Long distances to health centers, economic problems, and shortages of female doctors, medicines, and medical equipment have created serious difficulties for women in rural areas in accessing healthcare services. According to statistics from the Ministry of Public Health, more than 4,000 health centers are operating and more than 35,000 health workers are currently working across Afghanistan.
This report is based on interviews with 19 women, eight men, four doctors, two midwives, and one nurse in 11 provinces. Among the 19 women interviewed, 18 said they did not have easy access to health services, while only one woman said she had relatively easy access to these services.
The women who participated in this report identified poverty, shortages of medicines and medical equipment at rural clinics, poor roads, long distances between health centers and their homes, and transportation problems as the main factors limiting access to health services.
Fatima, a 31-year-old resident of Nahrin district in Baghlan province who suffers from kidney stones, says the long distance to health centers and the lack of transportation have made it particularly difficult for her to access medical services, especially at night and during winter.
“In winter, it sometimes takes more than five hours to travel from our area to the health center, and when it rains, traveling becomes almost impossible. Many times, I have to wait for hours to find a car. One night, I was in severe pain. I felt like I was going to faint from the pain, and my husband tried very hard to find a car, but there was no vehicle available to take me there,” she says.
The lack of female doctors, shortages of medicines, and the poor quality of health services and medicines were also among the concerns raised by the women interviewed.
Among the 19 women interviewed, 12 said there were no female doctors or that female doctors were not available during all clinic working hours. Four said there were female doctors at their health center, but the number of female doctors was not enough to meet patients’ needs. Three others said that a shortage of medicines was one of the main problems they faced when visiting health centers.
Pari Gul, a 26-year-old resident of Gharb-e Aqsa village in Pashtun Kot district of Faryab, says the lack of female doctors and shortage of medical facilities have created serious difficulties for her and other women in the village.
“When we go to the clinic in our village, there is one doctor and one midwife. Most of the time, the male doctor is there. He does not examine us; he just asks from a distance where it hurts. If he wants to, he checks our blood pressure; if he does not, he doesn’t. Because of this, we face many difficulties,” she says.
Similarly, Zarin, a 35-year-old resident of Archeto village in Sancharak district of Sar-e Pol, considers the lack of female doctors and shortage of medicines at health centers to be the main problems facing healthcare services. She has to buy the medicines she needs in the city because of the shortage of medicines in her village.
“The lack of female doctors is one of our major problems. When there is no female doctor, many women do not feel comfortable, and some families do not allow women to visit male doctors. Also, the medicines we need are not always available at the clinic. Several times, we have been given prescriptions, but we have had to buy the medicines from the market, and they were too expensive for us,” she adds.
The challenges, however, do not end with women’s individual experiences. Some women also described cases in which other women lost their lives or faced serious health problems because they could not reach a doctor or health center in time.
Of the 19 women interviewed, 11 described serious incidents caused by the lack of health services, long distances to health centers, and delays in transporting patients. They recalled cases of women dying from severe bleeding and women giving birth on the way to hospitals.
Fatima, a 20-year-old resident of Takhta Chenar village in Shahristan district of Daikundi, recalls the death of a woman after childbirth because of severe bleeding.
“One of our neighbors was poor. She gave birth and then had severe bleeding. Here, people rely on traditional midwives. Traditional midwives do not know enough and cannot stop the bleeding. Because of the severe bleeding, she died on the way to the health center,” she says.
Among the 19 women interviewed, seven said delays in receiving treatment had reduced their ability to carry out daily activities and care for their children. Six talked about the financial pressure caused by medical expenses, buying medicines, and transportation to health centers. Another six said these difficulties had increased worry and anxiety in their families and made them fear that the health conditions of family members would worsen.
Mahnaz, a resident of Tonikah village in Jawzjan, says the lack of a clinic in their area has made life difficult for her and her family and has delayed access to medical services and treatment for herself and her children.
“Life has become very difficult for us and our children. When we get sick, we cannot go to a clinic or hospital because it takes too much time to get there. Because of this, our living conditions are very difficult, and we suffer a lot because there is no clinic,” she says.
Alongside women, men living in rural areas also spoke about their experiences and concerns regarding women’s access to healthcare services in their families. All eight men interviewed said that, at least once, treatment for women in their families had been delayed because of economic problems, a lack of a vehicle, or the long distance to a health center.
Abdul Hamid, a 48-year-old farmer and resident of Khost wa Fereng district in Baghlan, says economic problems and the lack of a female doctor in the area have prevented his family from accessing medical care on time. He says this situation caused the loss of his child.
“If the women in our family become sick, it is not easy for them to see a doctor. There is a long distance between our area and the health center, and this problem causes many patients to remain without treatment for days or even weeks,” he says.
Mohammad Amin Bahrami, a 17-year-old resident of Shahristan district in Daikundi, also says that his family’s economic problems prevented his grandmother from accessing medical services on time, and she died because of the delay in treatment.
“In our family, my grandmother was sick, and because of economic problems, we did not have enough money to take her to a doctor. By the time we were able to take her to a doctor, it was already too late, and unfortunately, she died,” he adds.
Interviews with four doctors, two midwives, and one nurse in villages across seven provinces also show that the healthcare delivery process in rural areas faces limitations because of a shortage of medical facilities and services.
Sharmila Habibi, an obstetrician and gynecologist in Kohistanat district of Sar-e Pol, says long distances, lack of transportation, a shortage of female doctors and midwives, and poverty have limited women’s access to healthcare services. She explains,
“Problems such as long distances, a lack of transportation, a shortage of female doctors, and poor economic conditions have prevented many women from visiting health centers. Our facilities are limited, and there are not enough necessary medicines or equipment to meet the needs. Fortunately, no maternal deaths were recorded at our center last year, but about 10 child deaths were recorded, most of them due to delays in seeking treatment, long distances, a shortage of facilities, and poverty.”
A number of obstetricians and gynecologists also consider women’s timely access to health services one of the important factors in reducing maternal deaths. Abeda Raha, an obstetrician and gynecologist, says,
“Women’s access to health services plays a very important role in reducing maternal deaths. When pregnant women and mothers have timely access to healthcare and health services, their health problems can be diagnosed on time, they can receive proper advice, and postnatal care can be provided properly. As a result, maternal deaths can be reduced.”
Meanwhile, Abdul Ghaffar Ghaffarzada, a religious scholar, says that to protect the health of citizens, including women, healthcare services need to be expanded as much as possible across Afghanistan.
“The government is responsible for meeting people’s basic needs, whether healthcare, religious education, or health services for children, women, and others. One of the objectives of Sharia is to protect life, so efforts should be made in this area. To protect women’s health, health centers should be established,” he says.
However, officials at the Ministry of Public Health say that more than 4,000 health centers are operating across Afghanistan. Sharafat Zaman Amarkhil, spokesperson for the Ministry, says these centers provide health services at different levels and that more than 35,000 female and male workers are working within the ministry’s formal structure.
“The Ministry of Public Health has more than 4,000 health centers across Afghanistan that provide basic services as well as tertiary-level services, including surgery. Some hospitals operate with funding from international organizations, while others provide services as part of the Ministry of Public Health’s formal structure. The Ministry of Public Health’s formal structure across the country consists of a workforce of more than 35,000, including both women and men,” he adds.
Findings from international organizations also show that challenges in accessing health services in Afghanistan continue. The World Health Organization (WHO) and the United Nations Population Fund (UNFPA) have said that funding cuts and existing restrictions have left women facing more challenges in accessing health services, particularly in remote areas.
Reporter: Momina Zarif
