Afghans Asked to Pay for Healthcare

For the first time, patients are being asked to pay for treatment at public hospitals in Afghanistan. Although the constitution stipulates that all Afghans are entitled to free healthcare, a pilot programme being tested in the northern province of Balkh could change all that.

The trial began earlier this month when a price list appeared at the entrance of Balkh’s public hospital, the prices for procedures ranging from five afghanis, about 10 US cents, to 300 afghanis.

For example, the list said that patients would be charged five afghanis for treatment of minor cuts, 10 afghanis for internal examinations, 100 for an appendectomy and 300 for a gall bladder removal.

The prices do not reflect the actual cost of the procedures but are simply a way for the hospital to raise badly needed money.

Those too poor to pay can appeal to a local commission.

Hospitals in Afghanistan face numerous problems and conditions are extremely poor. Even before the new charges were introduced, patients routinely had to pay for all medicines and many basic items, such as syringes, plasters, bandages and surgical gloves.

Those requiring more sophisticated forms of treatment are often required to travel aboard.

Dr Mirwais Rabi, head of Balkh public hospital, said the money is regarded as a donation from patients and is used solely to improve conditions and provide better facilities for patients.

"This is a very good programme for Afghanistan people,” he said. “These contributions will go a long way to help us buy new equipment."

"It is the best way of helping health centres stand on their own feet," said Dr Saeed, of the Afghanistan health ministry.

He said that the new payment system was favoured by President Hamed Karzai, who wanted it introduced throughout the country.

But some patients waiting outside the hospital were not quite so enthusiastic about the new payments,

Noor Jahan, a 55-year-old mother waiting for treatment for her daughter, claimed she had been waiting for three days to see a doctor.

"They send me from one ward to the other but still nothing has been done," she said. "When they see that I am not well dressed and know that I don't have any money they don't want to speak to me. If I had money they would soon admit my daughter."

But Ghulam Sarver, 41. who was also waiting outside, supported this programme. "It is best that our hospitals stand on their own feet," he said.

He added that he did not want free treatment. "I want to pay and be treated well in return," he said.

Muhammad Nabi, 30, said in the past he has travelled to India for treatment.

"If charging money creates advanced medical methods it would be a big step in Afghanistan's development,” he said. “The list I saw in this hospital is cheap, while treatment in India is 50 times more expensive than that."

But some worry that the poor will avoid getting necessary treatment if they have to pay for it.

Healthcare sector analyst Mohammad Qasim Akhgar told IWPR, "I believe this programme is unsafe considering the economical situation in Afghanistan and the poverty of the people. It will simply be an added burden for many.”

Sayed Yaqub Ibrahimi is an IWPR staff reporter in Mazar-e-Sharif.