Assessing the health workforce in Afghanistan: a situational analysis into the country's capacity for Universal health coverage.

IF 3.1 2区 医学 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Narges Neyazi, Nima Yaghmaei, Mirwais Ahmadzai, Elisabeth Kleipool, Nadine Naumann, Myrte Wassenaar, Muhammad Haider Omar, Fethiye Gülin Gedik, Sandra Alba, Marjolein Dieleman, Abdul Ghani Ibrahimi, Alaa AbouZeid
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引用次数: 0

Abstract

Background: Universal health coverage (UHC) is a key component of Afghanistan's health plan, but the country faces challenges due to decades of conflict and instability. Concurrently, healthcare successes have been achieved despite significant shortages in the health workforce. A fit-for-purpose health workforce is crucial for achieving UHC, and requires decision-making by policy-makers driven by sufficient evidence. This study presents a comprehensive situational analysis of Afghanistan's health workforce in 2023, focusing on distribution by geography, gender, facility type, as well as trends in health worker production.

Methods: A multi-stage assessment of the active health workforce was conducted through a national census-style count using active registries and facility-level verification through sampled facilities visits. Health worker production was estimated through an analysis of enrollment and graduation figures from public and private institutions from 2019 to 2023.

Findings: We estimated 63,632 health workers in Afghanistan in 2023, with 73% in the public sector and 27% in the private sector. Key health workers (physicians, nurses and midwives) total 10.3 per 10,000 population, falling significantly short of the aspirational UHC threshold (44.5 key health workers per 10,000). Substantial geographic disparity exists between provinces, with remote provinces reporting far fewer key health workers compared to the national average and Kabul representing approximately 50% of the country's specialized physicians. Significant gender imbalances exist as only 18% of specialized physicians and 29% of nurses are female. Health workforce production is largely dependent on the private sector, and has declined for certain cadres due to restrictions on female education, which are increasing in severity. Majority female cadres, such as Obstetrics/Gynecology, are anticipating significant declines in active staff, jeopardizing aspirations of UHC.

Interpretation: Afghanistan faces critical health workforce challenges, including shortages, gender imbalances and unequal geographic distribution. These findings provide essential insights for policymakers to guide human resources policies aimed at achieving UHC.

评估阿富汗卫生人力:对该国全民健康覆盖能力的情景分析。
背景:全民健康覆盖是阿富汗卫生计划的关键组成部分,但由于数十年的冲突和不稳定,该国面临挑战。与此同时,尽管卫生人力严重短缺,但仍取得了卫生保健方面的成功。一支符合目的的卫生人力队伍对于实现全民健康覆盖至关重要,需要决策者在充分证据的推动下做出决策。本研究对2023年阿富汗卫生人力进行了全面的情况分析,重点关注按地理、性别、设施类型划分的分布以及卫生工作者生产的趋势。方法:通过全国人口普查式的统计,利用活跃的登记处和抽样设施访问的设施级验证,对活跃的卫生人力进行多阶段评估。通过分析2019年至2023年公立和私立机构的入学和毕业数据,估计了卫生工作者的产出。研究结果:我们估计2023年阿富汗有63,632名卫生工作者,其中73%在公共部门,27%在私营部门。关键卫生工作者(医生、护士和助产士)的总数为每万人10.3人,远远低于全民健康覆盖的理想门槛(每万人44.5名关键卫生工作者)。各省之间存在着巨大的地理差异,偏远省份报告的关键卫生工作者远少于全国平均水平,喀布尔约占全国专科医生的50%。严重的性别失衡存在,只有18%的专科医生和29%的护士是女性。保健工作人员的生产在很大程度上依赖于私营部门,由于对女性教育的限制日益严重,某些干部的人数有所下降。大多数女性干部,如产科/妇科,预计在职人员将大幅减少,危及全民健康覆盖的愿望。解读:阿富汗面临严峻的卫生人力挑战,包括短缺、性别失衡和地域分布不平等。这些发现为决策者指导旨在实现全民健康覆盖的人力资源政策提供了重要见解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Conflict and Health
Conflict and Health Medicine-Public Health, Environmental and Occupational Health
CiteScore
6.10
自引率
5.60%
发文量
57
审稿时长
18 weeks
期刊介绍: Conflict and Health is a highly-accessed, open access journal providing a global platform to disseminate insightful and impactful studies documenting the public health impacts and responses related to armed conflict, humanitarian crises, and forced migration.
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