Noh Jin-Won, Im Yu-Mi, Kim Kyoung-Beom, Kim Min Hee, Kwon Young Dae, Cha Jiho
Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju 220710, Korea.
Department of Nursing, Dankook University, Cheonan 31116, Korea.
Healthcare (Basel). 2021 Apr 27;9(5):506. doi: 10.3390/healthcare9050506.
Despite recent progress in Afghanistan's health system from the support of international donors and NGOs, protracted conflicts combined with a series of natural disasters have continued to present substantial health risks. Extreme poverty has still aggravated social determinants of health and financial barriers to healthcare. Little is known about the context-specific factors influencing access to healthcare in the crisis-affected population. Using a subset of data from 'Whole of Afghanistan Assessment (WoAA) 2019', this study analyzed 31,343 households' data, which was collected between 17 July and 19 September 2019 throughout all 34 provinces in Afghanistan. The outcome measured was access to care in the healthcare facility, and multivariable binary logistic regression models were used to identify the specific factors associated with access to healthcare. Of 31,343 households exposed to complex emergencies in Afghanistan, 10,057 (32.1%) could not access healthcare facilities when one was needed in last three months. The access to healthcare was significantly associated with displacement status, economic factors such as employment status or total monthly income, and the distance to healthcare facilities. Significant increase in healthcare access was associated with factors related to communication and access to information, such as awareness of humanitarian assistance availability and mobile phone with a SIM card, while disability in cognitive function, such as memory or concentration, was associated with poorer healthcare access. Our findings indicate that the crisis-affected population remains vulnerable in access to healthcare, despite the recent improvements in health sectors. Digital determinants, such as access to mobile phone, need to be addressed along with the healthcare barriers related to poverty and household vulnerabilities. The innovative humanitarian financing system using mobile communication and cash transfer programs would be considerable for the conflict-affected but digitally connected population in Afghanistan.
尽管在国际捐助者和非政府组织的支持下，阿富汗卫生系统近期取得了进展，但长期冲突加上一系列自然灾害，继续带来重大的健康风险。极端贫困仍然加剧了健康的社会决定因素以及医疗保健的经济障碍。对于影响受危机影响人群获得医疗保健的具体背景因素，人们了解甚少。本研究使用了“2019年阿富汗全面评估（WoAA）”数据的一个子集，分析了2019年7月17日至9月19日期间在阿富汗所有34个省份收集的31343户家庭的数据。测量的结果是在医疗机构获得护理的情况，并使用多变量二元逻辑回归模型来确定与获得医疗保健相关的具体因素。在阿富汗面临复杂紧急情况的31343户家庭中，有10057户（32.1%）在过去三个月需要医疗保健时无法获得医疗机构的服务。获得医疗保健与流离失所状况、就业状况或月总收入等经济因素以及到医疗机构的距离显著相关。医疗保健可及性的显著提高与通信和信息获取相关的因素有关，例如对人道主义援助可用性的认识以及有SIM卡的手机，而认知功能障碍，如记忆力或注意力不集中，则与较差的医疗保健可及性相关。我们的研究结果表明，尽管卫生部门最近有所改善，但受危机影响的人群在获得医疗保健方面仍然很脆弱。需要解决数字决定因素，如手机的使用，以及与贫困和家庭脆弱性相关的医疗保健障碍。对于阿富汗受冲突影响但有数字连接的人群来说，利用移动通信和现金转移计划的创新人道主义融资系统将是相当可观的。
