BackgroundIn the last decade, the health status of Afghans has improved drastically. However, the health financing system in Afghanistan remains fragile due to high out-of-pocket spending and reliance on donor funding. To address the country’s health financing challenges, the Ministry of Public Health investigated health insurance as a mechanism to mobilize resources for health. This paper presents stakeholders’ opinions on seven preconditions of implementing this approach, as their understanding and buy-in to such an approach will determine its success.MethodsKey informant interviews and focus group discussions were conducted with stakeholders. The interviews focused on perceptions of the seven preconditions of introducing health insurance, and adapting a framework developed by the International Labor Organization. Content analysis was conducted after interviews and discussions were transcribed and coded.ResultsAlmost all of the stakeholders from government agencies, the private sector, and development partners are interested in introducing health insurance in Afghanistan, and they were aware of the challenges of the country’s health financing system. Stakeholders acknowledged that health insurance could be an instrument to address these challenges. However, stakeholders differed in their beliefs about how and when to initiate a health insurance scheme. In addition to increasing insecurity in the country, they saw a lack of clear legal guidance, low quality of healthcare services, poor awareness among the population, limited technical capacity, and challenges to willingness to pay as the major barriers to establishing a successful nationwide health insurance scheme.ConclusionsThe identified barriers prevent Afghanistan from establishing health insurance in the short term. Afghanistan must progressively address these major impediments in order to build a health insurance system.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2081-y) contains supplementary material, which is available to authorized users.

Some blind people use echoes to detect discrete, silent objects to support their spatial orientation/navigation, independence, safety and wellbeing. The acoustical features that people use for this are not well understood. Listening to changes in spectral shape due to the presence of an object could be important for object detection and avoidance, especially at short range, although it is currently not known whether it is possible with echolocation-related sounds. Bands of noise were convolved with recordings of binaural impulse responses of objects in an anechoic chamber to create 'virtual objects', which were analysed and played to sighted and blind listeners inexperienced in echolocation. The sounds were also manipulated to remove cues unrelated to spectral shape. Most listeners could accurately detect hard flat objects using changes in spectral shape. The useful spectral changes for object detection occurred above approximately 3 kHz, as with object localisation. However, energy in the sounds below 3 kHz was required to exploit changes in spectral shape for object detection, whereas energy below 3 kHz impaired object localisation. Further recordings showed that the spectral changes were diminished by room reverberation. While good high-frequency hearing is generally important for echolocation, the optimal echo-generating stimulus will probably depend on the task.

No abstract

No abstract

No abstract