Neyazi Narges, Mirzazadeh Ali, Ibrahimi Abdul Ghani, Ahmadzai Ahmad Mirwais, Tanoli Jamshed Ali
Health System Development Department, World Health Organization, Kabul, Afghanistan.
Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California, San francisco, USA.
BMC Health Serv Res. 2025 Jul 3;25(1):923. doi: 10.1186/s12913-025-13093-x.
Afghanistan is a low-income country where providing essential healthcare services is lifesaving for millions. The COVID-19 pandemic, the government and the international aid changes have affected the overburdened and fragile health system and put a risk on universal health coverage in Afghanistan. In this study, we aim to study the changes and backlogs to the essential health services during and after COVID-19 pandemic (Feb 2020 to Sep 2022) in Afghanistan.
A cross-sectional study of health facilities was conducted in nine provinces of Afghanistan. A randomly selected 165 public and private primary care centers and hospitals in 49 districts were studied. A WHO standardized questionnaire was used for this survey. Trained staff met the facility managers in person and completed the questionnaire by individual interviews during September 2022.
Hospitals located mostly in urban areas (n = 39, 65%) and clinics were located mostly in rural areas (n = 74, 71.1%) and governed by the government and the NGOs (76.6% of hospitals and 84.7% of clinics). The average number of staff per facility was 118 (SD = 180) for hospitals and 16(SD = 7) for clinics. 27 (46.5%) of hospitals and 44 (41.9%) of clinics reported that they experienced a higher outpatient service utilization in the previous month, compared to the month before. nearly half of the backlogs during the pandemic were related to routine preventive services such as annual check-ups antenatal care, and childhood immunization (55.0% for hospitals, and 45.7% for clinics). prioritizing high risk patients (86.7%), promoting self-care interventions wherever appropriate (75.0%), redirecting patients to alternative healthcare facilities (73.3%), providing all care in a single visit for multiple morbidities (60.0%), and providing home-based care for certain patients (58.3%) in hospitals. However, the most used strategies in clinics were prioritizing high risk patients (93.3%), redirecting patients to alternative healthcare facilities (75.2%), and providing home-based care for certain patients (66.7%).
The pandemic exacerbated existing health inequities and hindered progress toward Universal Health Coverage (UHC). Health facilities employed various strategies to cope with the disruptions, such as prioritizing high-risk patients, promoting self-care, and redirecting patients to alternative facilities. However, the increased cost of transportation and health services, along with limited availability of medicines, remained significant barriers to healthcare access.
阿富汗是一个低收入国家，提供基本医疗服务对数百万民众来说至关重要。新冠疫情、政府及国际援助的变化影响了负担过重且脆弱的卫生系统，给阿富汗的全民健康覆盖带来了风险。在本研究中，我们旨在研究新冠疫情期间及之后（2020年2月至2022年9月）阿富汗基本医疗服务的变化和积压情况。
在阿富汗的九个省份对医疗机构进行了横断面研究。对49个区随机选取的165家公立和私立基层医疗中心及医院进行了研究。本次调查使用了世界卫生组织标准化问卷。2022年9月，经过培训的工作人员与医疗机构管理人员亲自会面，并通过个人访谈完成问卷。
医院大多位于城市地区（n = 39，65%），诊所大多位于农村地区（n = 74，71.1%），由政府和非政府组织管理（76.6%的医院和84.7%的诊所）。每家医院的平均工作人员数量为118人（标准差 = 180），每家诊所为16人（标准差 = 7）。27家（46.5%）医院和44家（41.9%）诊所报告称，与前一个月相比，它们在上个月的门诊服务利用率更高。疫情期间近一半的积压与常规预防服务有关，如年度体检、产前护理和儿童免疫接种（医院为55.0%，诊所为45.7%）。医院优先考虑高危患者（86.7%），在适当情况下推广自我护理干预措施（75.0%），将患者转诊至其他医疗机构（73.3%），为多种疾病患者在一次就诊中提供所有护理（60.0%），并为某些患者提供居家护理（58.3%）。然而，诊所最常用的策略是优先考虑高危患者（93.3%），将患者转诊至其他医疗机构（75.2%），以及为某些患者提供居家护理（66.7%）。
疫情加剧了现有的健康不平等现象，阻碍了全民健康覆盖（UHC）的进展。医疗机构采用了各种策略来应对干扰，如优先考虑高危患者、推广自我护理以及将患者转诊至其他机构。然而，交通和医疗服务成本的增加，以及药品供应有限，仍然是获得医疗服务的重大障碍。
