Digital and Economic Determinants of Healthcare in the Crisis-Affected Population in Afghanistan: Access to Mobile Phone and Socioeconomic Barriers.

Jin-Won Noh,Jiho Cha,Min Hee Kim,Kyoung-Beom Kim,Yu-Mi Im,Young Dae Kwon

doi:10.3390/healthcare9050506

Abstract

Despite recent progress in Afghanistan’s health system from the support of international donors and NGOs, protracted conflicts combined with a series of natural disasters have continued to present substantial health risks. Extreme poverty has still aggravated social determinants of health and financial barriers to healthcare. Little is known about the context-specific factors influencing access to healthcare in the crisis-affected population. Using a subset of data from ‘Whole of Afghanistan Assessment (WoAA) 2019’, this study analyzed 31,343 households’ data, which was collected between 17 July and 19 September 2019 throughout all 34 provinces in Afghanistan. The outcome measured was access to care in the healthcare facility, and multivariable binary logistic regression models were used to identify the specific factors associated with access to healthcare. Of 31,343 households exposed to complex emergencies in Afghanistan, 10,057 (32.1%) could not access healthcare facilities when one was needed in last three months. The access to healthcare was significantly associated with displacement status, economic factors such as employment status or total monthly income, and the distance to healthcare facilities. Significant increase in healthcare access was associated with factors related to communication and access to information, such as awareness of humanitarian assistance availability and mobile phone with a SIM card, while disability in cognitive function, such as memory or concentration, was associated with poorer healthcare access. Our findings indicate that the crisis-affected population remains vulnerable in access to healthcare, despite the recent improvements in health sectors. Digital determinants, such as access to mobile phone, need to be addressed along with the healthcare barriers related to poverty and household vulnerabilities. The innovative humanitarian financing system using mobile communication and cash transfer programs would be considerable for the conflict-affected but digitally connected population in Afghanistan.

Highlights

Despite a fragile economy and an infrastructure devastated by decades of conflicts and instability, Afghanistan’s health system has made significant improvements in recent years [1,2,3]
Socioeconomic factors included highest education level achieved by household members, literacy, employment status, total monthly income, total debt, bank account, and phone with a subscriber identification module (SIM) card in household
For the distance to health care center, 77.8% of households were within a 5 km radius of healthcare facilities

Summary

Introduction

Despite a fragile economy and an infrastructure devastated by decades of conflicts and instability, Afghanistan’s health system has made significant improvements in recent years [1,2,3]. Since 2003, the Ministry of Public Health (MoPH) has strived to develop the healthcare system through the Basic Package of Healthcare Services (BPHS) and Essential Package of Hospital Services (EPHS) by contracting public health services with non-governmental organizations (NGOs) and a semiautonomous agency within the health ministry [1,5]. These packages have involved significant increases in the number of functioning primary health care facilities and the quality of care in publicly financed facilities, which have enabled the increase of health facility deliveries and in antenatal care from a skilled provider [1,6]. Standard clinical and administrative management have been provided to supply basic health care services [2,4,7]

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