Afghanistan: Miracle in Health Services!

In 2000, during the Taliban regime, my mother got sick; I was 17 years old. My father was doing business in Kabul and as I was the oldest male in the family, I needed to take care of her.  After visiting many doctors and Mirwais Hospital(the only general hospital in Southern Afghanistan),  it took almost a week to find out what was ailing my family member.  Her condition was getting worse and worse every day and she was on the brink of death. Thanks to one of the few private ultrasound clinics in Kandahar, she was diagnosed and given a second life. Every year, hundreds of people would die from diarrhea and cholera in summer in the southern districts of Kandahar, due to a lack of health professionals. There was not one single doctor present in the 17 districts of Kandahar province. The only professional health practitioners in the region were in Kandahar City. People who can afford travel had to visit Pakistan to see a doctor.

During the Taliban regime, there were no asphalted roads across Afghanistan.  To travel to Quetta, a city on the Pakistan side of the Durand line, which is 237 kilometers to the south of Kandahar city, would take a whole day. I personally have visited Quetta several times, due to a simple sickness, like an allergy or indigestion; to be seen by a doctor and be given tests that will take 4 to 5 days to return home. Due to Afghanistan’s low rate of inflation, visiting Pakistan for medical reasons, in some cases, would cost a whole year’s earnings.

The question is how much of that situation has changed from 2000 till now? Was it possible without Western and other allied countries’ generous donations and expertise to Afghanistan? As a native Kandahari, most of my focus in this piece will be on Kandahar province, but I will provide a few examples of other parts of Afghanistan as well.

Currently, there are more than 40 government and private hospitals and clinics in Kandahar City and over 60 in the 17 districts of Kandahar province, which provide quality services to the people of Kandahar compared to the one and only Mirwais Hospital during the Taliban regime. The improvement is so vast and very visible while comparing “1” to “100” and the list gets larger when ‘Examination Offices’ were included run by individual doctors in the 17 districts of Kandahar province and Kandahar city. It is worth mentioning that all hospitals, clinics, and other healthcare provider facilities provide free medical care to all citizens that are funded by the government, NGOs and any other donors to Afghanistan. One of the biggest concerns of Pakistan’s Private Hospitals Association a couple years ago was that their business almost dried, in most cases, by 90% due to standard health care services that are available inside Afghanistan. According to UNICEF, Under Five Mortality Rate from 2000 to 2016 dropped from 130 per 1000, to only 70 per 1000.

The health system in Afghanistan continues to face many challenges. However, growing numbers of trained health-care workers are gradually helping to deliver quality healthcare services to more and more people. More specifically, greater numbers of skilled female healthcare workers are still needed to meet the healthcare needs of women and children in the country. In recent years, (WHO) alone has contributed a lot to the establishment of training courses for midwives in Afghanistan. As a result, since 2003, more than 2700 midwives have been trained; the number grows bigger if we include the women that have been trained by UNICEF, ICRC, and the Ministry of Public Health of Afghanistan, other United Nations agencies, NGOs and private schools.

Currently, there is a government medical university and an institute, four private universities and three institutes in Kandahar City that train students in different medical fields. These schools are playing an important role in health development, not only in Kandahar, but in Afghanistan as a whole. During the Taliban Regime, there were only (10,000) university students across Afghanistan, but now there are almost (5,000) medical students in Kandahar alone. Eighteen years ago, the doctors in Kandahar could not treat an allergy. However, a few months ago, a Kandahar University graduate had performed a kidney transplant in one of Kandahar’s hospitals. More importantly, one third of the above-mentioned hospitals are well equipped by modern medical equipment such as CT scan, Ultrasound, Echocardiography, C-arm, Endoscopy, laparoscopy, ECG, Lithotripsy and others necessary equipment that serves people 24/7.  Local people, in rare cases, need to go to India or Pakistan for medical treatment.

Close friends of mine, who are Kabul Medical University graduates, have opened clinics in several remote districts of Kandahar and a few work with different government departments, UN and other NGOs as doctors and healthcare worker in very remote areas. I cannot imagine hearing that when settling in Toronto.  God knows how many more new graduate doctors across Kandahar have opened clinics. There are 60 active and well equipped clinics across the 17 districts of Kandahar that provide free healthcare services to locals 24/7. Each district provides 24/7 free ambulance services; the vaccinators provides 8 types of immunizations for epidemic diseases. It was beyond imagination to have a male nurse or health practitioner in one of Kandahar’s districts, but currently, female MD doctors, professional vaccinators, and nurses provide health services in 60% of Kandahar’s districts.  (The mother and Baby) program has decreased the mortality rate to 5% in Panjwai district, with more than 200 regular deliveries occurring on a monthly basis.

The Ministry of Public Health’s 2017 report states: currently the ministry provides health services across Afghanistan in 2,863 hospitals, clinics and health centers of which 448 of them opened just last year and treated 56 million patients including 17 million children under five, 25 million women over five which shows 3 million increased than the previous year. The ministry report does not provide information about the private sector. The ministry is conducting a door-to-door polio eradication immunization program across the country that has reached 98 percent of its population. No incident was reported last year from 30 provinces: the only areas that are under polio threat are the remote parts of Nangarhar, Kunar, Kandahar and Helmand provinces. More than hundreds of rehabilitation hospitals and centers were built for drug-addicted men, women, non-adults and prisoners. A major hospital in Kabul can treat up to 8,000 addicted people a year. The Ministry of Public Health is building a hospital in Kabul which is funded by the Italian Agency for Development and Cooperation in Afghanistan.  This will enable treatment many types of newly born babies’ diseases and, after its completion, Afghan sick kids will no longer need to go to western countries for Pediatric Cardiac Surgery and other medical treatments.

Besides healthcare, Afghanistan has developed remarkably in many areas, despite its immense challenges; the war against the Soviets, Civil War, Taliban and now 17 years of devastating war against international terrorism.  Afghanistan still has a long way ahead to improve its citizen’s health services, and it is ranked #173 by the World Health Organization but still has left behind tens of stable and wealthy countries including South Africa. If Afghanistan were given a chance of peace, it would shine like many other developed and developing countries.

Afghanistan is a low-income country with fragile socio-economic status and political instability. It is a mostly rural country with low literacy, insufficient infrastructure, weak public sector policies, and significant dependence on foreign aid. However, after almost four decades of devastating conflict, the country has experienced rapid improvements in its socio-economic status since the end of the Taliban era, with significant improvements in income, education, infrastructure, and health. Per capita income rose by 226 percent between 2006 and 2014. Since 2002, school enrollments have increased from 1 million to 8.7 million, including more than 3 million girls. At the same time, the number of teachers has grown from 20,000 to more than 187,000. The number of schools has increased almost fivefold and the number of public sector health facilities by fourfold in just eight years. Similarly, the number of functioning health facilities has increased from 496 in 2002 to more than 2,000 in 2012, and 2,863 in 2016, with an increased proportion of female staff.

Afghanistan has designated 2015‒2024 as its (Transformation Decade) to be marked by the gradual hand over of program and financial responsibilities by international supporters to the Afghan government, using a self-reliance model. This new paradigm has significant ramifications for the future of the health sector and health of all Afghans. Over the next five years, the MoPH is determined to build institutional, governance, and human resource capacity. All with the aim of improving public and private health services and public health towards better socio-economic and health status. To achieve the objective and policy priorities, “the policy requires that the 2016 – 2020 national health strategy focus on the five national health policy areas. These priority areas are governance, institutional development, public health, health services and human resources for health.

The Ministry of Public Health report states: Currently, there are 31 Specialized hospitals, 34 Provincial hospitals, 6 Regional hospitals, 82 Districts hospitals, 423 Comprehensive Health Center (CHC), 881 Basic Health Center (BHC), 786 Health Sub Center (HSC), 195 Mobile Health Team (MHT) and 428 others Healthcare government facilities across the country. This is my Afghanistan development story, and it is a good story. This story is a good example to show the world that we are not the same country we were 18 years ago. We have changed for good, and we will never return to the old ages.

Ghulam Wali Noori is a former historian of former Afghan President Hamid Karzai, Political and Cultural Advisor of the United States Army and Canadian Forces in Afghanistan, Data Analyst for (UNHCR), Deputy of the Internal Affairs Department at National Security Council of Afghanistan and currently working as a financial analyst in Toronto, Canada. He is also a published translator and author of 13 books and a Political Sciences graduate from Carleton University.

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