Primary care in post-conflict rural northern Afghanistan

Little is known regarding the nature of primary care in post-conflict communities for several reasons, including: data collection is often given a lower priority than the immediate medical care needs in emergencies; and dynamic changes in a patient population and their needs make it difficult to collect data over the long term. Kinderberg International, e.V. is a German humanitarian organization that has been providing primary care in northern Afghanistan for the past 3 years. The aim of this article is to provide demographic data, pattern of clinic visits and descriptive epidemiology of the large data set from the primary care units.

Observational study.

Patient data gathered using the standardized government tally sheet were reviewed for 1 January to 31 December 2008. The data contained information from 12 primary care clinics and mobile clinics in three northern provinces in Afghanistan.

In 2008, the 12 primary care clinics had more than 250,000 clinical encounters. There were significantly more visits due to diarrhoea and dehydration during the summer months. Overall, the number of primary care clinic visits showed clear seasonal variation, while the number of visits to mobile clinics remained stable throughout the year. Forty-three percent of all clinic visits were due to acute respiratory tract infection and diarrhoeal diseases, and 43% were due to uncategorized diagnoses.

Based on the data from three provinces in northern Afghanistan, mobile clinics can be an effective method to provide medical care in remote areas. A substantial proportion of diagnoses in patients at the clinics was not classified into pre-defined disease categories; these patients presented with numerous symptoms needing treatment. The high volume of ill-defined visits with various complaints to primary care clinics in emergencies may support the claim that primary care clinics are providing more than medical solutions, but also provide care for various complaints and an indispensable safety net to communities under stress. From this standpoint, primary care clinics in post-conflict communities should be considered as a vital element of peace building.