The hidden digital determinant of health - Technology Access in Afghanistan

How access to technology can help improve access to healthcare for the people of Afghanistan

By: Maria Mian

The Struggle for Survival

Afghanistan is a country that has been victim to extreme poverty and never ending conflict, filling history books with records of atrocious events. As this article is being written, millions of Afghans are paralyzed in a cycle of deep poverty and limited access to food, water, shelter and basic healthcare. In 2018, the World Health Organization (WHO) reported that Afghanistan has a total of 3135 healthcare facilities that were functional and about 87% of the population had access to these facilities at a 2 hour distance. This is largely due to the many social determinants that prevent individuals from accessing health care services. With the already fragile economy, putting food on the table is extremely expensive while fees for healthcare services are profoundly unaffordable. Transportation to hospitals is extremely costly and in many cases saving a life is a race against time, often jeopardizing the likelihood of making it to the next day. Although the traditional determinants of health such as education, income and access to resources influence an individual's health, research has shown that there is another hidden determinant, one that is a societal norm but for individuals in developing countries is an unimaginable luxury. The determinant of access to technology is a revolutionary resource for the 20th century and might just be the turning point in saving millions of lives by providing healthcare access to all.

Investigating the situation

The constant conflict and fighting has destroyed many healthcare facilities in Afghanistan and shipment of medical resources is extremely difficult. Many displaced Afghans are not aware of the limited healthcare services or the location of health clinics leading many individuals to suffer in silence unaware of the life saving help available. In today’s society information is spread digitally through technological devices such as phones and laptops. In many countries, information regarding the nearest cardiologist, ultrasound clinic or pharmacist is a fingertip search away. Unfortunately, countries such as Afghanistan do not have access to such technological devices, leaving the traditional television and radio as the main source of information.

The Whole of Afghanistan Assessment (WoA Assessment) 2019 was used to study the humanitarian needs of individuals in Afghanistan during the internal conflict. Between July 17 and September 19, 2019 structured household surveys were conducted amongst a sample of 31,343 displaced and crisis-affected households in accessible areas throughout all 34 provinces in Afghanistan. The household survey was based on a random cluster sample (Noh JW, 2021). This study was unique in nature as, along with the demographic factors of households such as number of family members and level of education of household members, the factor of access to technology was also investigated. More specifically, households were asked whether they had a phone with a subscriber identification module (SIM) card. Participants were also asked whether they had access to healthcare facilities in or near their village in the past three months. The findings showed that about 53.1% of participants owned a phone with a registered SIM card. However, only 10% of households reported having information about humanitarian assistance. When analyzing results of distance to healthcare centers, 77.8% of households reported being within 5 km radius of healthcare facilities. Unfortunately, from the total of 31,343 households exposed to complex emergencies in Afghanistan, 10,057 (32.1%) could not access a healthcare facility when it was needed in the last three months (Noh JW, 2021). This is largely due to not knowing that healthcare facilities exist in their area.

By investigating a never before analyzed factor the study came forth with some interesting findings. Having access to technology is crucial in modern society as the vast majority of information is spread digitally across the globe. Unfortunately, developing countries like Afghanistan have many other priorities, making technological access to citizens something of less importance. The use of technology to receive healthcare information and location of health service facilities was further studied to determine just how influential modern day tools are on individuals' health and survival. More importantly access to information regarding reproductive, maternal, newborn and child health (RMNCH) was studied as much of the population is made up of young, developing individuals who need access to such knowledge.

Technological advancements

The country of Afghanistan is home to about 38 million people with half of the population under the age of 19 creating a huge “youth bulge” and 22.2% of individuals between the age of 15-24 years. As the youth develop into adults, get married and have children they play a key role in reproductive, maternal, newborn and child health. Reproductive and child development is a very fragile time for mothers, infants and the entire family which is why information to ensure proper development is crucial. Unfortunately, the ongoing conflict in Afghanistan has resulted in many young adults becoming displaced causing access to formal health services to be near to impossible.

The result of armed conflict, natural disasters including drought and flooding coupled with extreme poverty has led to a number of internally displaced persons (IDPs) in Afghanistan. Statistics from 2018 have shown that nearly 2.6 million of the estimated 35.5 million people in the country were displaced. Another report in 2018 by the United Nations Refugee Agency (UNHCR) showed that 42% of Afghan IDPs did not have access to healthcare. Although individuals in urban areas had slightly better access to health services then those in rural areas, costs of healthcare treatment was very high and the quality of healthcare available was low.

With so many young individuals being displaced, many programs have begun to develop different methods of communication to provide health information through the use of mobile phone technology. In recent years, the use of mobile phone technology has increased significantly all across the world, even in conflict-bound Afghanistan. What is even more empowering to hear is that more women and youth also have access to these resources. From 2014- 2018 the number of mobile phone users in Afghanistan almost doubled from 12 million to 22 million (Alami et al., 2013). Another important finding was that a 2012 survey of Afghan women showed that 80% had access to a mobile phone, 48% owned a mobile phone and 32% could borrow one when needed.

The widespread use of technology in Afghanistan suggests that this is a great source to optimize the exposure of information especially regarding RMNCH. This information is especially important for IDPs youth who have little to no access to healthcare services. Therefore, a study was conducted to determine whether mobile phones would be a preferred source of receiving RMNCH information for IDP youth. Data was collected of participants background information, household possession of media devices (i.e. television, radio and mobile phones), their exposure to sources of health information, their longing for specific type of health information, and finally whether they would prefer to use a free mobile-phone based system to obtain health information.

As mentioned before, television and radios are the primary source of information for many households in Afghanistan. Access to such appliances differed between provinces as about half of the participants reported having a radio and a quarter reported having a television. However, mobile phone ownership showed detailed differences between provinces and genders. It was found that a vast majority (94.0%-98.7%) of males reported having mobile phones. Unfortunately, this number was considerably lower for women (Alami et al., 2013). Access to the internet was also fairly low, however it was notably lower for women. Displaced youth also had little to no exposure to print media or television and just over half of male IDPs youth reported at least weekly radio exposure, while this number dropped to a quarter for women (Alami et al., 2013). These statistics are quite alarming when taking into consideration the role mothers play in their own health as well as their children. More initiatives need to be put in place to provide women with technological resources to access health information.

The study also asked participants to recall whether they were exposed to health related information through a communication channel in the past 3 days before the survey. The few health related information individuals recalled was regarding immunization, family planning, hygiene and nutrition. It was also noted that few male and no young women reported getting information from the internet. In a time where many young individuals use technology as a tool to gain information from social media and the world wide web, the future generations of Afghan youth are missing out on life changing opportunities and advancements.

Across all provinces it was found that youth would rather have health information provided by the health care providers and home visits by community health workers as a second option. Although not many young male IDP youth wanted information regarding RMNCH through mobile means, 16.4% of women showed interest in receiving RMNCH information through a telephone hotline (Alami et al., 2013). It is worth noting that some participants did ask whether they would be met with a recorded message or if they could speak with a live person as most participants preferred speaking to a live person when obtaining information.

Call to action

In a time where technology has revolutionized the way the world works, healthcare is no exception. In modern times a quick Google search of your symptoms can give you an unofficial diagnosis or the nearest walk-in clinic that is open 24 hours. Unfortunately, many individuals do not have access to such luxury resources such as those stuck in conflict, poverty and areas that lack access to resources.

The people of Afghanistan are some of the most brutally hurt global citizens as they have faced years of conflict, poverty and limited resources. Due to poor healthcare infrastructure many Afghans have fallen victim to treatable diseases and illnesses. Research has shown that access to technology not only allows individuals to learn more about their illnesses and develop healthy lifestyle habits, but provides the location of treatment facilities that they can access. This is especially important for vulnerable patients such as expecting mothers, young children, the elderly and those with life-threatening conditions.

Recent studies have explored how the use of mobile phones could be a crucial turning point in access to health care for those in conflict driven areas such as Afghanistan. Many individuals have access to mobile technology suggesting that this is a great tool to share information regarding health resources and services. Although there is much to consider when implementing such initiatives, this is a great step towards bringing health care accessibility to all. A hotline for health would be a great initiative that allows individuals to speak with professional practitioners and receive the assistance they need, saving the lives of thousands of Afghans each year.

Sources

• Primary source

Noh JW;Im YM;Kim KB;Kim MH;Kwon YD;Cha J; (2021, April 27). Digital and ECONOMIC determinants of healthcare in the crisis-affected population in AFGHANISTAN: Access to mobile phone and socioeconomic barriers. Healthcare (Basel, Switzerland). https://pubmed.ncbi.nlm.nih.gov/339256948/.

• Secondary sources

Alami, S. O., Dulli, L., Santo, L. D., Rastagar, S. H., Seddiqi, S., Hemat, S., Burke, J. M., & Todd, C. S. (2013, October 23). Getting health information to internally displaced youth in AFGHANISTAN: Can mobile phone technology bridge the gap? Gates Open Research. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7459210/.

WHO. (2021). Eastern Mediterranean region. World Health Organization. http://www.emro.who.int/afg/programmes/health-system-strengthening.html.