An assessment of the barriers to accessing the Basic Package of Health Services (BPHS) in Afghanistan: was the BPHS a success?

Abstract

Afghanistan is one of the most fragile and conflict-affected countries in the world. It has experienced almost uninterrupted conflict for the last thirty years, with the present conflict now lasting over a decade. With no history of a functioning healthcare system, the creation of the Basic Package of Health Services (BPHS) in 2003 was a response to Afghanistan’s dire health needs following decades of war. Its objective was to provide a bare minimum of essential health services, which could be scaled up rapidly through contracting mechanisms with Non-Governmental Organisations (NGOs). The central thesis of this article is that, despite the good intentions of the BPHS, not enough has been done to overcome the barriers to accessing its services. This analysis, enabled through a review of the existing literature, identifies and categorises these barriers into the three access dimensions of: acceptability, affordability and availability. As each of these is explored individually, analysis will show the extent to which these barriers to access are a critical issue, consider the underlying reasons for their existence and evaluate the efforts to overcome these barriers. Understanding these barriers and the policies that have been implemented to address them is critical to the future of health system strengthening in Afghanistan.

“The midwife helped me ... otherwise I could have died”: women’s experience of professional midwifery services in rural Afghanistan - a qualitative study in the provinces Kunar and Laghman

“…Thus some women, regardless of their age, felt confident about coping with childbirth on their own. As has been observed elsewhere in Afghanistan, some viewed pregnancy and childbirth as natural processes that should not require external help [8]. Such cultural attitudes may on the one hand reflect resilience, but on the other hand represent barriers to safe childbirth in the event of unexpected problems and emergencies.…”

“…The ongoing conflict and insecurity situation in Afghanistan is well known, is currently worsening and is an international concern. This pervasive situation reduces the availability of healthcare and limits access to essential health-care services in the long run [8,26]. This has a secondary impact on health-care workers and health-care services, as they have become integrated into the conflict.…”

“…This has a secondary impact on health-care workers and health-care services, as they have become integrated into the conflict. Nevertheless, healthcare providers continue to provide services and expose themselves to this insecurity [8,26].…”

“…The Basic Package of Health Services (BPHS) was introduced in 2003, to address the country's poor health indicators. The maternal mortality ratio in Afghanistan was by then 941/100,000 [1], and in some areas of the country 1600/100,000, which was among the highest number ever recorded [8]. After implementation of BPHS, both access to and utilisation of health-care services increased [8,9].…”

Accessible magnetic resonance imaging: A review

“…Iraq, with 1.629 pmp with a life expectancy of 70 years, upper‐middle income group, and an Internet user group of 9.2%, is the median observation in the region. The geographical, economic, and cultural MR access challenges in Afghanistan are attributed to acceptability (cultural norms), affordability, availability, landlocked mountainous terrain, and recent unpeaceful history, among others . Qatar, on the other hand, has utilized its economic prowess and efficient policy making to rank as the 13 th best healthcare system in the globe and the best in the Middle East (Legatum Prosperity Index 2017)…”