Access to Care for Mental Health Problems in Afghanistan: A National Challenge.

Viviane Kovess-Masfety,Elie Karam,Ajmal Sabawoon,Bashir Ahmad Sarwari,Katherine Keyes

doi:10.34172/ijhpm.2021.46

Abstract

This paper describes the access to care for mental health problems in Afghanistan, according to the nature of the mental health problems and the service provider. Following the Andersen model, it evaluates the respective roles in access to care of "predisposing," "needs," "enabling" factors, and other "environmental" factors such as exposure to traumatic events and level of danger of the place of residence. Trans-sectional probability survey in general population by multistage sampling in 16 provinces, nationally representative: N=4445 (15 years or older), participation rate of 81%. Face to face interviews using standardized measures of mental health (CIDI, Composite International Diagnostic Interview). Different logistic regression models are presented. The 12-month rate of mental health help-seeking was 6.56% with substantial regional variation (2.35% to 12.65%). Providers were mainly from the health sector; the non-health sector (religious and healers) was also prevalent. Most consultations were held in private clinics (non-governmental organisation, NGO). The severity of mental health disorders as well as the perceived impairment due to mental health were independently very important: odds ratio (OR) = 6.04 for severe disorder, OR=3.79 for perceived impairment. Living in a dangerous area decreased access to care: for high level of danger and for very high level: OR=0.22. Gender, education and ethnicity were not associated with mental health help-seeking after controlling for exposure to trauma. Access to care for mental health problems depended mainly on the needs as defined as disorder severity level and impairment, and on environmental factors such as exposure to traumatic events. The system seems equitable; however, this is counterbalanced by a very challenging environment. This survey is a testimony to the hardship experienced by the Afghan population and by health professionals, and to the efforts to deliver organized mental healthcare in a challenging situation. This research may inform and support policy-makers and NGOs in other countries undergoing similar challenges.

Highlights

Mental disorders are important contributors to the global burden of disease.[1,2] They cause personal distress and carry major consequences in the functioning of daily life
Description of Access to Care and Care Providers by Mental Health Problem Among those who ever sought help, 1.18% declared either “self-help,” “somebody who was a family member or a friend,” or “other.” If the latter was the only type of help sought, it was considered that help was not sought
Globally, mental health services in Afghanistan appeared relatively accessible, at least at the same rate as in low middle and high middle countries and with no difference concerning sex, education or income, whereas needs for care were the main determinants of help seeking

Summary

Introduction

Mental disorders are important contributors to the global burden of disease.[1,2] They cause personal distress and carry major consequences in the functioning of daily life. Lowand middle-income countries are the least able to bear the burden of population morbidity in general, including mental disorders, due to factors including funding, governmental resources, and awareness.[3] In Afghanistan, years of armed conflicts rendered health systems disorganized[4] and disproportionally affected the mental health system.[5]. Afghanistan, similar to many developing countries, has few mental health specialized resources. An important part of the mental healthcare system belongs to the private sector: many nongovernmental organisations (NGOs) operate in Afghanistan. An important part of the mental healthcare system belongs to the private sector: many nongovernmental organisations (NGOs) operate in Afghanistan. under the supervision of the Ministry of Health, but this renders the system fragile and hard to control in a vast and diverse country

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Discussion

Conclusion