Rough roads to better care

Abstract

Mohammad Qasim, a portly man from southern Afghanistan, has criss-crossed some of the most dangerous terrain on earth in search of a cure for his haemorrhoids. Sitting on a hospital bed in Kabul, the Afghan capital, he explained how he had travelled down dirt roads dotted with homemade mines to see doctors capable of treating his condition. It's a big problem for me, he says. A lot of people with this problem haven't been cured and now they're in big pain. am trying to solve it before it gets that bad. At clinic after clinic Qasim says doctors prescribed pills that had no effect, or left him feeling worse. From his home of Gereshk he went south to the provincial capital of Lashkar Gah. From there he made the difficult 500 kilometre overland journey to Kabul, and back again. He is now in Kabul a second time, about to undergo surgery after various medications have failed to ease the pain. I took a lot of pills, he says. Now I'm just trying to be careful with my diet. He reckons he has spent around US$ 200 on tablets, doctor's fees and transport--the equivalent of three months' pay. lengths to which Qasim has gone may seem extreme, but many Afghans venture back and forth across their ravaged country to seek medical attention. In the same hospital in Kabul was a man from the suburbs of the northern province of Takhar, who had made the day-and-a-half journey across the backbone of the Hindu Kush to get orthopaedic treatment. [ILLUSTRATION OMITTED] Another patient had spent the past month travelling between Kabul and his home in Ghazni province--along one of the country's most dangerous highways--for an operation, and then further care after complications set in. In the southern city of Kandahar, one person interviewed derided the regional hospital as a place you go to if you want to die. 60% of patients in the Pakistani city of Quetta are said to be Afghans who prefer travelling abroad to making do with the health-care facilities at home. Since the overthrow of the Taliban regime in 2001 and the ensuing flood of aid money, the Afghan government and donors have established a nationwide health-care system almost from scratch. government has contracted nongovernmental organizations to provide a basic package of services in areas that it cannot cover. This arrangement has left the government and more precisely the Ministry of Health to focus on a stewardship role that involves policy and strategy setting, coordination, contract management and monitoring and evaluation. Despite its flaws, health-care experts say the funding and delivery of health care in Afghanistan have taken remarkable strides over the past few years. Merlin is a nongovernmental organization that delivers health services to people living in inaccessible regions, such as Badakhshan province in north-eastern Afghanistan. The gains ... have been fantastic, says Ben Mascall, country director for Merlin. Some of the people we reach have never seen a doctor before, he says. Although some serious medical conditions require treatment that is not available, the presence of basic community clinics helps limit out-of-pocket expenses for minor complaints. Although there have been enormous gains, Dr Abdul Wall Ghayur, from the Ministry of Public Health, admits that all measures, the people of Afghanistan fare far worse, in terms of their health, than any other country of the region. He also claims that the services delivered to the population over the last six years have increased substantially with impressive results. Now attention should be paid to improve the quality of the Basic Package of Health Services, improve hospital and referral systems and initiate partnerships with private providers in the hospital sector to make sure the health problems are addressed. This will require sustained efforts of all partners. Financing for the health system comes from three main sources: external funding from donors, public funding from the government and out-of-pocket spending by patients. …