Over the past ten years, health care has improved in Afghanistan. Life expectancy has increased and lower child and maternal death rates mean that better health care has had an impact. Basic health services are organised by province in Afghanistan and SCA is responsible for all the primary health care for more than one million people in two provinces, Wardak and Laghman.
In spite of this good news, indicators show that the health situation is still among the worst in the world. Health care is uneven between town and country areas; bad roads, long distances and the security situation mean that many people cannot get to the health care that actually does exist. Women, children and people with disabilities have the most problems. People have limited knowledge of health and hygiene, and where to go for health care. Lack of safe drinking water is a serious problem, often leading to diarrhoea and dehydration and young children are affected the worst, diarrhoea being the most common cause of death for children under five.
Women, children, people with disabilities and rural communities are an SCA priority and these groups have the same rights to health as everyone else. In Wardak and Laghman Provinces, SCA works in hospitals and health centres as well as in a large number of health posts close to people in country areas.
Women often cannot go to healthcare because of the serious shortage of trained female health staff, so SCA runs three schools for midwives and two for nurses in Wardak, Laghman and Samangan. After two years of studies, these young women return to their home areas to work as midwives with SCA or other organisations in their communities. The midwife schools trained 70 students in 2015 and in September, 38 nurses graduated from Wardak, the majority immediately starting work at SCA. SCA also supports the Afghanistan Midwives’ Association as they mentor midwives which has strengthened both the association and the midwife profession generally. This has also led to increased demand for midwifery services; an important development when the goal is to cut maternal deaths.
Information saves lives
One strategy used to improve knowledge about health and hygiene, nutrition and safe drinking water is to give out health information on as many different occasions as possible; in training inputs, in waiting rooms, in schools. Any time a patient visits health care, this is a chance to raise their awareness. One effect is that parents take their children for treatment at an earlier stage. Through community health councils and family groups, SCA gradually improves people’s knowledge of preventive health care. Radio spots and learning-for-healthy-life classes, which combine literacy and health information, also help towards this goal.
But information alone is not enough. SCA cooperates with community development councils to drill wells for safe water and improve the quality of drinking water by reducing waste at water points and by building latrines.
Accessible to all
People with disabilities are often less healthy than others and receive less care because they do not understand that they have rights and what can actually be done. SCA aims to change this through information on the radio and on television and by ensuring that this group are represented on, and planned for, by community health councils. SCA also trains its health staff to make sure that people with disabilities get proper treatment and are not discriminated against.
Gender based violence
In 2015, the Afghan Ministry of Public Health and the World Health Organisation announced that doctors, nurses and midwives are to be trained to deal with gender-based violence. This initiative covers all the country's 34 provinces and the goal is to increase knowledge about victims of gender-based violence. This year, 24 male and 12 female health staff were trained for this programme at SCA clinics.
Teachers employed at SCA community-based schools have started voluntary training to become health promoters. The 54-day training programme is run according to guidelines from the Afghan Ministry of Public Health. The teachers will, in addition to giving health-related information to students and parents, act as a link between the school and the nearest clinic.
Progress made last year
The proportion of children under five who needed treatment for diarrhoea at SCA clinics and hospitals decreased from 12% to 7% compared to last year. This is a large number and developments in this field must be monitored closely. Exactly why this has happened is unclear, but the decrease is very welcome and in line with the SCA information campaigns in Wardak and Laghman about the importance of safe water and hygiene.
As SCA and other organisations train midwives and put them to work, maternal deaths have decreased in Afghanistan. The number of births assisted by trained SCA personnel in Wardak and Laghman increased by 6% in 2015.
Early detection of illness means patients recover more quickly and resources are used more efficiently because each patient needs less treatment. Better coordination between SCA programmes for health and education, and shared goals, meant that more students could to undergo health checks. Improved awareness in community health shuras led to more patients being referred to SCA clinics and workshops to get orthopaedic help such as prostheses, braces, crutches or wheelchairs.
A study of health council capacity in Laghman and Wardako and a study of the accessibility of health facilities were made. SCA started a study on knowledge, attitudes and practices related to health in 2015, however the security situation made it impossible to proceed. Hopefully it will be resumed in 2016.
Construction at provincial hospitals and the two new emergency wards do not fulfil the needs of people with disabilities. This was mainly due to lack of coordination, but may also show that not even SCA is yet able to consider the rights of this group in their planning. A team has been formed tasked to coordinate major construction works so this does not happen in the future.
In 2015, there were only 10 female doctors at SCA, although the goal was 26. There were 101 male doctors compared to the goal of 57. The main reason is that female doctors in Laghman got jobs at private clinics in Jalalabad as the security situation is better there than in the areas where SCA works. This impacts women’s right to health care as a female doctor is often a requirement.
Strengthening community health councils is a priority, but making sure they represent the wider community is a challenge. Although more women do participate in the councils, cultural barriers and the security situation are not good enough excuses for the fact that men outnumber women five to one.
Representation of people with disabilities is even lower although some progress was made. One important SCA objective is to increase inclusion and participation and counteract prejudice.