The international health society has increasingly adopted strategies that aid in improving the social determinants of health. They, therefore, contribute to the strengthening of the health systems around the country. Primarily, Afghanistan offers an outstanding case study of the accomplishments in improving health care services through the collective will, national and local leadership, and international support from organizations such as the World Health Organization in countries with constrained resources. Although donor and international programs have facilitated the success experienced in the Afghanistan health care system, some aspects of the country demonstrate the vital need for nationally initiated initiatives to rationalize, leverage and align some programs. Consequently, they aid in the design and creation of critical national quality and equality programs. Moreover, Afghanistan illustrates how advancements inpatient care in services and delivery programs while creating procedural capacities at all levels through the integration of national policy-making and leadership. Most low-income nations have specific challenges attributed by their social determinants to their health systems when creating integrated national policies and adopting quality programs. Furthermore, these challenges are influenced by the multiplicity of the external and internal stakeholders, including international players such as the WHO. Afghanistan is, therefore, a country that indicates that the implementation of national health care programs and strategies can cause better outcomes of health services and the capability to strengthen health systems significantly.
Primarily, social change can be described as the modification of the order in society to ensure positive and healthy interactions that allow for social development. Various determinants are critical when initiating social change, including cultural, economic, demographic, political and physical environmental factors. Social determinants of health generally cause the societal dilemma of the wellbeing of people –for instance, depression, diabetes and obesity in today’s world. In Afghanistan, social determinants of health affect the country include, first, the level of income among the citizens is low as well as the country’s GDP. According to De Groot et al. (2019), low socioeconomic status has a significant influence on health outcomes and limited access to health facilities for the citizens. Low income in Afghanistan has caused various adverse effects on the wellbeing of many people who have died for lack of health care. Moreover, the country lacks adequate resources to buy medications and health equipment for its citizens. Low income leads to high prenatal deaths due to increased risk of miscarriages caused by inadequate delivery equipment and access to clinics.
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Secondly, gender inequality in the country is a significant factor that determines the health of people. Samar et al. (2014) stipulate that the Afghanistan gender inequality directory illustrates that 70% loss in growth is contributed by the inadequate involvement of women in employment, deprived women’s health outcomes and low education. Primarily, the level of gender inequality affects maternal health in a country. According to Najafizada, Bourgeault & Labonté (2017), Afghanistan has a high mortality rate of live births. The research indicates that the leading causes of these high rates include inadequate maternal education and socio-cultural practices. They affect the general health of the pregnant mother and their unborn child. Gender inequality in Afghanistan significantly contributes to the high mortality rates of live births in the country. Mainly the nation does not have high regard for women since they only view them as objects of pleasure.
Thirdly, destabilization of the political, social and economic environment in Afghanistan has contributed to various issues in the health sector. Majorly, the government is more concerned with buying arms than the health resources needed to ensure the wellbeing of its people. Additionally, the education of the country is low. People, therefore, hardly undertake sex education which consequently magnifies the HIV status in the country. A study conducted by Psaki et al. (2019) indicates that a causal effect relationship exists between sexual education and low-income countries. From a review by Jaquet & Dabis (2017); low income countries barely educate their citizens on the importance of safe sex, which then leads to increased cases of sexually transmitted infections, including HIV. It is vital to address the income level of Afghanistan since it directly affects the health of its citizens. Moreover, aspects of gender inequality have led to high mortality rates of infants and thus addressing this issue will help in reducing the mortality levels. It will also aid in ensuring equal opportunities for all genders in accessing and using health facilities. Additionally, it is imperative to initiate sex education in the system to train people on the importance of having safe sex and how to use protection. Consequently, it will help in reducing the level of sexually transmitted infections in the country. Addressing social and political destabilization will help in redirecting resources to the health sector hence improving general health care.
Health inequalities in Afghanistan have been contributed by various factors which affect the life expectancy in the country. A report by WHO, Afghanistan has a low health life expectancy of 62.6 years. Likewise, the results include that gender inequality in health care contributed to high avoidable mortality and morbidity rates among women (World Health Organization, 2018). Although the rate of maternal and infant deaths has considerably reduced over the years, it remains a major concern in the country. Gender-based inequality contributes to these maternal mortality rates –for instance, the ministry of health recorded 1,291/100 000 live births in 2015 (World Health Organization, 2018). These rates are mainly contributed by the inequalities of health services in local hospitals.
Various strategies have been developed by the Afghanistan government to promote the quality of health services and reduce health inequalities. To begin with, the country has developed the Islamic Republic of Afghanistan’s National Strategy for Improving Quality in Health Care (IQHC) (Samar et al., 2014). The strategy was launched early 2011 by the ministry of health to progress its mission to improve the health and nutritional statuses of its citizens by ensuring equality and quality of health care (Samar et al., 2014). In the past, the war had destroyed numerous health infrastructure around the country; hence, the remaining facilities were used by people from high social classes or those with high incomes. The low-income earners in the country would, therefore, lack the resources to go to the healthcare amenities. The introduction and implementation of the strategy have significantly reduced health inequalities — for instance, the introduction of more female health providers in facilities. The new system has helped the foundation in ensuring equal chances for both men and women, low and high-income earners.
In 2010, the Afghanistan government introduced the National Improvement Strategy and Infrastructure for Improving Health Care in Afghanistan (Samar et al., 2014). Afghanistan has various health inequities. For instance, in 2009, only 9% of the population was able to access essential health services (Samar et al., 2014). Primarily, the strategy was founded on the importance to improve the resources in the ministry of public health, reduce health disparities in the country and to increase health workers in healthcare facilities. Several challenges have affected the success of the policies. Mainly, the coordination of the performance of the health services in the diverse geographical conditions has been affected by inadequate human and financial resources nationally. The development and adoption of these strategies have been aimed to improve various aspects of healthcare, including inequalities and workforce management.
Health literacy primarily refers to the ability of people to access and understand core health services and information when making suitable health-related decisions. In Afghanistan, health literacy is low due to the inadequacy of health practitioners. Moreover, the citizens rely on international health support from organizations such as the WHO to offer health education. For instance, Brennan-Olsen et al. (2017) indicates that many low to middle-income countries experience a social disadvantage linked to the prevalence of arthritis due to inadequate information on the disease. Although reducing the level of preventable child and mother deaths have been a significant health concern globally as indicated by the United Nations Sustainable Development, it remains a menace in Afghanistan due to lack factors that promote health literacy.
Several public issues may be encountered during health literacy and cultural awareness in Afghanistan. To being with, unemployment will be experienced since most people are not employed, which then affects the level of income of the individuals. It is, therefore, vital to understand this factor as it influences numerous aspects of life, including social, economic and cultural. When unemployment increases in a country, it affects not only an individual but the society hence becoming a public issue. Additionally, it increases the rate of crime in the country. Berman et al. (2011) declare that in Afghanistan, the rate of unemployment is high and has a significant relationship to violence rates in the nation. Gender inequalities in a significant public issue in the country. It is primarily sourced from the cultural beliefs of the citizens. Women in Afghanistan are considered as objects of pleasure. Moreover, they have few rights compared to the men, and thus they may fail to attend the programs aimed to facilitate health literacy and cultural awareness. For instance, women are discouraged from using contraceptives since they are termed as western poisons, and thus it becomes hard to educate them on the importance of family planning. Additionally, the political instability of the country provides various challenges to the initiatives. The lack of adequate resources directed to health care will contribute to major issues when dealing with health literacy and cultural awareness. It is, therefore, imperative to take into consideration these public issues when providing people with access and an understanding of health information and services in the country.
It is vital to develop health policy in Afghanistan. The plan will aid in ensuring adequate resources are disbursed to the ministry of health, and it will assist in mitigating health inequalities in the country. The policy will follow the guidelines provided by the WHO when formulating national health policies, plans and strategies. The first stage includes engaging with various stakeholders. During the implementation process, the stakeholders, including the residents of Afghanistan, the ministry of health, the national government and medical practitioners will be consulted to ensure the reliability, viability and validity of the policy. Other stakeholders include the nongovernmental organizations, donors and aid agencies. The facilitation of the policy conversation will help bring the various players into gathering information, conducting debates and building consensuses.
Secondly, a situation analysis and priority setting will be done. An intense situation evaluation will include the collection of demographic, health and epidemiology facts of the community. Furthermore, it will include a comprehensive range of present and future health problems and their determinants. This assessment will, therefore, become the yardstick for setting several priorities to be addressed by the policy. Thirdly, bringing all the materials from the evaluation together. In Afghanistan, a key concern will be to ensure adequate links to health issues and specific policies. It is thus essential to connect national and program planning to avoid the problems resulting from poor implementation. Fourth, ensuring the proper transition of the vision to its operations. Strategic planning is vital in ensuring the appropriate execution of health policies at the local level. Moreover, the costs of the system should be evaluated to determine a cost-benefit assessment. Finally, it is essential to confirm the continued monitoring and evaluation of the policy to ensure it is working as expected.
Finally, Afghanistan is one of the numerous low-income countries in the world. Fundamentally, its health system is affected by various social determinants. Low income of the citizens and the country significantly influences the health care of the nation. Additionally, gender inequality results in high mortality rates of mothers and children. The conflicts and attacks in the country have led to the destruction of numerous health facilities, and medical staff have disrupted and deprived millions of Afghans health services, including lifesaving treatments. Moreover, the political instability of the country threatens the health and physical safety of Afghans. Health inequalities have reduced the life expectancy of the country to 62.6 years over the past two decades. Some of the public issues that an individual may face during health literacy and cultural awareness are unemployment, gender discrimination and political instability. Developing a health policy in Afghanistan will follow five major stages including engaging stakeholders, situation analysis, collaboration and coordination of various policy aspects, transitioning from a vision to an operation, cost assessment and then monitoring and evaluation. It is therefore essential to evaluate social determinants of health, health inequalities, public issues and the existing policies when developing new health policies.
References
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