More Doctors Needed in Afghan Districts

Central government needs to increase health provision in more outlying districts of the country, according to speakers at recent debates organised by IWPR.

Events in Logar, Khost, Uruzgan and Paktika provinces heard that medical care tended to be concentrated in cities, leaving many people in isolated parts of the country struggling to access help.

Logar activist Anahita Alamyar said that women were particularly badly affected by this unequal distribution of facilities.

“In remote areas of Logar province, women have problems during pregnancy and in childbirth for which they need expert medical care,” she said.

 “The population of Logar province is high, but the number of healthcare centres are low,” added Abdul Rahman Tawakuli, head of the regional council in the eastern province. “And what health clinics we currently have don’t have sufficient medicine.”

Ashiqullah Majidi, head of Logar’s central hospital, said that there were 50 health centres spread across the province, but agreed that these were not enough to meet public health needs.

In Khost province, the provincial public health department also said that while maternal mortality had fallen, women and children remained extremely vulnerable.

“Every year 250 to 300 mothers and children die in Khost province,” said Hedayatullah Hameedi, the acting head of the department of public health. “We are trying to control the situation.”

Hameedi said that the poor provision in more remote areas of the eastern province posed a real danger to women and their children.

Khost provincial council member Nurshah Nurani called on the ministry of public health to increase the budget for healthcare in the province and provide more medical professionals to work in its clinics.

The event in Uruzgan also heard that services were not distributed around the province.

“We need more basic healthcare facilities now,” said Faridullah Farhan, a lecturer at the Uruzgan Institute of Higher Education, a branch of Kandahar University. “The services offered in most of the remote areas of this province are minimal, which has led to many public health issues.”

Civil society activist Ataullah Afghan warned of a lack of professionalism among medical staff.

“In this province, medical doctors do not stick to their own speciality and many times [for instance] a gastroenterologist will work as an orthopaedic doctor. This causes many problems for people,” he said.

A local journalist, Hameedullah Watani, said he had heard many reports of medical negligence.

“Many times patients lose their lives because of doctors’ carelessness,” he said.

Debate participant Abdul Wali raised the problem of doctors writing prescriptions for medicines available at only one pharmacy, a practice he complained encouraged corruption.

Uruzgan’s deputy head of public health, Mohammad Eissa, said in response that such actions should be reported immediately.

“If any doctor writes such a prescription for a patient, you can bring it to the department of public health and we will take action,” he said.

 Eissa also defended healthcare provision in outlying parts of the province.

“Currently, besides the provincial capital, people in the districts and more remote areas have access to medical centres,” he continued. “Almost everyone can visit a medical centre when they need to.”

In southeastern Paktika, provincial health council head Sayedullah agreed that there was a local health crisis. He noted that there was only one female doctor covering the entire province.

“Paktika is a large province. However, in most places, the healthcare services offered are almost non-existent,” he said.

Sayedullah added that the province had been long neglected when it came to infrastructure development and there was a desperate need for doctors.

Tribal council head Abdul Manan accused local parliamentarians of failing to bring the attention of central government to the health crisis in Paktika.

Asadullah Rasooli, deputy head of the provincial public health department, agreed that the public needed better health services. It was hard to attract professionals to come and work in the remote province, he explained.

 “Together with donor organisations we have advertised many jobs here, but no one is willing to come to Paktika province to work and if they do, they want more benefits.”

His department was doing the best they could with limited resources, Rasuli continued.

“It’s true that we only have one female doctor in Paktika province, but there are trained midwives in every clinic who help women during childbirth,” he said. 

Civil society activist Ghulam Rahman disputed this, adding that he had heard of many cases in which mothers and their infants died while travelling along dirt roads to try and get medical help.

“We have a 60-bed hospital in the provincial capital Sharana which has insufficient staff and is only semi-functional, so just think what the healthcare services in remote districts are like,” he concluded.

This report is based on an ongoing series of debates conducted as part of IWPR’s Afghan Youth and Elections programme.