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Table 3 Facilitators, barriers and recommendation affecting health system in conflict areas of Afghanistan

From: Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan

 FacilitatorsBarriersRecommendations
Health Workforce- Hiring of qualified local people along with incentives for retention- Unpredictable security conditions- Hire more female staff and reduce gender imbalance
- Security threats- Send female staff on rotation basis to conflict areas
- Lack of female health workers- Provide adequate training
- Absenteeism and lack of capacity of healthcare staff- Provide housing and basic necessities
- - Low salaries- Merit based hiring
- Absence of accommodation and basic facilities for doctors- Doctors or staff to provide replacements when going on leave
- Quacks (traditional or religious healers) are preferred by people over doctors
Service Delivery- BPHS and EPHS has improved service delivery (through contracting out)- Non-functional healthcare facilities- SOPs should be implemented
- Changing demographic pattern- Work on infrastructure for the uptake of health care intervention
- Establishment of various new primary healthcare facilities- No services in remote areas
- Lack of HIV prevention program, orthopedic care, dental care, laboratory and screening tests and emergency care- Stringent monitoring mechanisms using technology
- Improve community awareness and mobilization activities
- Poor infrastructure- Improving CMWs functionality
Supplies and Commodities- Different donors provide different supplies and services- Short budget allocation on supplies-Procurement decisions at the province level
- Enough supplies were provided- Conflict blocked supplies to the facilities- Procurement systems to simplified and made efficient
- Supply of fake medicines and documentation- Strict monitoring
- Allocation of budget for medicines not revised according to present needs- Stringent quality checks
- Absence of diagnostic facilities
Monitoring and Reporting- Developed SOPs- Poor quality of data- Promote E-Health
- Encourage third party monitoring- Preference of manual work over computer use- Improve quality of data
- EHIS system for reporting- Capacity gap- Do situational analysis before implementation
-Data to be used for decision
Finances- Donor dependent funding- Insufficient funds- To ensure sustainability of funding for existing programs
- Delay in release of funds from the donors
- Poor practice of budget allocation and improper utilization of funds
  1. CMW Community Midwives, SOPs Standard Operating Procedure, MnE Monitoring and Evaluatio, EHIS Evaluation and Health Information System