Geography and access to specialised health services

I worked with the Afghan Ministry of Public Health, witnessing firsthand the impact four decades of armed conflict has on the resources needed to deliver adequate specialized clinical services. I believed armed conflict and war, poor economy, and political instability were the key drivers affecting access to health services. My recent visit to Solomon Islands has altered my perspective: geography has an enormous impact on access to and delivery of health services in Afghanistan.

Data from the WHO Global Observatory eHealth reports show Afghanistan’s Maternal and neonatal mortality rates are five times that of Solomon Islands which is indicative of better access to primary health care.  However, when it comes to specialised clinical services, such as interventional cardiology, neurosurgery and oncology, people in Afghanistan may have better access.

Why? Afghanistan is a landlocked country with access to specialised healthcare services and education in neighbouring countries a few hours’ drive away. Learning lessons from the neighbouring countries, the Afghan government also established the Afghan Medical Council (AMC) in 2016 as an autonomous body in 2016 to accredit medical institutes and specialists returning from the neighbouring countries. Situated in the middle of the Pacific, Solomon Islands are 1000s nautical miles from its neighbours. Travel is difficult and expensive.  Patients and doctors in Solomon Islands cannot easily travel to Australia or New Zealand to access quality healthcare services for their patients or further education.

The RACS Global Health Pacific Islands Program (PIP) strengthens specialised clinical services, clinicalMale and female in surgigal scrubs holding surgical instruments and looking off camera as if to a screen Photo credit: RACS governance, specialist education, training, and workforce development across the Pacific region. The program increases access to surgical care across 11 Pacific Island countries by providing education and training to Pacific surgeons, nurses, and other health workers and by supporting surgical teams to deliver surgeries locally. We travelled to Honiara, the capital of Solomon Islands, to undertake an End of Program Evaluation for RACs and provide recommendations for effective delivery of the program.

It has been an enlightening thinking process for me to consider the effects of geography on access to specialised clinical services as a key factor in addition to all other factors. While Afghanistan’s geographical location contributes to its insecurity and political instability it also positively contributes to people’s access to specialised clinical services.

Improving access to equitable healthcare services is complex. As System Thinkers, the Nossal Institute is working with stakeholders to understand the impact on the health and wellbeing of people of strategies and programs in different settings. We are helping identify the interventions that contribute to equitable healthcare services.

Noor Shah Kamawal is a Technical Advisor at the Nossal Institute for Global Health. From 2008 to 2021, Noor worked with the Ministry of Public Health in Afghanistan as the Coordinator for AIDS program, Director for Health System Strengthening, CEO for the National Medicine and Healthcare Products Regulatory Authority and Director General for Afghanistan National Public Health Institute.

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Noor Shah Kamawal