The distribution of the disabled population

Health 90 Figure 8.6 Labour force participation rates and unemployment rates, by disability status, sex

8.6 Conclusions

For various health indicators, the NRVA provided new information to assess the health status in the population and the performance of the health sector of Afghanistan. To the extent that methodological similarities allow, trends can be established by comparing the present results with the findings of the MICS 2003, NDSA 2005, NRVA 2005 and AHS 2006. The overall conclusion of this assessment is that many health indicators are improving, but remain well below desirable levels, and are often abysmal in comparison to levels in other countries. The build-up of health infrastructure and access to health services, especially in rural areas, are badly needed. It is, therefore, not surprising to find that improvement of health facilities invariantly ranks among the top priorities for community development, regardless of gender perspective. Presently, of the large rural majority seeking affordable public health care only about half 54 percent can reach a facility within one hour walking. In remote areas, where motorized transport is required to reach health centers, transport costs play an additional role as barrier to health care access. Women are in a particularly disadvantaged position since they usually cannot travel alone, which doubles out-of-pocket expenditure on transportation. In addition, lack of female staff – only 29 percent of nearest health posts has a female community health worker – feeds the resistance to health center visits by women in need of medical assistance, probably especially if it concerns reproductive health. These factors contribute to the low use of family planning 23 percent overall, 15 percent using modern contraceptive methods, antenatal care 36 percent and skilled birth attendance 24 percent, and denies many women life-saving emergency obstetric care. Early pregnancies, closely spaced births 53 percent of reported birth intervals less than 24 months and bearing many children a TFR of 6.3 further make women pay a high price for giving new life. For almost all indicators, the figures underline the substantial differences that exist between rural, urban and Kuchi populations. Whereas the NRVA analysis paints a harsh reality, it also discovers some hopeful signs of improvement. Section 3.3.2 reported that for successive younger cohorts the share of women marrying before age 20 declined and section