Travel time to nearest health faclity: percentage with access within one hour

Health 76

8.2.2 Impeded access for women

It should be borne in mind that access to health services is even more constrained for women, since they are usually required to be accompanied by a male, doubling any travel costs. Thus, for a typical female rural patient, a return trip to a health facility will easily amount to several hundreds Afghanis, which is a large sum in a low cash-flow economy like that of Afghanistan. Another section in the NRVA questionnaire investigated into the reasons for not seeking medical care by women and girls who had been ill or injured. 1 This showed that among the multiple reasons that could be mentioned, 47 percent of women and girls cited distance as a reason and 49 percent cited expenses without specifying travel costs or other medical costs. Apart from restricted mobility, the provision of services itself may also involve cultural barriers if a female client or her husband or family disapproves of treatment by male health staff. This barrier is real, as the health system not only faces a critical shortage of health care workers at every level, but especially of female staff, which is also related to low female education levels see chapter 7. Table 8.2 shows the assessment of the presence of female health staff by community shuras in various health facilities. It is evident that within the public health structure only higher up in the referral system and in urban areas any presence of female staff reaches higher levels. However, the picture should not disguise the fact that even in clinics and hospitals, the share of female staff is inadequate within the cultural context of Afghanistan. This underrepresentation of female health personnel may significantly contribute to the low level of antenatal care and professional birth attendance see section 8.4.2, and consequently to the presumed high maternal mortality ratios. The survey question on reasons for not seeking care indicated that 6 percent of women and girls mentioned the lack of female health personnel, 5 percent mentioned that there was no one to accompany them, and another 5 percent mentioned other traditional constraints, such as prohibition by the husband or family. Table 8.2 Percentage of female staff among total health staff, by residence, and by type of health facility, type of staff Shura assessment Type of health facility, type of staff Residence Urban Rural Kuchi National

a. Health post

Community health worker 36 28 20 169

b. Clinic

Doctor 74 38 38 45 Nurse 77 48 42 53 Midwife 74 60 64 62

c. District or provincial hospital

Doctor 98 87 88 89 Nurse 99 89 87 91 Midwife 98 92 89 93

d. Private doctor of hospital

Doctor 93 52 51 60 Nurse 84 47 38 54 Midwife 91 58 52 64

d. Private pharmacy

Doctor 15 12 7 12 _________________________________________________________ 1 No less than 2.4 million women and girls of age 10 and over reported having been ill or injured in the month preceding the survey, which corresponds to 32 percent of the female population in that age range.