issues for consideration at the berlin donor conference ... - ReliefWeb

4 THE ROAD AHEAD
Barriers to Health Care for Women
Afghanistan’s culture and history have created particular constraints on already-strained efforts to
provide for women’s health. Many women are simply unaware that they now have access to health
care, after so many years without. Muslim tradition also dictates in favor of women being seen by
female doctors and nurses, but the majority of the country’s female health care practitioners left
during the Taliban regime. Only 40 percent of all BHCs presently have female staff. 17 Only 28
percent of facilities that provide maternal and newborn care employ a female health worker. 18
Challenges Ahead
The Afghan government has offered some means of addressing the present obstacles.
• The MoPH’s Interim Health Strategy calls for focusing all efforts in the sector on national
strategic priorities such as basic health services for Afghans living in rural communities. The
two-year program (2002-2004) is meant to ensure that donors are not tempted to fund high
profile tertiary care hospitals, which have less of an impact on vulnerable populations. 19
• The MoPH’s Health and Nutrition Sector Development Program lays out longer-term goals
in service provision. 20 The Afghan government aims to provide (through subcontractors)
maternal and infant health care, child health and immunization, nutrition, and vaccinations
for communicable diseases for the entire population in the next three to seven years.
Services will be delivered through health posts, basic health centers, comprehensive health
centers, and district hospitals.
The government’s program falls short in several areas.
First, the government and donors must prioritize paying reasonably competitive salaries for health care workers and
addressing the issue of “brain drain” in the health care profession. Government documents supporting the
NDF do not specifically address the “brain drain” issue as pertains to the health sector. The
government envisions that community health workers, many of whom will be working in rural areas,
will either work for free or be remunerated through community financing, 21 a system that is not
likely to be sustainable. Efforts since December 2001 to entice health care workers to return, such
as offering rent-free accommodations, have shown only modest success. 22 A more concerted effort
will be needed to help fill the dearth of qualified Afghan health care providers.
17 Dr. Ferozudeen Feroz, Remarks at Congressional Briefing, “Rebuilding Afghanistan’s Health System: What’s Next?”
December 11, 2002.
18 Health and Nutrition Technical Annex.
19 Ibid. As an example, Kuwaiti charities built a state-of-the-art, well-stocked hospital in 1999 in the rural Paktika
province, but it has never been used, for lack of trained professionals. See Pamela Constable, “Anti-Terror Efforts Put
Vise on Afghan Region,” The Washington Post, March 15, 2004, A16.
20 The Health and Nutrition Sector Development Program includes 5 areas: 1) Basic Package of Health Services, 2)
Special Programs, 3) Improving Quality of Hospital Services, 4) Human Resource Development, and 5) Administrative
Reform and Capacity Building. See Health and Nutrition Technical Annex.
21 Ibid.
22 “Working Draft: Assessing Subnational Administration in Afghanistan: Early Observations and Recommendations for
Action,” World Bank and Afghanistan Research and Evaluation Unit report, March 13, 2003,
(accessed
November 13, 2003).