost daily access to TV (adOR = 1.16: 1.01-1.33). However, the likelihood of receiving 5-8 services was lower in women who used private clinics (adOR = 0.64: 0.55-0.74) and who received services from nurses (adOR = 0.27 (0.08-0.88).

CONCLUSION

Our findings have the potential to influence the design and implementation of ANC services of health interventions to improve the delivery of services to pregnant women during ANC visits.

Conducting Health Research in the Current Afghan Society: Challenges, Opportunities, and Recommendations

Research makes a significant contribution to academic excellence and holds the potential to facilitate societal development. Despite the increasing importance of health research in developing new therapies and galvanizing notable progress in public health, the landscape of health research in Afghanistan remains profoundly deficient. This article reveals that health research in Afghanistan requires significant growth to meet the standards set on regional and global grounds.