Afghanistan has a long history of military conflicts, that had left its economy, infrastructure, and healthcare system far behind when compared to many other countries in the world. For the past 50 years, the country has seen the fall of several governments to religious fundamentalists, the Soviet invasion, and the intervention by Western powers.
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The country exists in a state of guerrilla war between foreign anti-terrorist forces and various mujahedeen formations located in the mountains of Afghanistan, which contributes to the already difficult healthcare situation in the country. The people frequently suffer from various healthcare hazards, ranging from diseases to a lack of heat, medicine, and clean water. The purpose of this paper is to evaluate eight healthcare determinants for the population in Afghanistan, including age, gender, socioeconomic status, environment, education, access to healthcare, the burden of disease, and the economy.
Main Healthcare Determinants in Afghanistan
There are eight main healthcare determinants, which are universally used to assess the state of the civilian population in regards to healthcare. These determinants are often interconnected, with one or several factors influencing one another, typically in a negative way. For example, age and gender have a direct impact on education and socioeconomic status. The majority of Afghanistan is governed by Sharia law, which severely restricts women and girls in terms of both labor and education. Socioeconomic status, in the condition of scarcity, is directly affecting access to healthcare. The ability to give birth puts women in greater danger associated with maternity.
Geography and proximity to relief centers also have a direct effect on all eight determinants of healthcare. In the following paragraphs, we will analyze each of these determinants separately and identify how they affect the healthcare situation in Afghanistan.
Age is one of the large healthcare determinants, which affects a multitude of parameters. Diseases and other healthcare threats differ from one age group to another. Children are more predisposed to viral infections and traumas due to having underdeveloped immune systems as well as smaller and weaker bodies. Coincidentally, elders suffer from a variety of healthcare issues associated with old age. Fractures and falls present significant challenges to them, especially when society does not account for low-mobility individuals. Adult patients of both genders are more likely to contract work-related diseases and traumas.
In Afghanistan, age plays a crucial role, affecting nearly all other healthcare determinants. Around 48% of the entire population is comprised of children aged 15 and under, meaning that the country is experiencing severe shortages in the adult workforce (Mansoor et al., 2016). As a result, children become more exposed to various hazards, such as child labor, early pregnancies, and violence. Children are expected to play a socioeconomic role, which they are not ready to fulfill due to poor physical development, underwhelming education, and a lack of experience.
Gender is an intrinsic healthcare factor that determines a person’s predisposition towards certain diseases and health hazards. Due to differences in physiology, men and women have different predispositions to cancer, diabetes, heart diseases, and various sex-related issues. The process of childbirth presents a major healthcare hazard for women, especially in rural areas with the absence of adequate healthcare. In addition to biological influence, gender has an influence on socioeconomic status.
Gender is a significant healthcare determinant in Afghanistan. Due to a lack of healthcare facilities, maternity mortality rate in the country is extremely high, standing at 1600 deaths per 100,000 live births (Najafizada, Bourgeault, & Labonte, 2017). In addition, women are subjected to numerous rules under the Sharia law, such as the necessity of being accompanied by male relatives to visit doctors, and the necessity to cover their bodies at all times. Education for females is worse, making it harder for them to achieve higher social status and gain better access to healthcare. Male population, on the other hand, is more likely to be injured or killed in combat.
Socioeconomic status plays a very important role in access to high-quality healthcare. Even in countries with universal healthcare systems in place, additional financial resources allow individuals and families to afford a higher quality of medical treatment. At the same time, poverty is a significant barrier to healthcare, as it prevents access to those living below the poverty line. Socioeconomic status affects not only the ability to receive and afford healthcare but also the geographic proximity to hospitals.
In Afghanistan, the socioeconomic situation is dire. With 50% of the population being children, and 74% of individuals living in rural areas, the majority of the population cannot afford a doctor (Trani, Kuhlberg, Cannings, & Chakkal, 2016). This results in high mortality rates, high infant death rates, high maternity death rates, and various other complications. The situation is even worse for women, who are restricted from many opportunities to improve their wealth and position in society.
The surrounding environment creates an ecosystem where humans exist. Depending on the nature of the climate, the terrain, and various other geographical properties, different health conditions and diseases are prevalent in the populace. For example, cold and moist climates are associated with greater numbers of respiratory infections, whereas arid climates generate issues in regards to water shortages. Thus, healthcare affects the healthcare situation in a myriad of specific ways.
Afghanistan is a country of mountains and stones. It is classified by dry, arid mornings and cold nights. Rough terrain makes transportation difficult, making various locations remote and preventing effective emergency care. Afghanistan experiences severe shortages of water. Only a third of the population has clean drinking water, while the rest are forced to rely on various decontamination techniques to survive (Trani et al., 2016). Water contamination is a major reason for high child mortality in the country.
Education affects the state of healthcare of the population in a few ways. First, education is a major variable to determine a person’s socioeconomic status, which, in turn, affects access to high-quality healthcare. In addition, education may refer to healthcare education, meaning the lack or presence of basic sanitary knowledge, skills, and habits to maintain healthy standards of living. Higher education rates typically correlate with lower mortality rates and increased life expectancy.
The state of education in Afghanistan is poor. Literacy rate does not exceed 38%, with male literacy rates being at 52%, while female literacy rates remain at 28% (Trani et al., 2016). Children begin attending schools at 12-13 years of age, and average educational periods do not exceed 8 years. Disease prevention education is sporadic and largely conducted by NGOs operating in Afghanistan. Homeschooling is widespread but does not enable social mobility. As a result, the population remains largely uneducated and poor, unable to receive and afford proper healthcare.
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Access to Healthcare
Access to healthcare is an important geographical and economic determinant. Healthcare facilities are usually limited to certain locations, and reaching them can present itself as a significant distance barrier. In other situations, high costs of healthcare can prevent access to vulnerable and poorer populations. Lastly, the limited capabilities of healthcare facilities can create situations where medical attention is scarce and limited.
Afghanistan suffers from severe healthcare shortages on all fronts. Hospitals are located in large cities, such as Kabul, Bagram, Farah, and a dozen others. The total number of hospitals in the country is 117 (Mansoor et al., 2016). The number of available physicians is 0.3 per 1000 individuals, which is one of the lowest in the world. Healthcare costs, especially the costs of hospital stay, which are associated with 80% of all healthcare expenses, make it unattainable for the majority of the population (Trani et al., 2016). The problem is exacerbated by growing inflation rates in the country.
Burden of Disease
The burden of disease is used to describe various impacts of healthcare deficit on the overall healthcare status of the nation. Global Burden of Disease (GBD) framework accounts for the total number of deaths, disability-adjusted life years, years of lives lost, years of lives lived with disability, maternal and neonatal mortality rates, as well as deaths under 5 years of age (Massahikhaleghi et al., 2018). These parameters affect the health of every individual throughout their lifespan and can be used as criteria to assess the overall level of healthcare.
Afghanistan is a low-income country with a young population, which affects its GBD score considerably. Although the overall GBD score has been decreasing between 1990 and 2016, they remain high when compared to the rest of the world. Mortality rate, as it stands, is at 910 deaths per 100000 population, and maternal mortality is at 1600 deaths per 100000 live births (Massahikhaleghi et al., 2018). Major burdens of disease are added by terrorism, ischemic heart disease, and road injuries among males, whereas females suffer from congenital diseases and birthing issues.
The economic situation is a blanket term to describe the overall economic status of a country. It includes a myriad of parameters ranging from individual income of a person or a population subgroup to the prosperity of the community as a whole. Typically, higher GDP and rates of economic development indicate higher individual income and, as a result, better access to healthcare. However, this criterion is not absolute, as there are exceptions. China, for example, is one of the most prominent economic powers in the world, which suffers from various healthcare system deficiencies due to its large population numbers.
Afghanistan is a poor low-income nation ravaged by war (Trani et al., 2016). The majority of its population live in autonomous regions of the country, providing sustenance for themselves and engaging in few productive economic activities besides farming and animal husbandry. As such, many natives have non-convertible goods, such as wool, animals, and dairy products, which cannot be used to pay for medical services. Distances between villages and large cities and lack of transport also play a detrimental role in Afghanistan’s healthcare system (Trani et al., 2016).
Afghanistan remains one of the problem sports for healthcare institutions worldwide. It possesses numerous barriers to deliver proper healthcare. Although short-term solutions may provide temporary relief, united humanitarian and policy efforts should be aimed at improving the situation, using eight determinants of healthcare as a framework for investment and policy direction. Age, gender, socioeconomic status, environment, education, access to healthcare, the burden of disease, and the economy play a massive role in determining how healthcare hazards affect the population of Afghanistan.
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