Health System Development Department, World Health Organization, Kabul, Afghanistan.
Department of Epidemiology and Biostatistics, and Institute of Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States.
Front Public Health. 2023 Jan 12;10:1097680. doi: 10.3389/fpubh.2022.1097680. eCollection 2022.
The COVID-19 pandemic has disrupted provision of essential health services and overwhelmed even robust health systems worldwide. The Afghanistan health system has suffered both from the pandemic, as well as from political upheaval and regime change.
We evaluated essential service delivery using data collected from a cross-sectional survey of health care facilities in Afghanistan based on administration of a World Health Organization standardized assessment of frontline service readiness. A multi-stage sampling scheme was used to identify a representative sample of 92 health facilities (68 clinics and 24 hospitals) providing essential health services in five provinces. Facility managers were asked to report on changes in health service delivery in late 2021 and early 2022 (corresponding to the end of a significant national COVID-19 surge in infections) compared to the same period one year earlier.
Among health facilities evaluated; 29 were in urban and 63 were in rural settings. Most facilities reported an increase in the provision of outpatient care particularly in maternal and child health services as well as for tuberculosis, chronic respiratory diseases, mental health, and substance abuse; the number of in-patients also increased. In contrast, provision of services for malaria, neglected tropical diseases, and community outreach programs decreased. Nearly all facilities used strategies to maintain services, including targeting high-risk patients, promoting self-care, and redirecting patients to alternative health care sites. Nearly three fourth (70.6%) of facilities provided no training about COVID-19 to staff; only 65.2% referred COVID-19 patients to designated hospitals and 44.6% had safe transportation for these patients.
Increased demand for services during this period was likely due to a backlog in need generated during the preceding COVID-19 surge and the political changes happened a few months earlier to this survey. Facilities used various methods to maintain services, although the decrease in provision of community outreach was concerning. Facilities appeared to be able to maintain essential health services, despite an increase in demand. However, awareness and training of COVID-19 protocols and appropriate and safe referrals need to be improved. In general, these series of surveys are informative and helpful to identify any changes in provision of essential health services and can facilitate recovery of health systems during and after pandemics.
COVID-19 大流行扰乱了基本卫生服务的提供，使全球即使是健全的卫生系统也不堪重负。阿富汗卫生系统既受到大流行的影响，也受到政治动荡和政权更迭的影响。
我们使用从阿富汗卫生保健设施的横断面调查中收集的数据，根据世界卫生组织对一线服务准备情况的标准化评估，评估了基本服务的提供情况。采用多阶段抽样方案，在五个省份确定了 92 个提供基本卫生服务的卫生设施（68 个诊所和 24 个医院）的代表性样本。要求设施管理人员报告 2021 年末和 2022 年初（对应 COVID-19 感染高峰结束时）与一年前同期相比，卫生服务提供情况的变化。
在所评估的卫生设施中；29 家位于城市，63 家位于农村地区。大多数设施报告说，门诊服务，特别是孕产妇和儿童保健服务以及结核病、慢性呼吸道疾病、精神健康和药物滥用服务的门诊服务有所增加；住院病人人数也有所增加。相比之下，疟疾、被忽视的热带病和社区外展服务的提供减少了。几乎所有的设施都使用了维持服务的策略，包括针对高危患者、促进自我护理和将患者转介到其他卫生保健地点。近四分之三（70.6%）的设施没有向工作人员提供有关 COVID-19 的培训；只有 65.2%的设施将 COVID-19 患者转介到指定医院，只有 44.6%的设施为这些患者提供了安全的交通。
在此期间，对服务的需求增加可能是由于前一波 COVID-19 期间积压的需求以及几个月前发生的政治变化所致。设施使用了各种方法来维持服务，尽管社区外展服务的减少令人担忧。尽管需求增加，但设施似乎能够维持基本的卫生服务。然而，需要提高对 COVID-19 协议以及适当和安全转诊的认识和培训。总的来说，这些系列调查提供了有关基本卫生服务提供情况变化的信息和帮助，并可以促进大流行期间和之后卫生系统的恢复。
