Handicap International experience in Afghanistan - CBM

The Health PictureAccess, Costs, NeedsSECTION3Since the end of 2001, attempts have been made by the government to secure peace and stability, andto rehabilitate the devastated infrastructures. Despite these efforts, the national health indicators remainalarming. The maternal mortality rate is reported to be 1600 per 100,000 live births, the under-five mortalityrate is estimated at 172 per 1000 births and the infant mortality rate is 115 per 1000 births 16 . Thesestatistics are the reflection of over twenty years of on-going conflict as well as political instability.While general statistics are used to gauge the progress of the health sector in addressing the needs of thepopulation, very little is known regarding the health status of one of the most vulnerable groups of Afghans,i.e., persons with disability. Knowledge regarding the health indicators of this population is very limited, evenmore so when it comes to their access to and use of health services. The 2005 National Disability Surveyin Afghanistan is the first survey aiming to provide insight into the health status and challenges faced byAfghans with disability.The Ministry of Public Health (MoPH) has been assigned the task of addressing the health needs of theAfghan population. In 2003, this ministry established a health services delivery policy called the BasicPackage of Health Services (BPHS) which outlined seven areas of priority in: maternal and newborn health,child health and immunisation, public nutrition, communicable diseases (tuberculosis and malaria), mentalhealth, disabilities, and finally, the supply of essential drugs. They were grouped into three tiers according topriority. Due to lack of knowledge on the scope of the problems, lack of resources and insufficient capacityto integrate services, both mental health and disabilities were associated with secondary tier interventions.With the revision of the BPHS in 2004 and 2005, the provision of mental health and rehabilitative servicesfor disabled Afghans was elevated to first-tier interventions. Despite this, comprehensive development ofservice-provision activities has been slow and is in need of guidance.Types of DifficultyIn general, persons with severe disability reported a number of difficulties in their ability:• To satisfy their daily self-care needs without any assistance or equipment (questions asked to childrenabove 8 years of age and adults);• To perform household chores (questions not asked to adult men);• To carry out tasks outside the house/in the field.While generalstatistics areused to gaugethe progress ofthe health sectorin addressingthe needs of thepopulation, verylittle is knownregarding thehealth status ofone of the mostvulnerable groupsof Afghans, i.e.,persons withdisabilityThis series of three major fields of activities gives a good overview of difficulties faced in everyday life byseverely disabled persons. Looking at the ability to function in everyday life also helps understand what theimpact of disability might mean to a household as a unit. The fact that a person with disability may requireassistance in a variety of tasks implies the need for caretakers within the household and/or the community.A large number of people rely on the other members of their family to fulfil their basic daily needs.Daily Self-Care NeedsOur results show that a majority of persons with disability need some kind of assistance in everyday functioning.This proportion can range from a minimum of 12.9% for going to the toilet and 13.4% for getting dressed,16UNDP (2004) op. cit.