Deficient facilities undermine quality of healthcare services in Afghanistan

1 Sep 2017
Deficient facilities undermine quality of healthcare services in Afghanistan

Press release: Despite hundreds of millions spent, public healthcare facilities suffer from bad design, lack of maintenance and mismanagement, new report finds

Wednesday, August 23, 2017 – Kabul: Integrity Watch Afghanistan launched a report analyzing the state of public health facilities in the country. The report indicates that despite hundreds of millions of dollar invested by the donor community in the public health sector, health facilities across the country suffer from major deficiencies. Integrity Watch inspected 184 public clinics and hospitals in 8 provinces that are built or operated with donor money.

More than half of the facilities experience structural and maintenance problems, the majority of which needs urgent repair. Almost half of the facilities were in poor hygiene and sanitation conditions with one-quarter of them not having toilets. Four out of ten facilities did not have potable water while one in every five facilities had no electricity at all. Access to health facilities has been pointed out as a major problem. Two-thirds of the facilities did not have ambulances, contributing to difficulties in accessing the clinics and hospitals. But, despite the imperfections, a significant percentage (99%) of the facilities remain operational during the day time.

Furthermore, lack of adequacy of personnel has been observed in the public healthcare facilities, especially female medical personnel that were less than 40 percent. The latter is so necessary to address the needs of female clients which are culturally preferred to be treated by female medical personnel.

Speaking to media, Sayed Ikram Afzali, Executive Director of Integrity Watch Afghanistan said, “The study shows that for adequate health service delivery, it is not enough to just build clinics and hospitals.” Referring to the findings of the report, he pointed out major issues such as lack of maintenance of the facilities, limited access to medical staff, lack of female health-care staff, and poor management control. “These deficiencies weaken the delivery capacity of healthcare in public hospitals and clinics,” he added.

“The research provides a number of lessons learned,” said Ezatullah Adib, Research Manager at Integrity Watch Afghanistan who worked on the report. “Observation of the facilities by our surveyors provides insight into the nature of shortcomings that limit the capacities to deliver quality services.” he said. The facilities building are in poor shape, with structural problems. Leaked ceiling, cracked walls, lack of water supply or sanitation facility. It has been learned that people in some areas do not have access to hospitals or clinics due to bad conditions of road or uncertain security situation. Non-availability of medical equipment and supplies has been reported by many facilities. It was also learned that poor management and irregularities seen in some facilities. The mentioned lessons and those already exist indicate poor planning and budgeting.

“Weak monitoring allows bad maintenance and mismanagement that lead to bad service delivery” Mr. Afzali added. “Therefore, to avoid such problems, regular monitoring by the government and the communities around the facilities is a dire need”, he said.



  • To accrue returns from both past and future investments in public health care, it is urgent for MoPH to first focus on rectification of the problems (structural, operational and management) of the current facilities and then undertake forward planning for new expansion and construction.
  • For realistic planning, visits to the operational facilities for appreciation of the existing problems and to the new planning sites for understanding of the contexts are recommended. For best results, the site visit team should be composed of ministry officials, civil society organizations, community representatives, medical professionals, engineers and budget and audit specialists.
  • The inclusion of expertise in the budget is essential for estimating realistic budget needs for construction, operation and maintenance and monitoring.
  • Community monitoring and oversight is an option that should be considered


Full report can be accessed through this link



A survey based study of the state of public health care delivery in Afghanistan

For information contact:

Wahidullah Azizi                                                                                                                                                                                                                                                                                             +93(0)705 666 962