TY - JOUR
T1 - Poverty, vulnerability, and provision of healthcare in Afghanistan
AU - Trani, Jean Francois
AU - Bakhshi, Parul
AU - Noor, Ayan A.
AU - Lopez, Dominique
AU - Mashkoor, Ashraf
N1 - Funding Information:
We would like to thank all the participants in this study, as well as monitors, supervisors and interviewers for their outstanding work in the field. We are grateful to Professor Nora Groce, Dr Maria Kett, Dr Ray Lang, Dr Veronique Alary and Nicki Bailey for their very useful and constructive comments along the way. We are also grateful to the three anonymous reviewers who made important suggestions to improve this paper. This study was funded by the European Commission, UNOPS/UNDP, UN Mine Action Center for Afghanistan (Voluntary Trust Fund), Handicap International, French Embassy and Swiss Agency for Development and Cooperation .
PY - 2010/6
Y1 - 2010/6
N2 - This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The 'scaling-up process' is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation.
AB - This paper presents findings on conditions of healthcare delivery in Afghanistan. There is an ongoing debate about barriers to healthcare in low-income as well as fragile states. In 2002, the Government of Afghanistan established a Basic Package of Health Services (BPHS), contracting primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled persons, and the poorest households. In 2005, we conducted a nationwide survey, and using a logistic regression model, investigated provider choice. We also measured associations between perceived availability and usefulness of healthcare providers. Our results indicate that the implementation of the package has partially reached its goal: to target the most vulnerable. The pattern of use of healthcare provider suggests that disabled people, female-headed households, and poorest households visited health centres more often (during the year preceding the survey interview). But these vulnerable groups faced more difficulties while using health centres, hospitals as well as private providers and their out-of-pocket expenditure was higher than other groups. In the model of provider choice, time to travel reduces the likelihood for all Afghans of choosing health centres and hospitals. We situate these findings in the larger context of current debates regarding healthcare delivery for vulnerable populations in fragile state environments. The 'scaling-up process' is faced with several issues that jeopardize the objective of equitable access: cost of care, coverage of remote areas, and competition from profit-orientated providers. To overcome these structural barriers, we suggest reinforcing processes of transparency, accountability and participation.
KW - Access to care
KW - Afghanistan
KW - Healthcare provider choice
KW - Perception of healthcare delivery
KW - Poverty
KW - Vulnerability
UR - http://www.scopus.com/inward/record.url?scp=77952546794&partnerID=8YFLogxK
U2 - 10.1016/j.socscimed.2010.02.007
DO - 10.1016/j.socscimed.2010.02.007
M3 - Article
C2 - 20359809
AN - SCOPUS:77952546794
VL - 70
SP - 1745
EP - 1755
JO - Social Science and Medicine
JF - Social Science and Medicine
SN - 0277-9536
IS - 11
ER -