title: An assessment of the barriers to accessing the Basic Package of Health Services (BPHS) in Afghanistan: was the BPHS a success?
abstract: Afghanistan is one of the most fragile and conflict-affected countries in the world. It has experienced almost uninterrupted conflict for the last thirty years, with the present conflict now lasting over a decade. With no history of a functioning healthcare system, the creation of the Basic Package of Health Services (BPHS) in 2003 was a response to Afghanistan's dire health needs following decades of war. Its objective was to provide a bare minimum of essential health services, which could be scaled up rapidly through contracting mechanisms with Non-Governmental Organisations (NGOs). The central thesis of this article is that, despite the good intentions of the BPHS, not enough has been done to overcome the barriers to accessing its services. This analysis, enabled through a review of the existing literature, identifies and categorises these barriers into the three access dimensions of: acceptability, affordability and availability. As each of these is explored individually, analysis will show the extent to which these barriers to access are a critical issue, consider the underlying reasons for their existence and evaluate the efforts to overcome these barriers. Understanding these barriers and the policies that have been implemented to address them is critical to the future of health system strengthening in Afghanistan.
authors.affiliation: Centre for Global Health, King's Health Partners and King's College London, London, UK. alexandra.frost@kcl.ac.uk.|Conflict and Health Research Group, King's College London, London, UK. alexandra.frost@kcl.ac.uk.
authors.forename: Alexandra
authors.identifier: 0000-0002-6755-2227
authors.initials: A
authors.lastname: Frost
authors.affiliation: Conflict and Health Research Group, King's College London, London, UK.|Centre of Islamic Studies, SOAS, University of London, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Wilkinson
authors.affiliation: International Prevention Research Institute, France and University of Strathclyde Institute of Global Public Health @iPRI, Lyon, France.
authors.forename: Peter
authors.initials: P
authors.lastname: Boyle
authors.affiliation: Conflict and Health Research Group, King's College London, London, UK.|Department of War Studies, King's College London, London, UK.
authors.forename: Preeti
authors.initials: P
authors.lastname: Patel
authors.affiliation: Centre for Global Health, King's Health Partners and King's College London, London, UK.|Conflict and Health Research Group, King's College London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Sullivan
mesh_terms: D000346:Afghanistan; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008952:Mobile Health Units / Q000706:statistics & numerical data*; D012424:Rural Population / Q000639:trends
keywords: Afghanistan; Aid effectiveness; Fragile states; Health system financing; Health system policy; Health system reconstruction; Maternal health