Policy Brief : Strengthening Afghanistan Healthcare Supply Assignment Sample

Introduction Of Policy Brief Strengthening Afghanistan Healthcare Supply Assignment

The healthcare system in Afghanistan faces problems because it does not have enough resources and a basic structure and depends heavily on outside help (Jabr, 2022). The healthcare and medical supply challenges grew greater thanks to political turmoil and security threats, plus disappearing foreign aid support that began in 2021.

Medical Supply Shortages

The medical sector suffers from empty shelves because importing medical supplies faces problems which create low availability of vital drugstore items and healthcare items (Abibo Wondie Mekonen et al., 2024). Healthcare facilities depend too much on foreign aid, making them react strongly when international funding changes. Limited pharmaceutical manufacturing within the country causes severe supply chain issues that force healthcare facilities to run out of needed medications.

The funding from the international market has put medical supply chains under immense pressure due to their financial breakdown. Many medical supplies were being imported from various international organizations, and many of those sources either cut back on their support or stopped altogether (Bown, 2021). As the country has not been able to obtain loans and faces severe restrictions on importing equipment and supplies, even the government and local healthcare providers have failed to help (Cohen and Rodgers, 2020). This situation is worsened by the absence of a viable, functional domestic pharmaceutical production joint venture, leaving the country’s markets highly vulnerable to expensive and frequently unreliable imported products.

However, the existing problems are so acute that the vaccination programs are the most affected. Outbreaks of polio, measles, and tuberculosis caused by routine immunisation campaigns have been exponentially interfered with in the current world (Jones et al., 2024). The outbreak of COVID-19 also worsened the situation, eradicating the developmental gains that were caused, and people’s vaccination uptake is slow because of the shortage and access constraints (Jones et al., 2024). The poorest and most vulnerable during the pandemic are pregnant women and newborns, patients with diabetes, heart disease, and other chronic diseases because they cannot receive the necessary medications and treatment.

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Healthcare Workforce Crisis

A major problem today is the industry's struggling supply of healthcare professionals. Doctors and medical staff depart Afghanistan due to unsafe conditions coupled with meagre salaries and restricted professional development paths (Filip et al., 2022). Women and children face restricted medical care because Afghan culture demands that physicians treating them must be female. Few medical training opportunities prevent from building a new generation of healthcare professionals, threatening the system's future survival.

Preventive healthcare programs have also been disgraced, which has caused the burden of infectious diseases to rise (Colzani, 2019). Tuberculosis, cholera and measles have recently occurred in different regions of the country and have also proved to be a major health menace. These outbreaks have almost become rampant due to the shortage of vaccines and antibiotics to address such issues, and this has placed the lives of thousands of people in intense danger (Ellwanger et al., 2021). The problem is compounded by poor or compromised availability of safe water resources and hygiene, resulting in water-borne illness.

Other diseases are becoming prevalent, such as cardiovascular diseases, cancer and diabetes, to mention but a few (Niohuru, 2023). However, most patients cannot get appropriate treatment due to a shortage of specialized healthcare providers and the absence of diagnostic equipment. Most of the Afghans who need surgery or other critical treatment have to miss out on the opportunity or try to find help in different countries, which is quite expensive and unachievable to most (Zhang et al., 2023).

Impact on Public Health

Preventive healthcare programs that halt infectious diseases have also suffered a reminiscent downfall (Caron et al., 2023). Tuberculosis, cholera, measles and other diseases have been described to be on the increase in various regions of the country, constituting a significant threat to human life. Due to the scarcity of vaccines and antibiotics, measures to curb these outbreaks have proven to be challenging, endangering thousands of lives. The effect is compounded by the scarcity of clean and safe water and poor hygiene in many areas of the world, which raises the incidence of waterborne illnesses (Okesanya et al., 2024).

There are also emerging other diseases known as non-communicable diseases, which include diseases of the heart, cancer, diabetes, and many more (Okesanya et al., 2024). Nonetheless, there is concern that many patients do not get the required treatment for various reasons, including a shortage of specialized healthcare personnel and the absence of diagnostic tools. A large number of these patients need surgical or other related procedures, and hoping to receive them in Afghanistan is utterly out of the question, or they have to go to neighbouring countries, which is financially and practically unfeasible for most (Hubbard et al., 2020).

Why This Issue Matters

The lack of health services in Afghanistan is an apparent suffering that has many impacts on socioeconomic and political realms (Dastan et al., 2021). This is in sharp contrast to developed nations. They have excellent healthcare systems, which means they have a productive working force in addition, they advance their nation’s economic woes. As the people are weak and sick, it hinders economic growth, making it hard for Afghanistan to reconstruct facilities and enhance the poor quality of life in the country. Besides, lacking good health could cause more violence and social discontent (Resta et al., 2021).

Target Audience: Afghanistan’s Ministry of Public Health

Afghanistan's healthcare system remains in a severe crisis, with shortages of medical supplies and doctors. Hospitals and clinics cannot cope with providing essential healthcare services because of years of political instability, economic decline and cuts in foreign aid (Filip et al., 2022). In rural areas, the lack of essential medical resources and qualified healthcare workers is highly costly to the situation, leading to increasing maternal mortality rates, vaccine-preventable disease outbreaks, and worsening of health outcomes (Hanson et al., 2022).

The Afghanistan Ministry of Public Health must confront the country’s health crisis. This policy brief examines the three strategic solutions to strengthen the health system and to improve service delivery. To increase the number of qualified professionals in the world of healthcare environments, expanding domestic medical training programs is essential. To improve workforce retention and capacity, medical education should be strengthened, desirable financial incentives should be provided, and working conditions should improve (Frenk et al., 2022). Sustaining international humanitarian aid can offer temporary health workers, mobile clinics that serve vulnerable populations and emergency medical supplies. PPPs (Public-Private Partnerships) will help develop local pharmaceutical production, investment in healthcare infrastructure and the introduction of digital health solutions enhancing health services efficiency and reach (Merry et al., 2023). Implementing these measures can help the Ministry of Public Health to undermine Afghanistan’s healthcare system and achieve a more resilient and self-sustaining healthcare system for Afghanistan.

Discussion and Critique of Policy Options

Policy Option 1: Strengthening Domestic Medical Training and Workforce Retention

Medical workforce programs at home could help to solve this problem (DAWSON et al., 2021). Afghanistan should use public funds to train medical students and pay competitive wages to healthcare workers to create a steady medical workforce. Establishing this system will build durable results but requires considerable funds and dependable leadership (Khan et al., 2024).

The MoPH is one of the most critical steps is to expand and improve domestic medical education and training programs to provide additional healthcare personnel (Makuku and Mosadeghrad, 2022). Reduction of reliance on external assistance is possible if it is invested into medical training institutions, scholarships for students studying healthcare professions and financial incentives for healthcare workers to stay in the country. To help meet that need, MoPH collaboration with regional partners including Pakistan, India and Iran to discuss training exchange programs with Afghan medical students and practitioners is a necessity (Boutros et al., 2023). This approach has several advantages. Enhancing medical education facilities and increasing scholarships for students who wish to study and later join the health facilities would eliminate the health professional shortage of the workforce (Rashed et al., 2024). Establishing adequate remuneration and improved working conditions would encourage locals to practice their occupations within the country instead of chasing employment opportunities in foreign lands. Other methods, such as increasing the reach of telemedicine and training the healthcare workforce online, might also help address the lack of medical educators and increase access to training in regions that lack facilities (Schwartz, Lane and Hassanpoor, 2023).

However, this policy has some issues. Due to the global economic downturn and scarcity of funds, it becomes almost impossible to top up the salaries or fund every training course. Moreover, the continuous political situation has reduced the chances of foreign medical schools, NGOs and investors investing in developing the health care personnel (Schwartz, Lane and Hassanpoor, 2023). Another significant difficulty is the scarcity of female teachers and trainers, and thus, the scarcity of role models to encourage women to become professional healthcare workers specialising in obstetrics and gynaecology.

Policy Option 2: Securing International Aid Through Structured Agreements

Though Afghanistan is unable to sustain its dependence on international humanitarian aid in the long run, a realistic short-term strategy for stabilising the healthcare system is to conclude structured, transparent and predictable agreements for aid (Rashed et al., 2024). Instead of looking to ad hoc humanitarian relief from organizations such as WHO, UNICEF and World Bank, however, the MoPH needs to work out bilateral and multilateral agreements with these organizations for dedicated funding for essential medical supplies and emergency response programmes (Blanchet and Shafique, 2023).

Unlike with general humanitarian aid, which loses control over the allocation of resources according to national healthcare priority, structured agreements allow the MoPH to retain some control over the resource allocation (Blanchet and Shafique, 2023). The ministry should create a national health coordination bureau that oversees aid distribution and gets more transparent in its effort to bridge the gap in access to health care all over provinces.

The most significant impact of this policy is that it would deliver an early boost to Afghanistan's challenged healthcare system. Aerial humanitarian assistance would further guarantee an unrelenting flow of medical supplies, drugs, and vaccines apart from overall medical equipment (Aggarwal et al., 2023). International organizations could also have their medical teams and mobile clinics reach rural deans where local health systems have collapsed. They could also assist with emerging quick-term social assistance projects to mitigate infectious disease contamination and enhance maternal and child health.

However, such dependence creates problems regarding future stability without the international community's help. Humanitarian support entails a constant change in funding due to some countries’ political affairs and preferences (Olatunji et al., 2023). Further, many NGOs lack the resources and security to work in Afghanistan and cannot implement massive, long-term aid projects. In addition, excessive reliance on foreign support hinders the further growth of the healthcare system because the government and businesses depend on extraneous cash rather than searching for enduring, domestic sources of funding (Olatunji et al., 2023).

Policy Option 3: Strengthening Public-Private Partnerships in Select Areas

Despite political instability, weak regulatory frameworks, and economic constraints, it is still challenging to encourage public-private partnerships (PPPs (Public-Private Partnerships)) in Afghanistan (Rezouki and Hassan, 2019). Nevertheless, despite this, the MoPH can consider limited and targeted partnerships in areas where private sector engagement, in particular, is possible, like pharmaceutical supply chains and essential healthcare services in urban centres. These agreements would allow the MoPH to instead pursue large-scale privatization of the low medicine supplies by entering service agreements with local regional pharmaceutical firms (Tabrizi et al., 2020). Further, contracting private clinics to serve in government-owned healthcare facilities in large cities could expand access to care using relatively little public investment.

These problems indicate political instability and a particularly fragile legal environment in Afghanistan, which can result in less private investment (Samsor, 2020). This creates uncertainty, and while some willing investors may be willing to proceed with the development of HC infrastructure, they are unlikely to do so without legal frameworks to protect healthcare investments or financial incentives and safeguards in place. Political risks also include corruption and governance issues that could dampen the public-private partnerships, and it would be hard to guarantee that private resources are being utilized for the benefit of public need and not for private gain (Afzali, Colak and Fu, 2021).

Comparison of Policy Options

The Domestic Medical Training and Workforce Retention policy targets the shortage of MSDH (MINISTRY OF PUBLIC HEALTH - MOPH) professionals by enhancing the production of more trained doctors, nurses, and midwives. It bridges the local need for skilled human resources, overcoming the problem of depending on foreign healthcare professionals (Afzali, Colak and Fu, 2021). However, it will not solve the current problem as training medical professionals involves time.

This policy provides an instant remedy by bringing nearly all vital medical resources and short-term health personnel on board (Flaubert, 2021). It has a timely supply of essential medicines, vaccines, and equipment to contain epidemic-prone diseases, lowering maternal and infant morbidity and mortality. However, it does not present a sustainable solution in the long run because Afghanistan still depends on foreign aid rather than engaging in building up its healthcare system (Kruk et al., 2019).

Through this policy, the government has encouraged local pharmaceutical production, training institutions for the health sector, and investment on health-related transport and communication (Kruk et al., 2019). It keeps reliance on foreign assistance for the long term and grants opportunities for high-quality treatment. Nonetheless, the delicate political environment and the lack of financial security imply that investors within the private sector of this country’s health sector could be financially insecure, thus restraining the instant effectiveness of a private sector approach (Haldane et al., 2021).

The population of this policy has a significant need for medical education and maintaining incentives for healthcare-providing personnel. However, due to the weak financial situation in Afghanistan and the absence of stable political leadership, it is often impossible to allocate enough money (Haldane et al., 2021). The implementation faces cultural obstacles even though gender remains an essential issue because it interferes with women doctors' training as well as their employment to treat female patients in Afghanistan.

This policy is probably the least problematic to implement in the short term, given that the World Health Organisation, the United Nations International Children’s Emergency Fund and Médecins Sans Frontières have provided emergency humanitarian assistance to Afghanistan. A more difficult problem is maintaining consistent funding and political support from donor countries as priorities shift and geopolitics evolves (Nilsen et al., 2020).

Policy Recommendation

A combined strategy with features from every policy alternative provides the best solution to Afghanistan's healthcare emergency (Basij-Rasikh, Dickey and Sharkey, 2024). Medical supplies need more help from international partners, while mobile clinics should offer basic healthcare immediately. Financial rewards and educational programs should begin now to protect experienced healthcare staff while teaching fresh graduates. Afghanistan's independent drug manufacturing and permanent healthcare facilities will eventually require fewer foreign healthcare donations (Karyda and Moka, 2022).

Medium-Term Strategy: Stabilizing the Healthcare System

The MoPH should join forces with regional academic institutions (Pakistan, India, Iran) in covering the medical exchange programs to address the shortage of doctors, nurses, and midwives. There is a need for Afghanistan to expand scholarships and residency training for medical students as well as strengthen existing medical schools with updated curricula and resources [Boutros et al. (2023)].

Blanchet and Shafique (2023) report on a successful strategy Bangladesh used to overcome its rural doctor shortage whereby medical graduates subject to a compulsory rural service program, which includes tuition waivers and security of employment guarantees. On the other hand, Afghanistan can take similar approach of requesting newly trained doctors to practice for a fixed term at rural area in exchange of educational scholarships and career advancement.

As Afghanistan lacks enough medical education facilities the trade off is logistical difficulty. Partnerships with regional medical schools will offset these challenges but partnering with NGOs that specialize in medical training can also help.

Another pressing problem is the lack of access to basic healthcare in rural and remote areas, which is very much due to the poor infrastructure (Valente et al., 2024). The MoPH should, therefore, seek to deploy short-term interventions to bridge the gap in existing healthcare. A practical way to expand mobile healthcare units and telemedicine programs would be in underserved areas where hospital infrastructure is minimal or nonexistent (Essar, Siddiqui, and Head, 2023). Apart from these, the deployment of emergency field hospitals and temporary clinics, backed by international NGOs and UN agencies, can provide emergency healthcare access in conflict affected zones (Essar, Siddiqui and Head, 2023).

There is a shortage of female healthcare providers in Afghanistan and given cultural restrictions, many women do not have access to medical care. To increase the training opportunities for female medical professionals, one way the MoPH can do is by establishing women only medical colleges and forming targeted scholarships to women pursuing healthcare careers (Basij-Rasikh, Dickey & Sharkey, 2024).

Launching women only nursing and medical training programs in Saudi Arabia proved successful in increasing female participation in the country’s healthcare. This model can be replicated in Afghanistan with incentives such as housing allowances, flexible workplace schedule and provision of childcare support to female healthcare workers (Frenk et al., 2022). Societal resistance in conservative regions can be traded off for the willingness to engage religious and community leaders to lobby for female medical training.

Long-Term Strategy: Building a Sustainable Healthcare System

A possible policy direction is to create self-sufficiency in healthcare workforce. Strategic investment in medical education and education of the workforce is needed and retention policies. To overcome the shortage of skilled professionals, expansion of medical school admissions, enhancement of residency programs, and specialized healthcare training (built in partnership with regional academic institutions) would be made (Singh et al., 2023). In addition, national scholarship and loan programs can encourage greater participation of students in careers in medicine, nursing and midwifery (Mcpake et al., 2023). This, however, is only successful if competitive salary structures and career advancement pathways are in place to stop skilled personnel from moving abroad (Mcpake et al., 2023). It is essential to address workforce retention to ensure that Afghanistan will have a reliable healthcare workforce.

For Afghanistan to become independent in the long term in healthcare, it must strengthen its domestic healthcare infrastructure as well as local pharmaceutical production. The two approaches involved encouraging public investment in the healthcare sector, and there was a focus on upgrading public hospitals and primary healthcare centres in rural and conflict-affected regions. Such a policy would enhance healthcare accessibility for underserved populations (Schwartz, Lane, Hassanpoor, 2023). Moreover, implementing a centralized system for medical supply distribution would help improve logistics efficiency and reduce shortages while ensuring prompt access to the necessary medicines and equipment (Schwartz, Lane and Hassanpoor, 2023).

Implementation Roadmap

Criteria for Choosing Options

Given Afghanistan’s current political and economic constraints, the policy option must be realistically implementable. The feasibility assessment includes:

Affordability: Is the option cost effective for an agency, in line with affordability constraints in the present politically and economically unstable conditions in Afghanistan?

We found that the MoPH can secure funding for the policy to be implemented and sustained, either from domestic sources or from international donors.

Does the option need significant infrastructure and regulatory frameworks that Afghanistan currently lack, or can it be quickly and efficiently executed?

For instance, mobile clinics expansion, telemedicine service expansion is higher ranked in terms of feasibility because they do not need high investment on heavy infrastructure nor relying on existing NGO support. Likewise, financial incentives to keep healthcare workers instead of starting new medical training programs is more financially possible compared to the other one with less funding or a quick policy change and taking more time than money and quick investment.

On the other hand, healthcare infrastructure public-private partnerships are also low in feasibility because private investors are shy to invest into an unstable environment. As Afzali, Colak and Fu (2021) have pointed out, both countries of South Sudan, and Ethiopia tested the assumption that foreign aid based healthcare solutions work surprisingly well in post conflict states more than a private investment driven models.

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