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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

 

Facilitators

Barriers

Recommendations

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