Independent, Kabul, Islamic Republic of Afghanistan; formerly of the Ministry of Public Health, Kabul, Islamic Republic of Afghanistan.
Boston University School of Public Health, Boston, MA, USA.
Glob Health Sci Pract. 2022 Aug 30;10(4). doi: 10.9745/GHSP-D-21-00658.
The Basic Package of Health Services (BPHS) is the basis for primary health care in Afghanistan and should be accessible to all citizens. Most of these health services have been provided by nongovernmental organizations with support from donors. Studies before 2018 found that utilization and quality of services were lower than they should be, partly due to insufficient resources, leading the Ministry of Public Health to conduct a costing study to determine the level of funding required for the BPHS.We expanded and refined that data analysis in this article. The main findings show that the total recurrent expenditure on BPHS interventions in 2018 was US$281 million (US$8.93 per capita)-only 62% of the US$452 million (US$14.34 per capita) required for good quality of care. It also showed that the need for services was probably not fully met by public facilities, with actual utilization less than 50% of the need in some cases. Furthermore, scaling up to entirely meet the need could require 2 to 3 times the resources used in 2018.Following the change of government in 2021, economic problems, food shortages, reductions in donor funding, and other factors have increased the need for public health services while the capacity and quality of those services have deteriorated. Nongovernmental organizations continue to provide the BPHS, which remains the main platform for primary health care services in Afghanistan, and international organizations are working to rebuild and support these health services. But additional donor support is needed. The results of this study provide important information on the cost and financing needs of the BPHS that can be used for advocacy and for financing and planning services. We also describe the methodology, challenges, and solutions that can be helpful to other countries interested in conducting similar analyses.
基本卫生服务包是阿富汗初级卫生保健的基础，应面向所有公民提供。这些卫生服务大多由非政府组织在捐助者的支持下提供。2018 年之前的研究发现，服务的利用率和质量低于应有的水平，部分原因是资源不足，这导致公共卫生部进行了成本核算研究，以确定基本卫生服务包所需的资金水平。我们在本文中对该数据分析进行了扩展和完善。主要结果表明，2018 年基本卫生服务包干预措施的经常性支出总额为 2.81 亿美元（人均 8.93 美元），仅为高质量护理所需的 4.52 亿美元（人均 14.34 美元）的 62%。研究还表明，公共设施提供的服务可能无法满足服务需求，在某些情况下，实际利用率低于需求的 50%。此外，要想完全满足需求，可能需要 2018 年使用资源的 2 至 3 倍。2021 年政府更迭后，经济问题、粮食短缺、捐助者供资减少以及其他因素增加了对公共卫生服务的需求，而这些服务的能力和质量却有所恶化。非政府组织继续提供基本卫生服务包，它仍是阿富汗初级卫生保健服务的主要平台，国际组织也在努力重建和支持这些卫生服务。但是需要更多的捐助者支持。本研究的结果提供了关于基本卫生服务包的成本和融资需求的重要信息，可用于宣传和融资及规划服务。我们还描述了可对有兴趣进行类似分析的其他国家有帮助的方法、挑战和解决方案。
