It is unlikely that the medicine and healthcare will be at a decent level in a country where the war and destruction have been carried out for many years. At present, the level of the medical care in Afghanistan is gradually increasing; however, not in all the parts of the country and not due to the special governmental policy but due to the help of organizations such as the Red Cross, Red Crescent, and others. From this perspective, it was decided to examine the scope of health and health provision in the country to follow the tendency of its development.
The Islamic Republic of Afghanistan is a country in the southwestern part of Central Asia. The landlocked state (has no outlet to the sea) is situated between 29 ° 30 ‘and 38 ° 20’ N and 60 ° 30 ‘and 74 ° 45’ E. The state borders with Pakistan in the south and east, Iran in the west, Turkmenistan, Uzbekistan, and Tajikistan in the north, and with China and India in the far northeast (Johnson, 2011). The closest distance from its borders to the Indian Ocean is approximately 500 km.
The length of the territory from north to south equals 1,015 km and from east to west, 1240 km. Afghanistan occupies the northeastern part of the Iranian plateau including the high ridges and intermountain valleys. In the upper tier of the mountains, especially in the northeast, there are various types of glaciations. The climate of Afghanistan is dry continental (with significant temperature amplitudes).
According to the statistics of 2015, the country gives the home to more than 30 million people. The population density is 43 people per one square kilometer, but the population is spread unevenly (Johnson, 2011). Most of the population is concentrated in the valleys of large rivers, where cultivation is carried out and nearby the major cities. The most populated regions are the Kandahar and Kabul oases as well as areas of Herat, Mazar-e-Sharif, Kunduz, Baghlan and Jalalabad, where the population density exceeds 100 persons per square kilometer.
The growth of the population is characterized by a high birth rate and mortality. The growth has risen up to 4,77%. The birth rate per 1000 people is up to 47,02% while the mortality rate is 20,75 per 1000 people. The infant mortality rate is among the highest in the world (163,1 per 1000 births). The average life expectancy equals 42,9 years. There are more males in Afghanistan than females, and the prevalence of the male population over the female is the most noticeable in the age group of 15 to 64 years (Trimble, 2011). The average age of the Afghans is 17,56 years.
In accordance with the Constitution, the Islamic Republic of Afghanistan is a presidential form of government. The supreme executive power is vested in the President, who is elected by universal, direct, and secret election for a period of 5 years. The president is the supreme commander of the armed forces of the country, and he or she appoints ministers and other senior government officials with the approval of the Parliament (Johnson, 2011).
The government carries out its activities under the chairmanship of the President, who, with the approval of the national parliament appoints the members of the cabinet (Johnson, 2011). The government proposes laws, issue regulations, and instructions. There is also a traditional institution of the representative government, which is the Loya Jirga composed of the members of both Houses of Parliament and the chairpersons of provincial and district councils.
Due to the extended war, the Afghanistan’s economy has come to a complete standstill. Many businesses were destroyed as well as the transport system, and the trade links between the different parts of the country and other states. The economic cooperation with the outside world has almost completely stopped except for a joint attempt by the United States to organize the restoration of the telecommunications systems.
According to some estimates, over 53% of the Afghanistan’s GDP is represented by the agriculture, 28,5% to 18,5% by industry and the service sector respectively (Afghanistan, 2016). Transportation and warehousing, as well as public services, take a significant place in the composition of the industry. Nevertheless, the unemployment rate in the country is between 35% – 40% and about 36% of citizens live below the poverty line; the inflation rate is approximately 13,8%.
State of Health
The health situation in Afghanistan is rather complicated. The mortality at birth is around 1700 women per 100 thousand population, and one in five children dies before five years old (Health care for children, 2014). For every thousand newborns, almost 16 percent of children die (Afghanistan, 2016). Serious problems in the health system are frequently met, especially in remote areas of the country.
Every year about 70 thousand people fall ill with tuberculosis; 30% of the population is claimed to have it. Almost half of the country’s population is suffering from mental illnesses. In addition, most of the population is suffering from infectious diseases. Outbreaks of cholera, typhoid, dysentery, and malaria are common in Afghanistan. Urolithiasis, tumors, rickets, and cirrhosis of the liver are also typical (Salama & Alwan, 2016). Up to 90% of the population is struck by helminthes, and additionally, there are cases when the residents are sick with leprosy.
International medical assistance programs are crucial for the people of Afghanistan. They include the provision of free medical care for pregnant women, immunization and family planning (Health care for children, 2014). Also, a national campaign to help fight diseases that are transmitted through water. Traditional medicine in Afghanistan is an ambiguous concept. Many advances in health care are made with the help of other countries. Relatively modern hospitals can be found only in Kabul and other major cities. In general, the whole of Afghanistan is experiencing a serious need for medical staff, hospital beds, medical supplies, and medicines.
Healthcare System and Delivery
Governmental health-related agencies and health regulatory organizations
Unfortunately, there is no much information about this aspect of the healthcare system. It should be stated that the Ministry of Public Health is concerned with health regulations; however, there is no acute information whether there are other health organizations that manage this aspect of the infrastructure (Johnson, 2011).
Healthcare personnel and hospitals
Of the 31 provinces, only 11 have hospitals and health care services. In Herat province, for instance, the ratio is 800 thousand people to about 30 doctors. Hospitals and outpatient clinics have been destroyed, and the local veterinarians provide medical care (Salama & Alwan, 2016). After the reconstruction of the country has started, several major international health care programs were introduced. For example, a program to provide basic health care, which includes antenatal and postnatal care, family planning, and immunization, this program has enabled more than half the country’s population to get healthcare.
Since 2004, in Afghanistan under the auspices of the UNICEF and other partners, a nationwide campaign was implemented. The campaign facilitated the improved access to primary healthcare for 2 million people, enabled reconstructing 72 hospitals, clinics and women’s health centers. It provided the institutions with the necessary equipment and medicines. At present, the medical care is provided to about 5 million people in 13 provinces. Since 1979, the number of Afghan doctors has increased from 900 to 1200 in the country.
Nursing education system and accrediting organizations
The chief medical faculty in Kabul (Medical School) was founded in 1933 and was the first institution of higher education in Afghanistan. Currently, the Kabul Medical Institute has three faculties, which are medical faculty, pediatric faculty, and faculty of dentistry. Besides the basic faculty, in Afghanistan, there are 10 medical schools, three of which are also in Kabul (Salama & Alwan, 2016). However, due to the political, economic, and social misbalance in the country, these institutions are not accredited, to be more precise, there are no such organizations that can provide an accreditation service.
During the last 20 years of political instability and military conflicts in Afghanistan, medical schools were established in different provinces. It is crucial that some of these institutions were organized without the required academic standards, and teachers frequently have no special education. Currently, the number of students is more than 7000 people, which is quite burdensome for educational institutions due to the lack of textbooks, manuals, and equipment. Nowadays, the faculty of medical schools in Afghanistan is trained according to the WHO program in Iran, France, and the United States (Salama & Alwan, 2016).
Medecins Sans Frontieres is one of the associations calling for international organizations to provide medical assistance to Afghanistan to help the Afghan people get qualified and affordable healthcare. The UN Children’s Fund (UNICEF) has also taken action and offered its assistance to reduce infant mortality (Health care for children, 2014). In addition, since 2004, under the auspices of UNICEF and other partners, the country takes part in the nationwide campaign to combat diseases transmitted through water. The campaign combines health education, promotion of healthy lifestyles, and physical protection of the water supply.
Despite the achievements in the health sector largely made with the support of foreign and international organizations, the levels of child and maternal mortality rates remain high, as well as the problem of care provision for the population still requires extensive and sustained efforts. Due to the lack of security in Afghanistan, most of the population is deprived of access to healthcare (Stanhope & Lancaster, 2014).
In this regard, the main priorities for the country are the provision of medical supplies to areas of combat operations to treat the wounded and education of the population in first aid skills. Apart from that, the implementation of the monthly supply of medicines and other items in three local health points of the ICRC in the south and east of the country is crucial. Among other things, the other main priority is to educate the public to be health literate and to teach them practices of the basic hygiene.
It is most crucial to provide security in areas where medical assistance is furnished. For that matter, care providers must stay alerted most of the time. Nursing staff should strive for sharing their knowledge of the basic nursing practices and main principles of their specialization as well as execute their expertise to promote the best of care in the variety of settings. Along with that, care providers should educate the population to be health literate (reading and understanding prescriptions, basic hygiene activities, first aid and so on). Finally, the nursing staff should do their best to deliver care effectively where the demand for the care provision is high while accumulating their knowledge and providing supervision of the auxiliary staff.
Afghanistan. (2016). Web.
Johnson, C. (2011). Afghanistan development. Collingdale, PA: DIANE Publishing.
Health care for children and women in remotest Afghanistan. (2014). Web.
Salama, P., & Alwan, A. (2016). Building health systems in fragile states: The instructive example of Afghanistan. The Lancet Global Health, 4(6), 351-352.
Stanhope, M., & Lancaster, J. (2014). Public health nursing. St. Louis, MO: Elsevier Health Sciences.
Trimble, D. (2011). Afghanistan and Iraq. Collingdale, PA: DIANE Publishing.