Executive summary​

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Afghanistan’s healthcare infrastructure has relied on international aid for decades. Despite progress during the US presence, the strain of Covid-19 and widespread uncertainty following the government transition in August 2021 has left the healthcare system in a precarious situation. Urban and rural communities feel uninformed about available health services. The lack of qualified medical professionals, including female health workers, contributes to people’s feeling of insecurity. Ground Truth Solutions partnered with the World Health Organization (WHO) and the Awaaz humanitarian helpline to understand people’s perceptions of healthcare services, including how they view things since the recent regime change. This report combines data collected between November 2021 and May 2022 from a country-wide phone survey; focus group discussions with men, women, and community leaders in Kunduz, Kandahar, Nangarhar, and Helmand provinces; and in-depth interviews with frontline health workers and health providers.

Satisfaction with and access to health services is distressingly low – and everything is worse for women and people in rural areas. Barriers to access include distance to health facilities; insufficient supplies, including basic medicines; and high outof-pocket costs. New restrictions on women’s mobility and uncertainty over what is allowed under the current government further complicate access for women.

People feel strongly that access to health is unequal; however, they do not know how to give feedback about health services.

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Although satisfaction with health services is low, affected communities and frontline health workers see potential to address shortcomings through community engagement. Through consultations with community members and health workers, we gathered recommendations for how communities and health workers can collaborate to reduce barriers to access and improve overall health outcomes. Humanitarians and health service providers have discussed these recommendations to ensure that support to Afghanistan’s struggling healthcare system incorporates people’s perceptions and priorities.