ABSTRACT
Background: Afghanistan has the second lowest health workforce density and the highest level of rural residing population in the Eastern Mediterranean Region. Ongoing insecurity, cultural, socio-economic and regulatory barriers have also contributed to gender and geographic imbalances. Afghanistan has introduced a number of interventions to tackle its health worker shortage and maldistribution.
Aims: This review provides an overview of interventions introduced to address the critical shortage and maldistribution of health workers in rural and remote Afghanistan.
Methods: A review of literature [including published peer-reviewed, grey literature, and national and international technical reports and documents] was conducted.
Results: The attraction and retention of health workforce in rural and remote areas require using a bundle of interventions to overcome these complex multidimensional challenges. Afghanistan expanded training institutions in remote provinces and introduced new cadres of community-based health practitioners. Targeted recruitment and deployment to rural areas, financial incentives and family support were other cited approaches. These interventions have increased the availability of health workers in rural areas, resulting in improved service delivery and health outcomes. Despite these efforts, challenges still persist including: limited female health worker mobility, retention of volunteer community-based health workforce, competition from the private sector and challenges of expanding scopes of practice of new cadres.
Conclusions: Afghanistan made notable progress but must continue its efforts in addressing its critical health worker shortage and maldistribution through the production, deployment and retention of a fit-for-purpose gender-balanced, rural workforce with adequate skill mix. Limited literature inhibits evaluating progress and further studies are needed
Subject(s)
Humans , Male , Female , Medically Underserved Area , Rural Population , Public HealthABSTRACT
Anthroponotic Cutaneous Leishmaniasis is a common cause of ulcerative lesions and disfiguring scarring among children in Afghanistan. Most lesions occur on the face, and are commonly caused by the trypanosome protozoan parasite Leishmania Tropica, transmitted by the bite of an infected sandfly [Phlebotomus Sergenti]. This study compares the effectiveness of a single localized treatment with thermotherapy to five days of intra-lesional administration of Glucantime for the treatment of cutaneous leishmaniasis. Three hundred and eighty two patients with cutaneous leishmaniasis were randomly assigned to the two treatment groups and followed for six months. The cure rate for the thermotherapy group was 82.5%, compared to 74% in the Glucantime group. The authors conclude that a single localized treatment with thermotherapy was more effective than five days of intra-lesional administration of Glucantime. Additionally, thermotherapy was more cost effective, with fewer side effects, of shorter duration, and with better patient compliance than intra-lesional Glucantime