Team Leader: Amanullah Kakar
Members: Dr Syed Khalid Rashid and Dr Waheedullah Muslih
Reviewed by: Naseer Ahmad Nawidy
Afghanistan is among the countries where the economic, social and health sectors have been affected by coronavirus.
The first Covid-19 positive case from Heart province was reported by Ferozuddin Feroz, the former Public health minister on 24th February, 2020. The virus spread throughout the country while the World Health Organization (WHO) called the Covid-19 outbreak a global epidemic on 11th March, 2020 and the spread was at its peak in the neighboring country Iran.
According to International Refugee Organization, around 271,000 Afghan immigrants returned from Iran and Pakistan between 1st January, 2020 and May, 2020. The Iranian border was always open during the period. While the Turkham Passageway was only open for four days in April and a few days more in May, 2020. Although officials of Nangarhar province established an isolation center in Turkham, but due to lack of coordination among related bodies, establishment of the center was a failure as thousands of refugees returned at once and the center was unable to isolate them all.
The Coronavirus has spread in all 34 provinces of Afghanistan. Among them, Kabul, Heart, Kandahar and Balkh have the highest number of positive cases. One of the main reasons of the rapid transmission is flippant behavior of the people towards the pandemic or inability to maintain social distancing. For Instance, around 4.1 Million people have been displaced due to insecurities and natural disasters and are currently living in unstandardized houses. Hence, they are unable to maintain social distancing. In addition, inability to keep social distancing at prisons, gatherings in mosques and worship areas, and crowded markets are among the other reasons of the rapid spread of the virus. So far, more than 15 thousand people have been infected in Afghanistan. Unfortunately, 257 people have passed away aging 44 to 69. Among them are 12 health workers.
During the first stages of the spread, Afghan media representatives and the public called out the government to efficiently manage returning refugees and isolate and treat them before they transmit the virus to others in cities and villages. However, the government failed to take preventive measures. Hence, the virus spread in the country and the number of infected people increased rapidly.
Economic and Health Conditions
Although performance of the ministry of Public Health was comparatively satisfactory, but there are still areas in provinces that does not even have access to basic health services and are facing various problems. Among them are lack of health workers, supplies and infrastructure.
So far, there are 8 laboratories countrywide that can test for the Coronavirus and are able to perform 100 to 150 tests daily. The government plans to increase the number to 15.
On the other hand, statistics of the World Bank indicate that economic growth may drop by 4% due to Covid-19 Pandemic, while it was 2.9% in 2019. Manufacturing units who previously used to satisfy internal demand for certain goods have either halted their operations or have reduced their productions. Exports have reduced massively and foreign goods are also imported with higher prices. Therefore, prices of wheat, grains, cooking oil, rice have increased by 19%, 13%, 8%, 12% and 6% respectively from 14th March, 2020 to 18th May, 2020.
Most of Afghans are working in service sector which is highly affected by the lockdown. Manufacturing sector is also not in a condition to reduce poverty and eliminate challenges. Also, the pandemic has also negatively affected the private sector which has resulted reduction in government’s income.
Moreover, as more than 50% of the Afghans are living below the poverty line, the Covid-19 pandemic and lockdown may push the level to 70%. Consequently, ordinary people may face crisis due to progression of the coronavirus outbreak.
Also, more than 7 million students have been deprived from education due to the pandemic. Among them, 3.7 million were deprived from education even before the coronavirus outbreak. Although ministries of education and higher education have strived to find ways to enable students to continue to their studies at home, but unstandardized residence, lack of access to television, radio, internet and absence of electricity in some areas are among the challenges towards facilitating online studies.
Poverty, lack of health specialists, inability to implement preventive measures and others are among the reasons that assist the spread of Covid-19.
Non-Governmental Response towards Covid-19
In addition to government’s response to the Coronavirus outbreak, the nation also responded to fight the pandemic which should be backed and respected. Among the responses, the first systematic response was the establishment National Alliance to Fight Covid-19 (Nafcovid19).
The alliance which comprises various specialized and social organizations was able to accomplish remarkable works via coordination with government bodies. The first step of Nafcovid19 was to distribute brochures of public awareness prepared by World Health Organization (WHO) and Ministry of Public Health. The Alliance also prepared and distributed a high volume of special posters of public awareness for mosques.
Since the pandemic has triggered fear and mental health problems among people, the alliance published a booklet named “Mental support guideline” which contains valuable facts and information. The alliance also provided guidelines for dealing with coronavirus, disinfecting home, shrouding and inhumation of the dead. Additionally, Nafcovid19 shared enlightening information with the public via social media, established doctor and preacher program in Mosques to increase public awareness among people and instruct them in taking preventive measures.
For psychological support, the alliance and AIMA instigated “O Soldier! Do not fear!” program in which AIMA staff visited hospitals to appreciate and mentally support health workers.
The alliance was also able to distribute food and protective equipment through Ehsas welfare foundation to almost 10 thousand families.
In current unstable conditions, the alliance was able to conduct meetings with political figures to open a new front to combat the coronavirus, due to which, the coronavirus will be recognized by all sides including the Taliban as a national calamity and preparation will be commenced to effectively combat the calamity.
Lately, with collaboration of the ministry of Public Health, Nafcovid19 was able to undertake responsibilities of running Afghan-Japan hospital and improve qualities of its services through innovation and tireless efforts.
Foreign Aids and the Pandemic
Although there are various obstacles for attracting foreign aids, but some international donors are still enthusiastic to assist Afghanistan to fight the coronavirus. The Afghan government have had a poor management while attracting and efficiently spending foreign aids. Hence, needs serious attention and reform.
International donations to fight the coronavirus are not delivered to the government on time. Also, foreigners are only willing to spend on sections that are pre-specified by them. This indicates that international donors are still willing to sponsor health services. However, they are not tolerating any chances of negligence and misuse of funds and intends to witness transparency in expenditures.
The Afghan government allocated 15 million USD to combat Covid-19, among which, 3 Million USD were granted to provinces and 8 million USD were allocated to procure medical equipment from foreign countries. They equipment should have been purchased before the extensive spread of the coronavirus, as the prices of the equipment later rose due to high demand in international markets.
On the other hand, aids announced by World Bank, Asian Development Bank, European Union and others were not in liquid form. Conversely people assumed that the foreign aids are being delivered in liquid form. For instance, the World Bank has granted 100 Million and 400 thousand to Afghanistan during the last four year. However, inaccurate information has created an environment of mistrust between the people and the government. World Bank’s aids were allocated to fight the coronavirus and improve health information system.
The Asian Development Bank has granted around 40 Million USD, from which, only 15 million were allocated to combat Covid-19 and the remaining funds were allocated to purchase medical equipment.
The coronavirus is a global epidemic which has affected economies social lives of the third world countries. It is a national and religious duty of each Afghan to combat Covid-19. However, the Afghan government is on the front line to combat the pandemic. In order for the government to prevent the crisis and its impact on the country, it should accomplish many things. The following are some are some recommendations for the policy makers of the government.
Other political, cultural and civil bodies should also not remain inconsiderate, participate in the fight against Covid-19 and assist the government and the people overcome the challenges created by the coronavirus.
Administrative and Budgetary Recommendations
- Budget allocation for health sector should increase by 5% in national budget plans in future.
- The president, political and civil leaders should personally forward and share the messages and recommendations of the ministry of Public Health, strive to upturn trust and reliance on health organizations, and appreciate and reward health workers for their accomplishments and services.
- The government should increase its capacity to attract foreign aids in such delicate situation. With cooperation of all related sides, should reconsider and find efficient ways to combat Covid-19, avoid political disagreements and prioritize fight against the coronavirus.
- Under the supervision of finance ministry, a separate body should be established in order to represent accountability and transparency to international donors.
- The national budget should only be reformed when there is need for emergency funds. Apart from this, foreign aids should be attracted for long term sponsorships.
- The Afghan government should estimate future foreign aids and donations so that challenges can be avoided when aids are delayed or stopped in delicate stations.
- The national assembly should oversee and evaluate expenditures of government’s and foreign aids. Also, the media should investigate the spending and expose any cases of corruption and misuse.
- The government should also reconsider the current policies for imports and exports. Especially, the APTTA treaty should be reassessed, as only imports are currently allowed and exports are prevented. In addition, policies should be developed for exports to all other countries in emergency situations. This is due to the fact that most of the people earns from agriculture and exporting fruits. If exports are prohibited, people will face numerous problems in winter. Therefore, the government should not only create demand for products, but open new doors for exports.
- If the Covid-19 spread upholds, the government should restructure salaries of government employees and avoid high salary payments during the lockdown.
- The Afghan government should support private organizations in order to enable them to at least prepare and reserve funds to financially assist their employees for three months
- Considering the poor economic condition poverty, the people should maintain all protective measure in case of flexibility is brought in lockdown restriction. The government should also avoid any unnecessary assemblies in order to maintain social distancing.
- Governmental offices should establish new rules for customers during the pandemic. Especially plan should be made to maintain social distancing in offices which are highly crowded but has limited resources, such as electronic ID distribution centers.
- Basic goods and products that are produces within the country should be supported by the government in order for the products to arrive the markets on time, hence, any delays and price increments are avoided.
- Ministries of Economy, Public Health, and trade and industry should strive to preplan any upcoming economic and health crisis and overcome the current economic and health problems with deliberate planning.
- A particular mechanism should be created for all the refugees returning from Pakistan and Iran and their problems abroad should be resolved by the ministry of foreign affairs.
- The Afghan government should share accurate information about the happening in the country and any statements should be avoided that triggers mistrust and concerns of the nation.
- Through financial support, health experts should be shifted from the private sector to the public sector.
- As the coronavirus outbreak exposed weak points of many administrations, the Afghan government should find an opportunity to take corrective measures and reform their works.
Public Health Recommendations
- Those needy citizens, especially health workers who have lost their live due to the Coronavirus, their families should be continuously assisted financially.
- As patients with diabetes and heart disease are at high risk, distinctive measures should be taken to protect them from Covid-19. To do so, information about such patients should be collected so that they can be provided with medical support.
- Hospitals should have equipped emergency rooms with sufficient oxygen facilities. In addition, health workers should be equipped with Personal protective equipment (PPE) kits so that they can protect themselves from infection.
- With help of security bodies, the government should protect and back health workers so that they can peacefully carry out their duties and any threats and harms can be avoided.
- For capacity building, short-run and long-run plan should be made for health workers. In this regard, online workshops and seminars of foreign experts should be organized so that they can improve their skills and knowledge, and learn from international experts.
- A real time system should be established in order to record various diseases and deaths, and estimate about the future.
- Health facilities that are newly built as coronavirus isolation wards should be constructed considering its advantages in long run.
- For future’s sake, the government should provide scholarships for students to specialize in a number of viral diseases abroad.
- To provide health related information, a particular governmental or non-governmental agency should be establish so that personal experiments can be investigated and analyzed so that people can attain reliable information about products.
- Covid-19 diagnosis centers should be established on all borders of the country with the help of countries in region and World Health Organization (WHO). This is to examine all arrived passengers for the coronavirus and prevent increase of the spread.
- Medicines and equipment are key for the combat with Covid-19. Hence, an organized plan should be prepared in order to avoid any lack of necessity for equipment.
- Until the coronavirus outbreak is handled, the government should delay any decision about reopening of schools and universities. Until then, plans for facilitating remote studies should be developed and any obstacles in this regard should be eliminated. Elaborately justifying this recommendation requires a separate article.
- As the fourth pillar of the society, media should consider public awareness as their national responsibilities. Their purpose in this regard should not be financial means and should let the budget be spent on other services.
- The public should seriously consider instruction of public health departments. As their social responsibility, the people should not only protect themselves from the coronavirus, but should avoid any chances of unknowing transmission of the virus.
- To effectively fight the coronavirus, a culture of voluntary works should be popularized. The National alliance to fight Covid19 should be backed and the government should establish an online system so that voluntary works can begin and obstacles are eliminated in crisis.