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Lamberti-Castronuovo A, Valente M, Bocchini F, Trentin M, Paschetto M, Bahdori GA, Khadem JA, Nadeem MS, Patmal MH, Alizai MT, Miccio R, Ragazzoni L. Exploring barriers to access to care following the 2021 socio-political changes in Afghanistan: a qualitative study. Confl Health 2024; 18:36. [PMID: 38658962 PMCID: PMC11044283 DOI: 10.1186/s13031-024-00595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024] Open
Abstract
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.
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Affiliation(s)
- Alessandro Lamberti-Castronuovo
- CRIMEDIM, Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Via Lanino 1, Novara, 28100, Italy.
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, 13100, Italy.
- EMERGENCY NGO ONLUS, Milan, 20122, Italy.
| | - Martina Valente
- CRIMEDIM, Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Via Lanino 1, Novara, 28100, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, 13100, Italy
| | | | - Monica Trentin
- CRIMEDIM, Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Via Lanino 1, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
| | | | | | | | | | | | | | | | - Luca Ragazzoni
- CRIMEDIM, Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, Via Lanino 1, Novara, 28100, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, Vercelli, 13100, Italy
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Valente M, Lamberti-Castronuovo A, Bocchini F, Shafiq Y, Trentin M, Paschetto M, Bahdori GA, Khadem JA, Nadeem MS, Patmal MH, Alizai MT, Barone-Adesi F, Miccio R, Ragazzoni L. Access to care in Afghanistan after august 2021: a cross-sectional study exploring Afghans' perspectives in 10 provinces. Confl Health 2024; 18:34. [PMID: 38649938 PMCID: PMC11034132 DOI: 10.1186/s13031-024-00594-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
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.
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Affiliation(s)
- Martina Valente
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, via Bernardino Lanino, 1, Novara, 28100, Italy.
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, via Duomo, 6, Vercelli, 13100, Italy.
| | - Alessandro Lamberti-Castronuovo
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, via Bernardino Lanino, 1, Novara, 28100, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, via Duomo, 6, Vercelli, 13100, Italy
| | | | - Yasir Shafiq
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, via Bernardino Lanino, 1, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, via Solaroli, 17, Novara, 28100, Italy
- Department of Community Health Sciences and Centre of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, Pakistan
| | - Monica Trentin
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, via Bernardino Lanino, 1, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, via Solaroli, 17, Novara, 28100, Italy
| | | | | | | | | | | | | | - Francesco Barone-Adesi
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, via Bernardino Lanino, 1, Novara, 28100, Italy
- Department of Translational Medicine, Università del Piemonte Orientale, via Solaroli, 17, Novara, 28100, Italy
| | - Rossella Miccio
- EMERGENCY ONG ONLUS, via Santa Croce, 19, Milan, 20122, Italy
| | - Luca Ragazzoni
- CRIMEDIM - Center for Research and Training in Disaster Medicine, Humanitarian Aid and Global Health, Università del Piemonte Orientale, via Bernardino Lanino, 1, Novara, 28100, Italy
- Department for Sustainable Development and Ecological Transition, Università del Piemonte Orientale, via Duomo, 6, Vercelli, 13100, Italy
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