Center for Health and Wellbeing, Princeton University School of Public and International Affairs, Princeton, New Jersey, USA.
Princeton University School of Public and International Affairs, Princeton, New Jersey, USA.
BMJ Glob Health. 2024 Feb 20;9(2):e013760. doi: 10.1136/bmjgh-2023-013760.
Existing health system challenges in Afghanistan were amplified by the Taliban's August 2021 government takeover during which the country faced an evolving security situation, border closures, banking interruptions, donor funding disruptions and international staff evacuations. We investigated factors that influenced health sector and health service delivery following the takeover.
We purposively sampled individuals knowledgeable about Afghanistan's health sector and health professionals working in underserved areas of the country. We identified codes and themes of the data using framework analysis.
Factors identified as supporting continued health service delivery following August 2021 include external funding and operational flexibilities, ongoing care provision by local implementers and providers, health worker motivation, flexible contracting out arrangements and improved security. Factors identified as contributing to disruptions include damaged infrastructure, limited supplies, ineffective government implementation efforts and changes in government leadership and policies resulting in new coordination and capacity challenges. There were mixed views on the role pay-for-performance schemes played. Participants also shared concerns about the new working environment. These included loss of qualified health professionals and the associated impact on quality of care, continued dependency on external funding, women's inability to finish their studies or take on any leadership positions, various impacts of the Mahram policy, mental stress, the future of care provision for female patients and widespread economic hardship which impacts nearly every aspect of Afghan life.
Afghanistan's health sector presents a compelling case of adaptability in the face of crisis. Despite the anticipated and reported total collapse due to the country's power shift, various factors enabled health services to continue in some settings while others acted as barriers. The potential role of these factors should be considered in the context of future service delivery in Afghanistan and other settings at risk of political and societal disruption.
塔利班 2021 年 8 月接管阿富汗政府后，阿富汗现有的卫生系统挑战加剧，该国面临着不断演变的安全局势、边境关闭、银行中断、捐助者供资中断和国际工作人员撤离等问题。我们调查了接管后影响卫生部门和卫生服务提供的因素。
我们有意选择了了解阿富汗卫生部门的个人和在该国服务不足地区工作的卫生专业人员。我们使用框架分析确定了数据的代码和主题。
被确定为支持 2021 年 8 月后继续提供卫生服务的因素包括外部资金和运营灵活性、当地执行者和提供者持续提供护理、卫生工作者的积极性、灵活的外包安排以及安全状况的改善。被确定为导致中断的因素包括基础设施受损、供应有限、政府执行工作不力以及政府领导层和政策的变化导致新的协调和能力挑战。对绩效付费计划所起作用的看法不一。参与者还对新的工作环境表示担忧。这些包括合格卫生专业人员的流失及其对护理质量的影响、对外部资金的持续依赖、妇女无法完成学业或担任任何领导职务、Mahram 政策的各种影响、精神压力、女性患者护理的未来以及广泛的经济困难，这些都影响着阿富汗生活的方方面面。
阿富汗卫生部门在面临危机时表现出了令人信服的适应能力。尽管由于该国权力转移，预计和报告的卫生系统会全面崩溃，但各种因素使一些地方的卫生服务得以继续，而其他因素则成为障碍。这些因素的潜在作用应在阿富汗和其他面临政治和社会动荡风险的环境中提供服务的背景下加以考虑。
