The new Afghan minister of public health, Ferozuddin Feroz, has started his job recently. With so many important health issues to deal with, I have come up three most significant tasks and challenges that the Ministry of Public Health has to deal with in the next five years.
1 – SEHAT (System Enhancement for Health Action in Transition) is a 5-year health project that has two components: (1) to implement basic package of health services (BPHS), and essential package of hospital services (EPHS); and (2) to strengthen the stewardship role of the MoPH. The project runs between 2013 and 2018 with planned $408m dollars. The World Bank has committed $100m dollars; the EU has also promised to join SEHAT; there is uncertainty whether USAID will join the two or not. If USAID withdraws its support from the health sector, SEHAT project will fall short of around $150m. The MoPH has to make sure enough funding is secured to maintain the current healthcare services across the country.
2 – Out of pocket expenditure: Despite millions of dollars of aid from international donors, the Afghan households carry the highest burden of the national health expenditure. The biggest challenge, and the most important one, for the Ministry of Public Health is to set up a health financing system (i.e. health insurance) to curb out of pocket expenditures. The ministry already have a draft of health strategy to tax aviation and mining sectors, and set up health insurance schemes; However, there is a long way to go between a draft of a policy to approving it, and putting it into practice. This also includes setting up policies to regulate and control the so-called ‘medical tourism’, which takes away almost $286m each year.
3 – Quality control. The number of hospitals and health clinics has increased dramatically in cities, and yet there is no mechanism in place to regulate and monitor the quality of services. A number of indicators that must be monitored regularly can be:
- Right diagnosis,
- Running appropriate diagnostic tests,
- Prescribing the right medications,
- Undertaking the right surgical operations correctly
- Treating patients with dignity and respect
- Quality control
- Cost control
Aside from professional ethical control, two equity-related indicators of quality are (1) geographical locations of hospitals at places where needed, and (2) controlling costs of medical services.
Challenges of public health in Afghanistan are many, and the three priorities can be the beginning to having a universal health coverage, which is accessible, high-quality, and equitable.