CIET Trust Botswana, PO Box 1240, Gaborone, Botswana.
BMC Health Serv Res. 2011 Dec 21;11 Suppl 2(Suppl 2):S11. doi: 10.1186/1472-6963-11-S2-S11.
In rebuilding devastated health services, the government of Afghanistan has provided access to basic services mainly by contracting with non-government organisations (NGOs), and more recently the Strengthening Mechanism (SM) of contracting with Provincial Health Offices. Community-based information about the public's views and experience of health services is scarce.
Field teams visited households in a stratified random sample of 30 communities in two districts in Kabul province, with health services mainly provided either by an NGO or through the SM and administered a questionnaire about household views, use, and experience of health services, including payments for services and corruption. They later discussed the findings with separate community focus groups of men and women. We calculated weighted frequencies of views and experience of services and multivariate analysis examined the related factors.
The survey covered 3283 households including 2845 recent health service users. Some 42% of households in the SM district and 57% in the NGO district rated available health services as good. Some 63% of households in the SM district (adjacent to Kabul) and 93% in the NGO district ordinarily used government health facilities. Service users rated private facilities more positively than government facilities. Government service users were more satisfied in urban facilities, if the household head was not educated, if they had enough food in the last week, and if they waited less than 30 minutes. Many households were unwilling to comment on corruption in health services; 15% in the SM district and 26% in the NGO district reported having been asked for an unofficial payment. Despite a policy of free services, one in seven users paid for treatment in government facilities, and three in four paid for medicine outside the facilities. Focus groups confirmed people knew payments were unofficial; they were afraid to talk about corruption.
Households used government health services but preferred private services. The experience of service users was similar in the SM and NGO districts. People made unofficial payments in government facilities, whether SM or NGO run. Tackling corruption in health services is an important part of anti-corruption measures in Afghanistan.
在重建遭受破坏的卫生服务体系方面，阿富汗政府主要通过与非政府组织（NGO）签订合同，以及最近通过与省级卫生办公室签订强化机制（SM）合同，为民众提供基本服务。关于公众对卫生服务的看法和体验，社区层面的信息非常匮乏。
实地工作团队对喀布尔省两个区的 30 个社区进行分层随机抽样，访问了这些社区的家庭。这些社区的卫生服务主要由 NGO 提供，或者通过 SM 提供，并向他们发放了一份关于家庭对卫生服务的看法、使用和体验的调查问卷，包括对服务的付费和腐败情况。随后，团队与分别由男性和女性组成的社区焦点小组讨论了调查结果。我们计算了对服务的看法和体验的加权频率，并对相关因素进行了多变量分析。
调查涵盖了 3283 户家庭，包括 2845 名最近使用过卫生服务的人。在 SM 区，42%的家庭认为现有的卫生服务良好；在 NGO 区，57%的家庭认为现有的卫生服务良好。在 SM 区（紧邻喀布尔），63%的家庭通常使用政府卫生设施；在 NGO 区，93%的家庭通常使用政府卫生设施。服务使用者对私立机构的评价比政府机构更积极。如果政府服务使用者居住在城市地区、家庭户主未受过教育、在上周有足够的食物、等待时间少于 30 分钟，他们会对服务更满意。许多家庭不愿对卫生服务中的腐败行为发表评论；在 SM 区，15%的家庭报告曾被索要非官方支付；在 NGO 区，26%的家庭报告曾被索要非官方支付。尽管有免费服务政策，但仍有七分之一的使用者在政府设施中支付了治疗费用，四分之三的使用者在设施外支付了药品费用。焦点小组证实，人们知道这些付款是非官方的；他们害怕谈论腐败问题。
家庭使用政府卫生服务，但更喜欢私立服务。SM 区和 NGO 区的服务使用者体验相似。在 SM 或 NGO 运营的政府设施中，人们都支付了非官方费用。解决卫生服务中的腐败问题是阿富汗反腐败措施的重要组成部分。
