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Health facilities remain in a shambles: IWA study

Health facilities remain in a shambles: IWA study

Aug 23, 2017 - 18:55

KABULinfo-icon (Pajhwok): The Integrity Watch Afghanistaninfo-icon (IWA) on Wednesday said healthinfo-icon facilities across the country were unable to provide required services despite million of dollars investment by donors over the years.

Presenting an analytic report on the state of public health facilities in the country, IWA in a statement said it inspected 184 public clinics and hospitals in eight provinces built or operated with donor money

The report shows despite spending hundreds of millions of dollars by the donor community on Afghanistan’s public health sector, these facilities across the country face major deficiencies.
More than half of the facilities are experiencing structural and maintenance problems and a majority of the facilities need urgent repairs, the report finds.

Almost half of the facilities are in poor hygiene and sanitation conditions with a quarter of them not having toilets.

Four out of 10 health facilities lack potable water system while one in every five facilities has no electricity at all.

Access to health facilities is mentioned a major problem in the IWA report that claims two-thirds of the health facilities do not have ambulances, adding to difficulties in accessing clinics and hospitals.

But despite these problems, a significant number (99 percent) of the facilities remain operational during day time, the report says.

Furthermore, lack of adequacy among hospital staff was observed in public sector healthcare facilities, especially among female medical staffers who were culturally required to attend female patients
Speaking to reporters in Kabul, Integrity Watch Afghanistan director Sayed Ikram Afzali: “The study shows that for adequate health services delivery, it is not enough to just build clinics and hospitals.”

He said major issues in the public sector hospitals included lack of maintenance, unaccessblr medical staff, lack of female health-care staff, and poor management. “These deficiencies weaken the capacity of healthcare delivery in public hospitals and clinics,” he added.

 “The research provides a number of lessons to learn,” said Ezatullah Adib, Research Manager at Integrity Watch Afghanistan, who worked on the report.

“Observation of our surveyors provides an insight into the nature of shortcomings that limit the capacities to deliver quality services in the health facilities,” he said.

“Buildings of the health facilities are in a poor state have structural problems like leaked ceiling, cracked walls, lack of water supply or sanitation. It has been learned that people in some areas do not have access to hospitals or clinics due to bad condition of roads or uncertain security situation.”

Abid continued many health facilities in the country reported non-availability of medical equipment and supplies while poor management and irregularities were seen in other facilities, indicating poor planning and budgeting.

 “Weak monitoring results in bad maintenance and mismanagement that leads to bad service delivery” Afzali said. “Therefore, to avoid such problems, regular monitoring by the government and the communities around the facilities is a dire need”, he added.


  • To accrue returns from both past and future investments in public healthcare, it is urgent for MoPH to first focus on rectification of the problems (structural, operational and management) of the current facilities and then undertake forward planning for new expansion and construction.
  • For realistic planning, visits to operational facilities to reduce existing problems. For best results, the site inspection team should be composed of ministry officials, civil societyinfo-icon organizations, community representatives, medical professionals, engineers and budget and audit specialists.
  • The inclusion of expertise on budget is essential for estimating realistic budget needs for construction, operation, maintenance and monitoring.
  • Community monitoring and oversight is an option that should be considered



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