title: Patients struggle to access effective health care due to ongoing violence, distance, costs and health service performance in Afghanistan.
abstract: BACKGROUND
  The Afghan population suffers from a long standing armed conflict. We investigated patients' experiences of their access to and use of the health services.
  
  
  METHODS
  Data were collected in four clinics from different provinces. Mixed methods were applied. The questions focused on access obstacles during the current health problem and health seeking behaviour during a previous illness episode of a household member.
  
  
  RESULTS
  To access the health facilities 71.8% (545/759) of patients experienced obstacles. The combination of long distances, high costs and the conflict deprived people of life-saving healthcare. The closest public clinics were underused due to perceptions regarding their lack of availability or quality of staff, services or medicines. For one in five people, a lack of access to health care had resulted in death among family members or close friends within the last year.
  
  
  CONCLUSIONS
  Violence continues to affect daily life and access to healthcare in Afghanistan. Moreover, healthcare provision is not adequately geared to meet medical and emergency needs. Impartial healthcare tailored to the context will be vital to increase access to basic and life-saving healthcare.
authors.affiliation: Médecins Sans Frontières-Operational Centre Brussels, Advocacy and Analysis Unit, Brussels.
authors.forename: Niamh
authors.initials: N
authors.lastname: Nic Carthaigh
authors.affiliation: Médecins Sans Frontières-Operational Centre Brussels, Afghanistan Mission, Kabul.
authors.forename: Benoit
authors.initials: B
authors.lastname: De Gryse
authors.affiliation: Ministry of Health-Afghanistan, Direction Ahmad Shah Baba District Hospital, Kabul, Afghanistan.
authors.forename: Abdul Sattar
authors.initials: AS
authors.lastname: Esmati
authors.affiliation: Ministry of Health-Afghanistan, Direction Boost Provincial Hospital, Helmand, Afghanistan.
authors.forename: Barak
authors.initials: B
authors.lastname: Nizar
authors.affiliation: Médecins Sans Frontières-Operational Centre Brussels, Operational Department, Brussels.
authors.forename: Catherine
authors.initials: C
authors.lastname: Van Overloop
authors.affiliation: Médecins Sans Frontières-Operational Centre Brussels, Operational Department, Brussels.
authors.forename: Renzo
authors.initials: R
authors.lastname: Fricke
authors.affiliation: Médecins Sans Frontières-Operational Centre Brussels, Advocacy and Analysis Unit, Brussels.
authors.forename: Jehan
authors.initials: J
authors.lastname: Bseiso
authors.affiliation: Médecins Sans Frontières-Operational Centre Brussels, Operational Department, Brussels.
authors.forename: Corinne
authors.initials: C
authors.lastname: Baker
authors.affiliation: Médecins Sans Frontières-Operational Centre Brussels, Operational Research Unit, Brussels.
authors.forename: Tom
authors.initials: T
authors.lastname: Decroo
authors.affiliation: Médecins Sans Frontières-Operational Centre Brussels, Advocacy and Analysis Unit, Brussels mit.philips@brussels.msf.org.
authors.forename: Mit
authors.initials: M
authors.lastname: Philips
mesh_terms: D000293:Adolescent; D000328:Adult; D000346:Afghanistan; D000554:Ambulatory Care Facilities / Q000592:standards / Q000706:statistics & numerical data*; D000068337:Armed Conflicts; D003365:Costs and Cost Analysis; D005260:Female; D006282:Health Personnel / Q000592:standards; D006296:Health Services / Q000592:standards / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D014754:Violence; D055815:Young Adult
keywords: Afghanistan; Armed conflict; Delivery of health care; Health service accessibility