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Availability of health care staff
In the gender-sensitive context of Afghanistan, another impeding factor to seek health care is the absence of same-sex health care staff. Results from the NRVA 2011-12 show that within the public health system only higher up in the referral system and in urban areas any
presence of female staff reaches levels close to full coverage Table 9.2. For example, in rural areas only 52 percent of the population can
consult a female doctor in a public clinic and for 14 percent no midwife is available. However, compared to NRVA 2007-08 the availability of female health care staff has increased signiicantly: the corresponding igures for female doctors and midwives in public clinics at
that time were 38 and 60 percent only CSO 2009. The availability of male health care staff is generally better guaranteed. The igures presented here should be treated with care because of high non-response rates, as well as because of the possible respondents’ inability
to distinguish between different health care staff.
Table 9.2: Availability of health care staff in nearest health facility, by sex of staff, residence, and by health care provider, staff type in percentages
a
Type of health facility, residence Female health care staff
Male health care staff Urban
Rural Kuchi
National Urban
Rural Kuchi
National
a. Health post
Community health worker 91.9
58.3 45.9
67.4 96.8
72.7 93.9
79.6
b. Public clinic
Doctor 96.0
52.3 52.3
63.1 98.9
91.4 100.0
93.6 Nurse
96.0 66.3
60.1 73.3
97.2 88.5
96.8 91.0
Midwife 96.7
85.5 80.4
87.9 na
na na
na
c. District or provincial hospital
Doctor 97.6
87.1 89.0
89.7 100.0
97.9 100.0
98.5 Nurse
99.6 92.0
97.9 94.1
97.7 86.5
96.5 89.8
Midwife 100.0
97.1 98.6
97.9 na
na na
na
d. Private doctor or hospital
Doctor 95.7
72.3 88.9
79.1 98.3
92.0 100.0
94.0 Nurse
95.9 74.5
92.4 80.8
87.2 63.8
96.1 71.6
Midwife 97.9
86.3 92.4
89.5 na
na na
na
a
Figures are indicative only due to high levels of missing values, ranging from 8 percent for district or provincial hospitals to 43 percent for health posts.
9.2.2 Household expenditure on health
The 2006 AHS found that the third-most important reason – with 24 percent of all reasons – for not seeking medical care was the inability to pay the cost of treatment. For many households health expenditure may be prohibitive, especially
if advanced and prolonged treatment or hospitalisation is required. Table 9.3 provides an overview of out-of-pocket expenditure on health in the year preceding the NRVA 2011-12 interviews.
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Less than one quarter of all households had any costs for in-patient care, but if costs were made it was usually a large amount with a median of 6.6 thousand Afs. and an average expenditure of 34 thousand Afs. On average households
in Afghanistan – including those without costs – mentioned an expenditure of 7.5 thousand Afs. for in-patient care. Expenditure on out-patient care was considerably lower with a median of 300 Afs. and a mean of 1.5 thousand Afs.
by all households, but was made twice as often – by 51 percent of all households – as in-patient care costs. Other health-related expenditure was again smaller but more frequent by 63 percent of households. Overall, households in
Afghanistan spent on average more than nine thousand Afs. on health care, with a median expenditure of 1.1 thousand
Afs. For those households that did make any costs the corresponding igures are, respectively, 11.2 and 1.6 thousand Afs. It is notable that urban households have a signiicantly higher level of expenditure than rural households, which is
likely related to lower urban poverty levels and better access to health services.
Table 9.3: Mean and median household health-related expenditure for A. Households with speciied expenditure and B. all households, by expenditure type, residence in Afghanis
A. Households with speciied expenditure B. All households
Expenditure type, Households with expenditure
All households Mean
Median Mean
Median
a. In-patient care expenditure
Urban 46,445
8,000 11,376
Rural 30,756
6,000 6,586
Kuchi 21,082
6,000 3,684
Total 34,281
6,600 7,504
b. Out-patient care expenditure
Urban 3,735
1,100 2,119
450 Rural
2,535 1,200
1,301 200
Kuchi 1,903
1,200 901
Total 2,796
1,200 1,463
300
c. Other health-related expenditure
Urban 661
250 429
100 Rural
651 300
371 100
Kuchi 518
200 315
90 Total
646 300
381 100
d. Total health-related expenditure
Urban 16,021
1,600 13,924
1,200 Rural
10,035 1,600
8,258 1,050
Kuchi 6,103
1,380 4,900
1,000 Total
11,232 1,600
9,348 1,100
