Handicap International experience in Afghanistan - CBM
Handicap International experience in Afghanistan - CBM
Handicap International experience in Afghanistan - CBM
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The Health PictureAccess, Costs, NeedsSECTION3S<strong>in</strong>ce the end of 2001, attempts have been made by the government to secure peace and stability, andto rehabilitate the devastated <strong>in</strong>frastructures. Despite these efforts, the national health <strong>in</strong>dicators rema<strong>in</strong>alarm<strong>in</strong>g. 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 <strong>in</strong>fant mortality rate is 115 per 1000 births 16 . Thesestatistics are the reflection of over twenty years of on-go<strong>in</strong>g conflict as well as political <strong>in</strong>stability.While general statistics are used to gauge the progress of the health sector <strong>in</strong> address<strong>in</strong>g the needs of thepopulation, very little is known regard<strong>in</strong>g the health status of one of the most vulnerable groups of Afghans,i.e., persons with disability. Knowledge regard<strong>in</strong>g the health <strong>in</strong>dicators of this population is very limited, evenmore so when it comes to their access to and use of health services. The 2005 National Disability Survey<strong>in</strong> <strong>Afghanistan</strong> is the first survey aim<strong>in</strong>g to provide <strong>in</strong>sight <strong>in</strong>to the health status and challenges faced byAfghans with disability.The M<strong>in</strong>istry of Public Health (MoPH) has been assigned the task of address<strong>in</strong>g the health needs of theAfghan population. In 2003, this m<strong>in</strong>istry established a health services delivery policy called the BasicPackage of Health Services (BPHS) which outl<strong>in</strong>ed seven areas of priority <strong>in</strong>: maternal and newborn health,child health and immunisation, public nutrition, communicable diseases (tuberculosis and malaria), mentalhealth, disabilities, and f<strong>in</strong>ally, the supply of essential drugs. They were grouped <strong>in</strong>to three tiers accord<strong>in</strong>g topriority. Due to lack of knowledge on the scope of the problems, lack of resources and <strong>in</strong>sufficient capacityto <strong>in</strong>tegrate services, both mental health and disabilities were associated with secondary tier <strong>in</strong>terventions.With the revision of the BPHS <strong>in</strong> 2004 and 2005, the provision of mental health and rehabilitative servicesfor disabled Afghans was elevated to first-tier <strong>in</strong>terventions. Despite this, comprehensive development ofservice-provision activities has been slow and is <strong>in</strong> need of guidance.Types of DifficultyIn general, persons with severe disability reported a number of difficulties <strong>in</strong> 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/<strong>in</strong> the field.While generalstatistics areused to gaugethe progress ofthe health sector<strong>in</strong> address<strong>in</strong>gthe needs of thepopulation, verylittle is knownregard<strong>in</strong>g 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 <strong>in</strong> everyday life byseverely disabled persons. Look<strong>in</strong>g at the ability to function <strong>in</strong> 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 <strong>in</strong> a variety of tasks implies the need for caretakers with<strong>in</strong> 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 k<strong>in</strong>d of assistance <strong>in</strong> everyday function<strong>in</strong>g.This proportion can range from a m<strong>in</strong>imum of 12.9% for go<strong>in</strong>g to the toilet and 13.4% for gett<strong>in</strong>g dressed,16UNDP (2004) op. cit.