Access to Care in Post-Conflict Settings: A Mixed-Methods Study Exploring Access to Care Trends, Barriers, and Changes after the Taliban Takeover in Afghanistan

Introduction: The Taliban takeover in August 2021 put an end to over 40 years of conflict, albeit it resulted in the departure of several international organizations from the country and the freezing of assets, which unleashed economic and humanitarian crises. Taking advantage of the reopening of previously restricted areas and the longstanding presence of Emergency in the country, this study sought to achieve a thorough understanding of access to care in Afghanistan by exploring trends, barriers, and changes after August 2021. Methods: The project consisted of three phases: analysis of Emergency aggregated surgical, maternal, and pediatric data to explore healthcare utilization over the years; dissemination of a 67-item questionnaire to patients visiting Emergency facilities by trained local staff; and semi-structured interviews with local health professionals. The result of a collaboration between Emergency and CRIMEDIM. Results: Facilities’ records from 11 provinces were analyzed, 1807 questionnaires were collected, and 43 interviews were conducted. Data revealed a drop in consultations in August 2021, but rates returned to normal as early as September 2021, with more patients seeking care for civilian trauma rather than war wounds. Although patients feel safer when visiting health facilities, their ability to pay for care has decreased after August 2021. Many health system-related factors impact access to care and make people go straight to larger hospitals, aggravating the congestion of patients in tertiary hospitals. Conclusion: This study contributes to paving the way to Universal Health Coverage in Afghanistan. Although the country has a unique social, political, and economic context, these results can be generalized to other postcolonial settings. Full authorship: Martina Valente, Alessandro Lamberti-Castronuovo, Francesca Bocchini, Monica Trentin, Yasir Shafiq, Michela Paschetto, Ghulam Ali Bahdori, Jan Agha Khadem, Mirza Sayed Nadeem, Mohammand Hanif Patmal, Mohammad Tawoos Alizai, Francesco Barone-Adesi, Rossella Miccio, Luca Ragazzoni.