By Zarghoona Salehi
Millions of dollars have been poured into the health sector. Yet for many Afghans the nearest health centre is roughly three days away, and two-thirds of pharmacies do not have professional staff. An investigation by the Independent Media Consortium (IMC) Productions.*
Poor quality medical care has forced tens of thousands of Afghans to go abroad for treatment. Medical tourism has become a thriving industry in countries in the region.
The Ministry of Public Health (MoPH) admits to serious problems but blames it on a funds crunch. There is an acute shortage of medical facilities, medicines and health professionals particularly women doctors.
Pharmacies
Administration manager in the department of pharmaceutical affairs in MoPH Zekria Fatehzada says there are some 4,000 trained pharmacists and assistant pharmacists. Dr Sayed Ibrahim Kamel who head the ministry’s monitoring department, says more than 12,000 pharmacies are licenced. Under the law a pharmacy must have at least one assistant pharmacist.
Saifullah from Ghazni who is a graduate of the Omar Pharmacy institute in the province but does not work in a drug store, says most staff in pharmacies have not finished school. He says he has no faith in the staff. “Once I wanted a pain killer but they gave me an antidote for poison. When I asked them why they had given me a wrong drug, they said it was the same as written on the prescription. But that was not the case at all,” he says.
An Afghan man holds his 8 year old daughter waiting in line for an appointment at Boost Hospital in Lashkar Gah, Helmand province, Southern Afghanistan. (Photo: Mikhail Galustov)
Malek Delagha of Karokhil village in Khak-i-Jabbar district, Kabul province, told IMC of a pharmacy in the district where a 12-year-old boy was dispensing drugs. IMC interviewed the owner of the drug store, Noorwali, who claimed his son was 18 years old and studying in class 11. “He is only a cleaner in the store. I am selling the medicines,” he insisted.
Noorwali said he did a 13-months course for health workers after he graduated from school. He admitted his store was not licenced. “District health authorities have threatened to shut it down if I don’t get the permit,” he said.
The health department head of Khak-i-Jabbar Dr Zabihullah pointed out “unlicensed” pharmacies are a problem in many parts of the country.
Dr Mohammad Hasem Wahaj of Wahaj Diagnostic Clinic and Hospital in Kart-e-Parwan, Kabul, blames the authorities. “Statistics show there is one pharmacist for three drug stores. Who gave the license? How could the pharmacy be opened?” he asks.
He claims “high-ranking” officials in the MoPH are giving “extraordinary orders”. According to the doctor, he was once in a meeting of Welfare Commission of the National Assembly and heads of health laws and pharmacies of MoPH were present. “When they (heads) were asked why they allowed pharmacies to open without pharmacists, they said they received extraordinary orders from high ranking authorities,” he says.
Roshan Ara Alokozai, the secretary of the Welfare Commission, confirms they receive many complaints about unprofessionally-run pharmacies. MoPH officials have been summoned many times by the Commission, and they promise to sort out the problem but nothing changes, he adds.
Meanwhile, Deputy Minister of Public Health Dr Ahmad Jan Naeem insists, “We have not given extraordinary orders.”
He claims more than 12,000 licences for pharmacies were issued because there was no system of keeping track. “Now the ministry has a database, and knows who has opened or shut a drug store. We have taken the issue seriously,” he says.
According to Naeem, the council of ministers has taken a decision not to allow new pharmacies. Also, the MoPH has started investigations, and will cancel the licences of those who don’t have a pharmacist on their staff.
Director of Ibn Sina Emergency Hospital Dr Gula Jan Rahmat says patients are at risk when they consume the wrong medicines. He urges doctors to write out prescriptions clearly. “It has happened frequently that the doctor writes in shorthand and the untrained drug store assistant gives the wrong medicine.”
Street sellers
Hawkers sell medicines and tonics on the streets in Kabul. Ahmadullah has been hawking anti-pain cures and tonics next to Pul-e-Kheshti for three years. He says he pays the police to look the other way. Ahmadullah does not think his business is wrong. He says he has studied up to class five, and understands the medicines he dispenses.
He says he has a number of customers, and makes a fair living. He purchases the medicines from wholesale dealers.
IMC tried to interview other hawkers but they were scared to talk. Medicines are sold on the street in Charikar City, Parwan. In Khak-i-Jabbar customers can buy medicines in food stores. However, the business has gone off the roads of Kandahar City.
MoPH’s Dr Kamel says they plan to intensify monitoring. In Kabul “we will go to areas where hawkers are to be found, and confiscate their medicines,” he told IMC. But he admits that the hawkers will come back. “Unfortunately they come back … this is a chronic issue. The police should help us more,” he says.
Deputy spokesman of the Ministry of Interior Affairs (MoI) Najibullah Danesh says steps have been taken to stop hawking of medicines, and selling expired medicines.
He claims the police could never have taken a bribe from hawkers. “Our police has never perpetrated this (bribes),” he insists.
Scattered health centres
Mohammad Emran of Khwahan district in Badakhshan province says there are health centres in district headquarters but not in the villages.
Villagers living in the district’s Hawza Shah Bala, Hawza Shah Payeen, Rovenza, Gardi Bala, Safed Tangan, Cheshma Kel , Bostanak, Shalez, Chetgar, Luqman, Roteghza, Yakh Dara, Ghozan, Sheen Dara villages have to travel three days to get to the clinic.
There are no roads, and patients make the perilous mountain journey on donkeys. Between November and June the passes are blocked by snow.
Dr Noor Mohammad Khawari, the head of the provincial health department, admits there is a problem. “The problem is bigger in Badakhshan province than in other provinces,” he says.
Meanwhile Saifullah of Ghazni City says there are no health centres in the province’s Giro, Nawa, Ajrestan districts due to security problems. Patients are brought to Ghazni City which is between 100 and 150-kms away.
People who can’t afford to hire a vehicle have no access to health services, according to Saifullah.
Dr Ziagul Esfandi, the head of the health department of Ghazni, claims only Giro does not have a health centre.
• Villagers in Deh Yak in Khuja Omari district, Ghazni, say it takes them five hours to get to the health centre.
• From Ghaziabad district, Takhar, the nearest health centre is five hours in a car.
• The distance between Spera district, Khost, and the health centres is 120 km.
• Villagers of Sang Bolan in Kajaran district, Daikundi province, have to walk four hours to get to the health centre.
Deputy Minister of Public Health Dr Naeem says there are mobile health teams for remote areas, but Mohammad Omran, a resident of Khwahan district, insists no one has seen it.
According to information from the deputy public health minister, in 2001 there were 450 clinics and hospitals countrywide – catering to 9 percent of the population. Now there are 2,052 providing health care to 65 percent of people. However, the Afghanistan Independent Human Rights Commission (AIHRC), which has conducted a survey that is not yet published, believes only 58 percent of people have access to health services.
Female doctors
Health services are severely hindered by a shortage of female doctors. Strict segregation laws, particularly in rural areas, prohibit women from being treated by male doctors.
Abdul Jalil, a village elder from Shenan Village, Dai Chopan district in Zabul province said while all districts have a health clinic there are no female doctors or midwives. Female patients have to travel six hours to the provincial hospital in Qalat.
The journey is dangerous. Two weeks ago, a car carrying a patient from Mara Village in the district hit a roadside mine. Three passengers were injured.
Residents of Ghazni, Paktika, Kunduz, Farah, Bamyan, Kunar, Logar and Helmand provinces told IMC there were no female doctors or midwives in health centres.
Afghanistan has the worst rate of maternal mortality in the world, according to the World Health Organisation. But MoPH insists the situation has improved over the last 12 years. While one woman lost her life in child birth every half hour in 2001, the death rate is now one in two hours. The MoPH has tried to attract women doctors to work in remote areas with salaries that are nearly double male doctors.
* Independent Media Consortium is a joint initiative of Pajhwok Afghan News, The Killid Group (radio and print media), Saba Media Organisation (Saba TV-Radio Nawa networks) and Hasht-e-Subh. This story is part of a series of investigative reports on corruption and human rights cases supported by Tawanmandi.
A report by Pajhwok reporter Zarghoona Salehi