Protecting and improving healthcare: community insight from Afghanistan

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Lack of funding, the COVID-19 pandemic, and attacks on health care make Afghanistan’s health system fragile. Community perceptions on healthcare can inform better health programming.

Despite progress, Afghanistan continues to report health indicators that warrant improvement. Nationally, 30% of the population lack access to basic services. The health situation has been significantly worsened by COVID-19, with Afghanistan’s already weakened health system having limited capacity to deal with major disease outbreaks. Evidence gathered through rumour tracking in 2020 indicates that public trust in government healthcare facilities is low, and that pre-existing stigma and distrust of healthcare workers has been exacerbated by the pandemic.

Access is hampered by the pervasive lack of security: in many areas, health care facilities are under continuous threat of direct attacks, military occupation, forced closure, looting, and other forms of violence. Health care workers operating in such areas are at daily risk of physical and psychological violence, including kidnapping, blocked access, and harassment. A vicious cycle exists between community mistrust and attacks against health care: mistrust and misinformation can act as triggers for attacks, which in turn compromise delivery of health care services, leading to further lack of confidence in the health system and lack of community involvement in local efforts to protect healthcare systems. Barriers to essential health services and drivers of mistrust need to be better understood over time. Evidence generated so far has focused on limited direct access to services, but a deeper understanding of perceptions surrounding motivators or drivers of change is essential to developing appropriate mitigation strategies.

In collaboration with the WHO and the Awaaz Humanitarian Helpline, Ground Truth Solutions aims to identify and unpack barriers to essential health services, perceptions on trust in health workers and quality of care, and the general humanitarian response. Collecting perceptions and recommendations of communities in Afghanistan will enable health and other humanitarian actors to make informed decisions that improve the health response and strengthen a culture of accountability to affected people.