Financing of non-communicable diseases in Afghanistan

Afghanistan is suffering from a triple burden of diseases. One of every two Afghan is dying due to non-communicable diseases (NCDs). The national health account report shows that people are paying 77% of health expenditure from their pocket especially for diagnostic and treatment purposes. Considering the huge number of mortality and health expenditure related to NCDs, this paper aimed to analyze the financing system of NCDs and provide recommendations to the policy makers and program managers in national and international health institutions.

A qualitative method was used to interview with 39 experts in health system of Afghanistan during 2019 to 2021. A self-developed interview guide was used for data collection. For analysis of data, we used deductive framework method and used the six building blocks of the health system as a framework, in this study for financing.

In analyzing the financing of NCDs in Afghanistan, the findings are summarized in four categories as below. The strength points are donor-funded packages of health services, producing the national health accounts reports, implementing minimum excise tax on tobacco or sugar sweetened beverages and the existence of some guiding policy documents such as revenue generation strategies. The weak points are low budget allocation to health by the government, centralized financing system in Afghanistan, lack of key NCDs indicators in health information system, and high out of pocket payments. On the other hand, the opportunities are high level of Out-of-Pocket payment, corrective tax on tobacco and sweetened beverages, availability of implementing NGOs in health sector. Also, threats are weak governance structure and risk of corruption in the health sector, lack of public trust on the government, barriers to implementing Public Private Partnership program, low health literacy of people, collusion between public and private sector, and long bureaucratic process.

In general, health financing is closely linked to other health systems' functions especially governance, health information management, health workforce management, provision of medicine, medical supplies, and technology. Thus, to have functional health financing, we need to consider these intercorrelations and provide synergies among the building blocks of health system.