Mean travel costs to nearest health faclity in Afs.
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 Nationala. Health post
Community health worker 36 28 20 169b. Clinic
Doctor 74 38 38 45 Nurse 77 48 42 53 Midwife 74 60 64 62c. District or provincial hospital
Doctor 98 87 88 89 Nurse 99 89 87 91 Midwife 98 92 89 93d. Private doctor of hospital
Doctor 93 52 51 60 Nurse 84 47 38 54 Midwife 91 58 52 64d. 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.Parts
» MDG Indicators AFG 2007 NRVA report
» – Population structure and change 10 – Labour force characteristics 25
» – The agricultural sector 40 – Poverty incidence and poverty profiling 54
» - Education 65 - Health 73 Other Indicators
» Stakeholder involvement and questionnaire design
» Sampling design NRVA 20078 methodology
» Questionnaire contents and interviews
» Comparability of NRVA 20078 with previous rounds
» Data limitations NRVA 20078 methodology
» Second quarter December 2007-February 2008
» Third quarter March-May 2008 d. Fourth quarter June - August 2008
» Introduction - Household shocks and community preferences 109
» General population characteristics Population structure and distribution
» Geographic distribution Population structure and distribution
» Household structure Household structure and marriage patterns
» Marriage patterns Household structure and marriage patterns
» Total Fertility Rate Fertility and mortality
» Child mortality estimates Fertility and mortality
» General migration In-migration Migration
» Security and returnees Migration
» Conclusions - Household shocks and community preferences 109
» Labour force participation Labour force, employment and unemployment
» Employment and unemployment Conceptualisation of employment and unemployment
» Status in employment Characteristics of employment
» Industry and occupation Characteristics of employment
» Introduction Children and work
» Seasonal migration Labour migration
» Irrigated land Access to land
» Rain-fed land Access to land
» Crop production Agricultural production
» Opium production Agricultural production
» Introduction Irrigated land in summer
» Rain-fed land - Household shocks and community preferences 109
» Traction for cultivating land
» Use of fertilizers and pesticides
» Reasons for not cultivating land
» Community accessibility Rain-fed land
» Conceptualization of poverty Poverty across space and time
» Equality in consumption expenditure
» Household size and composition
» Characteristics of the head of household
» Characteristics of household members
» Introduction Literacy - Household shocks and community preferences 109
» Literacy rates - Household shocks and community preferences 109
» Gender gap indicators - Household shocks and community preferences 109
» Participation in school - Household shocks and community preferences 109
» Educational attainment - Household shocks and community preferences 109
» Travel time and travel costs
» Travel time to nearest health faclity: percentage with access within one hour
» Mean travel costs to nearest health faclity in Afs.
» Health post - Household shocks and community preferences 109
» Clinic - Household shocks and community preferences 109
» District or provincial hospital
» Private pharmacy - Household shocks and community preferences 109
» Supplementation of micro-nutrients Vitamin A supplementation
» Residence - Household shocks and community preferences 109
» Child immunization Educational attainment of mother
» Residence Educational attainment of mother
» Residence Educational attainment - Household shocks and community preferences 109
» Child feeding patterns Exclusive breastfeeding
» Educational attainment of mother
» Current use of family planning methods
» Use of maternal health care Antenatal care
» Fertility and pregnancy patterns
» Total - Household shocks and community preferences 109
» 16.9 - Household shocks and community preferences 109
» Conceptualisation and analysis of disability
» The distribution of the disabled population
» Causes and consequences of disability
» Housing characteristics Housing ownership and characteristics
» Construction material of walls
» 4.7 - Household shocks and community preferences 109
» Water and sanitation Housing facilities
» Other facilities Electricity Housing facilities
» Household decision making The position of women in decision making
» Age - Household shocks and community preferences 109
» Community decision making Marital status
» The face of women in population and marriage
» Labour force indicators - Household shocks and community preferences 109
» Education indicators - Household shocks and community preferences 109
» Educational disparities Indicators of community representation
» Health conditions Indicators of community representation
» Decision-making Indicators of community representation
» Household shocks and coping strategies
» Community preferences - Household shocks and community preferences 109
» Policy recommendations - Household shocks and community preferences 109
» Recommendations related to information provision
» Child health AFG 2007 NRVA report
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