Category: Afghanistan

Introduction

The country of Afghanistan consists of a land-locked Asian country that has an area of 652,225 square kilometers and is surrounded going in a clockwise direction from the south by Pakistan, Iran, Turkmenistan, Uzbekistan, Tajikistan, and China. The area that makes up the country of Afghanistan has historically been the link between Central Asia, the Middle East, and India. Therefore it has seen many invaders come and go and leave back a semblance of their religion and culture in the area, without really dominating the country for extended periods of time. This has led to Afghanistan comprising different fiercely independent ethnic groupings. Violence has been a part of the history of the country and continues to even today, in view of the strategic importance of the country. Afghanistan swallowed up in this vortex of continued violence is economically backward and dependent on the international community to provide sustenance and maintain peace and stability.

History Government and Politics

The history of violence in Afghanistan is the reflection of the country being caught between the dominating powers of the region, since the collapse of the Mongol Empire in the sixteenth century. This power struggle for domination of Afghanistan started with between the Mughal dynasty in India and the Safavid dynasty of Iran, which culminated in Afghanistan freeing itself in 1747 under the Pashtun leader Ahmad Shah, who managed to get the disparate tribal and ethnic groupings to forge unity. The Ahmad Shah dynasty was to rule Afghanistan for nearly two centuries, but it was not bereft of violence. European powers had more than started their territorial ambitions over the region. Russia and Britain were the competing European powers in the region at the start of the nineteenth century, and the conflicting interests between Russia and Britain caused Britain to send invading armies into Afghanistan, which set up puppet regimes in Afghanistan from time to time as a means of controlling their interests in the country.

Finally, Afghanistan became a British Protectorate till the end of the First World War in 1919, when Afghanistan under its then ruler Amanullah declared independence from the British. There were skirmishes between the British and Afghanistan, as Britain tried to regain control, but in a short, while Britain lost interest in Afghanistan, and it remained Independent. The ensuing period saw rulers come and go through assassination and abdication till the rule of Muhammad Zahir Shah. He was the last king of Afghanistan and ruled for about four decades. This period may be considered as the period when a semblance of development took place in this nation plagued with violence.

In 1973 king Zahir Shah was overthrown and Afghanistan comes to a republic under Daoud a family member of the king. The fires of violence in the country were reignited and remain lit to this day. Daoud had managed to seize power with the assistance of a pro-Soviet Union political party the Peoples Democratic Party of Afghanistan (PDPA). In his belief that he had consolidated his power in Afghanistan Daoud decided to take on the PDPA, which was his downfall. The PDPA ousted Daoud in a coup in 1978 and took the reigns of Afghanistan. The PDPA attempted to make the Muslim-dominated Afghanistan a secular nation and this led to the traditional tribesmen rising up against the PDPA in 1979. The consequence was the invasion of Afghanistan in 1979 by the Soviet Union and the installation of the puppet government of Karmal.

These were the days of the Cold War and it was not long before the United States of America entered the arena to counter the ambitions of the Soviet Union in Afghanistan. The American strategy was to arm the Mujahideen, consisting of several Islamic fundamentalist groups fighting the Soviet troops in Afghanistan. Gradually the willingness of the Soviets to continue this war of attrition in Afghanistan was eroded and they left the country in 1989. The departure of the Soviet Union witnessed the rise of the warlords dominating different parts of the country and violence in the country continued as different groupings of warlords attempted to dominate the country. This background allowed the Taliban, an Islamic fundamentalist movement, and the creation of the Pakistani Intelligence to seize power in Afghanistan. The Taliban made Afghanistan a Muslim theocratic state.

Osama bin Laden and his Al Qaeda were considered responsible for the attacks on America in September 2001, and Osama bin Laden and his group sought refuge in Afghanistan to avoid the American repercussions. The Americans demanded that the Taliban hand over Osama bin Laden and the elements of the Al Qaeda. When this was not forthcoming the Americans launched air and ground attacks in Afghanistan.

The American operation was called Operation Enduring Freedom. With the assistance of opposition elements, the final outcome was the overthrowing of the Taliban government. Some of its leaders along with Osama bin Laden went into hiding in the mountainous regions. To search out the elements of the Taliban and Al Qaeda and provide peace and stability in Afghanistan the International Security Assistance Force (ISAF) led by the Americans and essentially comprising of forces from NATO remains in Afghanistan. With assistance from the United States, the United Nations, and ISAF a democratically elected government under the leadership of President Karzai governs the country, subsequent to the creation of a new constitution that established Afghanistan as the Islamic Republic. Peace and stability still elude Afghanistan as the ISAF has still not been able to eliminate Al Qaeda and the Taliban in Afghanistan.

Demographics

In July 2008, the population of Afghanistan was estimated at 32,738,376, comprising 44.6% of people up to the age of 14 (7,474,394 males and 7,121,145 females), 53% in the age group 15-64 (8,901,880 males and 8,447,983 females), and 2.4 percent in the age group 65 years and older (383,830 males and 409,144 females). The median age for both males and females is 17.6, and the population is growing at the rate of 2.626%, with a birth rate of 45.82.100 population and a death rate of 19.56/1000 population. Life expectancy in Afghanistan is 44.21 years. Afghanistan is made up of several ethnic groups varying proportions that witnesses the Pashtuns at 42%, Tajik at 27%, Hazara at 9%, Uzbek at 9%, Aimak at 4%, Turkmen at 3%, Baloch at 2%, and others at 4% of the population. The country is predominantly Muslim comprising eighty percent Sunni Muslims, nineteen percent Shi’a Muslims, and one percent others. 43.1% of the male population in Afghanistan can read and write, while only 12.6% of the female population can read and write.

Language, Religion, and Culture

The many ethnic groupings have given a myriad of languages used in Afghanistan. There are two official languages made up of Afghan Persian or Dari, used by nearly 50% of the population, and Pashto used by 35% of the population. Then there is the Turkic language essentially Uzbek and Turkmen, which is used by 11 of the population. The remaining 4% consists of 30 minor languages, which are predominantly Balochi and Pashai. The presence of so many languages in the country has led to much bilingualism in Afghanistan.

Islam is the essential religion of Afghanistan and in spite of the different affiliations of the Sunnis and Shi’as, there is agreement on the supremacy of Islam, as in most of the Muslim states. The influence of Islam is so strong that it pervades into every stream of life in Afghanistan from politics to the way of life of the people. The food that they eat is governed by Islamic laws, in which meat meats like pork are prohibited, while meat that is consumed has to become from other animals, whose slaughter is governed by Islamic law. Social activities are again intertwined with Islam and there is gender bias, with the women restrained to domestic and family activities, while the men participate in social and other activities. Marriage customs follow Islamic guidance, and as a result, polygamy is accepted. On the whole, the culture of the country is governed by Islam, with variations originating from the different ethnic founding.

Relations with Other Nations

The reliance of the current government in Afghanistan on external support economically and in the maintenance of peace and stability coupled with American strategic interests has seen the development of a special relationship with the United States of America and other NATO countries. In the current dispensation, the United States of America is the chief influence over Afghanistan. Afghanistan looks forward to fellow Muslim nations in the Middle East, but the strong influence of America on Afghanistan acts as a hindrance to the development of these natural ties.

Afghanistan has always been the playground for influential neighbors to try and increase their influence and it continues to be so. Pakistan with its proximity to Afghanistan and its influence on the Taliban is a major player in Afghanistan. Relationships between the governments in Afghanistan and Pakistan have soured over the Afghan perception that Pakistan continues to harbor elements of the Taliban opposed to it. (7). Iran has always considered Afghanistan special with its Persian-speaking population and also as the means to link up with the Persian-speaking populations in Tajikistan and Uzbekistan. It, therefore, continues to try and increase its influence in Afghanistan. India is not a direct neighbor of Afghanistan but is an influential member of the region. Good relationships have existed in the past and continue to develop between India and Afghanistan, on the basis of Indian assistance in infrastructural development and other assistance.

Conclusion

The strategic location of Afghanistan has made it a target for other countries to try and impose their influence. The country of Afghanistan was born from violence and violence has been a close associate of the nation from a historical perspective. Things have not changed and violence continues to plague this nation to the detriment of its people.

References

1. “Culture of Afghanistan”. 2008. Web.
2. Ritscher, Adam. “A Brief History of Afghanistan”. 2001. Web.
3. “Afghanistan: Current Issues and U.S. Policy”. 2003. Report for Congress.
4. “Overview of Current Political Situation in Afghanistan”. Government & Politics. Afghanistan Online. 2008.
5. “Afghanistan”. CIA World Factbook. 2008. Indexmundi.
6. “Foreign Policy Priorities”. Embassy of Afghanistan. 2008.
7. “Pakistan, Afghanistan to repair relations”. people.com.cn. 2008.
8. Rais, Rasul Bakshi. “Conflict in Afghanistan: Ethnicity, Religion and Neighbours”. Ethnic Study Reports 22.1 (1999): 1-12.
9. Asraf, Fahimida. “INDIA-AFGHANISTAN RELATIONS: POST-9/11”. 2007.

Introduction

Afghanistan has been on the verge of destruction for almost three decades now but the prospects for a better country are still very high. Although the existence of the al-Qaida group of terrorists has always undermined the efforts to maintain peace and retain normalcy in the country, there is a window of hope to achieve the same (Menon, 2012). America has been at the forefront in championing the fight against terror on an international scale and this could be placing the US in a prime position to benefit from the anticipated growth of the country (Menon, 2012). Nonetheless, looking at the situation as it is currently, the country actually has very little to offer. Sceptics argue that there are no real prospects for economic growth apart from the illegal drug trafficking trade.

Political instability

The current political instability in the country has divergent impacts on the future relationship between Afghanistan and the United States of America. Protecting the American interests in the Middle East is vital for the survival of America and its citizens. Nonetheless, the US has a tainted image especially from the Middle East (Menon, 2012). Critics from the Middle East condemn the US for speaking peace and making war at the same time. The effect of the ombudsman’s function of the US over Afghanistan is slowly affecting its influence in the country (Usip, 2013). The locals do not feel safe in the hands of Americans instead they hold them in paranoia and dislike.

However, the presence of American troops in Afghanistan has little to do with the good of the Middle Eastern country (Menon, 2012). It is a measure carefully designed to safeguard the interests of the American government in terms of security, economic development and world influence. The plane crash of an American stealth drone RQ-170 Sentinel in Iran was a controversial event (Menon, 2012). However, there is more than meets the eye in the whole scenario. The drone was launched from Afghanistan and its mission was to conduct surveillance over Iran (Ebscohost 2013). Little is known about the drone that killed Osama bin Laden but the fact is it was launched from Afghanistan.

Benefits of American’s presence in Afghanistan

One of the major benefits of the presence of the American troops in Afghanistan is that it their presence destabilizes the terror groups that are mostly based there. The American government is responsible for the future of the coming generations. Paralysing the activities of the Taliban and the Haqqani networks is a major safeguard for the Americans and the world at large. Although it may seem like a negative approach towards peace, the extremists who are willing to lose their lives for a course they believe in it might be the only way to deal with the security challenges they pose to the entire world.

Afghanistan is one of the countries that give the US access to the Arab world and this is very crucial to the United States of America (Menon, 2012). Surveillance over some of the radical terror groups would be impossible without the American troops on the ground (Menon, 2012). This can be tragic not only to Americans but also to the entire world in a broader perspective. For that reason, Afghanistan’s stability becomes a very important concern for the US, which is a signal for a positive and legitimate reason. Withdrawing the troops from Afghanistan would increase the vulnerability of the Americans as a country as well as losing leverage on Iran and Iraq, which are the two very vital countries to keep an eye on (Commentary, 2011).

The future of America’s interests

The future of Americans’ interests in the Middle Eastern countries is greatly dependent on the stability of Afghanistan (Commentary, 2011). A number of rising regimes that carry great hatred towards the US have always attempted to stop and hinder America’s influence in the region. The Middle East is the hub for America’s oil, which is a major source of energy. Losing contact with the Arab world may be tragic to America’s economy, which greatly depends on oil from the Middle East. The positive impact of America’s presence in Afghanistan is that these resources are secure unlike otherwise. Therefore, the future of the United States with regards to oil and security threats is greatly controlled by having those troops there. Their presence makes it quite difficult for the existence of criminal gangs and the formation of terror groups. The recent capture of Osama bin laden was a great achievement and a great deal for Afghanistan.

Critics who oppose this move by the American government to safeguard its interests in the Middle East and specifically in Afghanistan seem to base their criticism on one side (Commentary, 2011). Most critics argue that the actions of the US are based on selfish ambitions to control the world. However, the most radical international terror groups have sprouted from within the borders of Afghanistan (Commentary, 2011). The most Arabic rebels to stage the greatest terror attacks globally have used Afghanistan as a base and financiers funding terror groups are finding a haven there (Menon, 2012). The anticipated post-American phase in Afghanistan might become a great challenge to the locals especially with the culture of impunity, corruption and political instability, as is the current situation.

Aftermath of America’s departure

Leaving with the current situation would greatly paralyze the country and create tension among the locals but more so affect the possibility of America protecting its interests. The lack of a government is a problem that could persist if the American troops are withdrawn from Afghanistan. The main reason for this assumption is that the native army is comprised of local tribesmen who come from different ethnic groups (Coll, 2009). These ethnic groups have many difficulties interacting and getting along therefore causing tension among each other.

Researchers predict an ensuing war in Afghanistan if the troops are withdrawn due to ethnic differences and other social factors (Coll, 2009). Therefore, for the future of Afghanistan and by extension the well-being of the future coexistence with the Americans, the troops should offer more support and put a government in place.

Therefore, it is not only sufficient to note the importance of American troops in Afghanistan, but also their role on a global scale. Protecting the American interests is the factor that has been greatly considered while making the decision on whether to retain their troops or not (Coll, 2009). However, in the same endeavour, their watch over the Middle East through Afghanistan has greatly helped enhance security for all and even for the future generations to come. As many people feel, the American troops should stay in Afghanistan a little longer to assist and help maintain calm and bring the country back to the rule of law and normal governance (Coll, 2009).

References

Coll, Steve (2009). U.S. Interests and Policy Choices in Afghanistan. Web.

Commentary (2011). The Benefits of U.S. Troops in Afghanistan. Web.

Ebscohost (2013). Current Situation in the Afghan War. Web.

Menon, Rajan (2012). When America Leaves: Asia after the Afghan War. Web.

Usip (2013). Afghanistan: The Current Situation. Web.

Introduction

Afghanistan has a long history of military conflicts, that had left its economy, infrastructure, and healthcare system far behind when compared to many other countries in the world. For the past 50 years, the country has seen the fall of several governments to religious fundamentalists, the Soviet invasion, and the intervention by Western powers.

The country exists in a state of guerrilla war between foreign anti-terrorist forces and various mujahedeen formations located in the mountains of Afghanistan, which contributes to the already difficult healthcare situation in the country. The people frequently suffer from various healthcare hazards, ranging from diseases to a lack of heat, medicine, and clean water. The purpose of this paper is to evaluate eight healthcare determinants for the population in Afghanistan, including age, gender, socioeconomic status, environment, education, access to healthcare, the burden of disease, and the economy.

Main Healthcare Determinants in Afghanistan

There are eight main healthcare determinants, which are universally used to assess the state of the civilian population in regards to healthcare. These determinants are often interconnected, with one or several factors influencing one another, typically in a negative way. For example, age and gender have a direct impact on education and socioeconomic status. The majority of Afghanistan is governed by Sharia law, which severely restricts women and girls in terms of both labor and education. Socioeconomic status, in the condition of scarcity, is directly affecting access to healthcare. The ability to give birth puts women in greater danger associated with maternity.

Geography and proximity to relief centers also have a direct effect on all eight determinants of healthcare. In the following paragraphs, we will analyze each of these determinants separately and identify how they affect the healthcare situation in Afghanistan.

Age

Age is one of the large healthcare determinants, which affects a multitude of parameters. Diseases and other healthcare threats differ from one age group to another. Children are more predisposed to viral infections and traumas due to having underdeveloped immune systems as well as smaller and weaker bodies. Coincidentally, elders suffer from a variety of healthcare issues associated with old age. Fractures and falls present significant challenges to them, especially when society does not account for low-mobility individuals. Adult patients of both genders are more likely to contract work-related diseases and traumas.

In Afghanistan, age plays a crucial role, affecting nearly all other healthcare determinants. Around 48% of the entire population is comprised of children aged 15 and under, meaning that the country is experiencing severe shortages in the adult workforce (Mansoor et al., 2016). As a result, children become more exposed to various hazards, such as child labor, early pregnancies, and violence. Children are expected to play a socioeconomic role, which they are not ready to fulfill due to poor physical development, underwhelming education, and a lack of experience.

Gender

Gender is an intrinsic healthcare factor that determines a person’s predisposition towards certain diseases and health hazards. Due to differences in physiology, men and women have different predispositions to cancer, diabetes, heart diseases, and various sex-related issues. The process of childbirth presents a major healthcare hazard for women, especially in rural areas with the absence of adequate healthcare. In addition to biological influence, gender has an influence on socioeconomic status.

Gender is a significant healthcare determinant in Afghanistan. Due to a lack of healthcare facilities, maternity mortality rate in the country is extremely high, standing at 1600 deaths per 100,000 live births (Najafizada, Bourgeault, & Labonte, 2017). In addition, women are subjected to numerous rules under the Sharia law, such as the necessity of being accompanied by male relatives to visit doctors, and the necessity to cover their bodies at all times. Education for females is worse, making it harder for them to achieve higher social status and gain better access to healthcare. Male population, on the other hand, is more likely to be injured or killed in combat.

Socioeconomic Status

Socioeconomic status plays a very important role in access to high-quality healthcare. Even in countries with universal healthcare systems in place, additional financial resources allow individuals and families to afford a higher quality of medical treatment. At the same time, poverty is a significant barrier to healthcare, as it prevents access to those living below the poverty line. Socioeconomic status affects not only the ability to receive and afford healthcare but also the geographic proximity to hospitals.

In Afghanistan, the socioeconomic situation is dire. With 50% of the population being children, and 74% of individuals living in rural areas, the majority of the population cannot afford a doctor (Trani, Kuhlberg, Cannings, & Chakkal, 2016). This results in high mortality rates, high infant death rates, high maternity death rates, and various other complications. The situation is even worse for women, who are restricted from many opportunities to improve their wealth and position in society.

Environment

The surrounding environment creates an ecosystem where humans exist. Depending on the nature of the climate, the terrain, and various other geographical properties, different health conditions and diseases are prevalent in the populace. For example, cold and moist climates are associated with greater numbers of respiratory infections, whereas arid climates generate issues in regards to water shortages. Thus, healthcare affects the healthcare situation in a myriad of specific ways.

Afghanistan is a country of mountains and stones. It is classified by dry, arid mornings and cold nights. Rough terrain makes transportation difficult, making various locations remote and preventing effective emergency care. Afghanistan experiences severe shortages of water. Only a third of the population has clean drinking water, while the rest are forced to rely on various decontamination techniques to survive (Trani et al., 2016). Water contamination is a major reason for high child mortality in the country.

Education

Education affects the state of healthcare of the population in a few ways. First, education is a major variable to determine a person’s socioeconomic status, which, in turn, affects access to high-quality healthcare. In addition, education may refer to healthcare education, meaning the lack or presence of basic sanitary knowledge, skills, and habits to maintain healthy standards of living. Higher education rates typically correlate with lower mortality rates and increased life expectancy.

The state of education in Afghanistan is poor. Literacy rate does not exceed 38%, with male literacy rates being at 52%, while female literacy rates remain at 28% (Trani et al., 2016). Children begin attending schools at 12-13 years of age, and average educational periods do not exceed 8 years. Disease prevention education is sporadic and largely conducted by NGOs operating in Afghanistan. Homeschooling is widespread but does not enable social mobility. As a result, the population remains largely uneducated and poor, unable to receive and afford proper healthcare.

Access to Healthcare

Access to healthcare is an important geographical and economic determinant. Healthcare facilities are usually limited to certain locations, and reaching them can present itself as a significant distance barrier. In other situations, high costs of healthcare can prevent access to vulnerable and poorer populations. Lastly, the limited capabilities of healthcare facilities can create situations where medical attention is scarce and limited.

Afghanistan suffers from severe healthcare shortages on all fronts. Hospitals are located in large cities, such as Kabul, Bagram, Farah, and a dozen others. The total number of hospitals in the country is 117 (Mansoor et al., 2016). The number of available physicians is 0.3 per 1000 individuals, which is one of the lowest in the world. Healthcare costs, especially the costs of hospital stay, which are associated with 80% of all healthcare expenses, make it unattainable for the majority of the population (Trani et al., 2016). The problem is exacerbated by growing inflation rates in the country.

Burden of Disease

The burden of disease is used to describe various impacts of healthcare deficit on the overall healthcare status of the nation. Global Burden of Disease (GBD) framework accounts for the total number of deaths, disability-adjusted life years, years of lives lost, years of lives lived with disability, maternal and neonatal mortality rates, as well as deaths under 5 years of age (Massahikhaleghi et al., 2018). These parameters affect the health of every individual throughout their lifespan and can be used as criteria to assess the overall level of healthcare.

Afghanistan is a low-income country with a young population, which affects its GBD score considerably. Although the overall GBD score has been decreasing between 1990 and 2016, they remain high when compared to the rest of the world. Mortality rate, as it stands, is at 910 deaths per 100000 population, and maternal mortality is at 1600 deaths per 100000 live births (Massahikhaleghi et al., 2018). Major burdens of disease are added by terrorism, ischemic heart disease, and road injuries among males, whereas females suffer from congenital diseases and birthing issues.

Economic Situation

The economic situation is a blanket term to describe the overall economic status of a country. It includes a myriad of parameters ranging from individual income of a person or a population subgroup to the prosperity of the community as a whole. Typically, higher GDP and rates of economic development indicate higher individual income and, as a result, better access to healthcare. However, this criterion is not absolute, as there are exceptions. China, for example, is one of the most prominent economic powers in the world, which suffers from various healthcare system deficiencies due to its large population numbers.

Afghanistan is a poor low-income nation ravaged by war (Trani et al., 2016). The majority of its population live in autonomous regions of the country, providing sustenance for themselves and engaging in few productive economic activities besides farming and animal husbandry. As such, many natives have non-convertible goods, such as wool, animals, and dairy products, which cannot be used to pay for medical services. Distances between villages and large cities and lack of transport also play a detrimental role in Afghanistan’s healthcare system (Trani et al., 2016).

Conclusions

Afghanistan remains one of the problem sports for healthcare institutions worldwide. It possesses numerous barriers to deliver proper healthcare. Although short-term solutions may provide temporary relief, united humanitarian and policy efforts should be aimed at improving the situation, using eight determinants of healthcare as a framework for investment and policy direction. Age, gender, socioeconomic status, environment, education, access to healthcare, the burden of disease, and the economy play a massive role in determining how healthcare hazards affect the population of Afghanistan.

References

Mansoor, G. F., Chikvaidze, P., Varkey, S., Higgins-Steele, A., Safi, N., Mubasher, A., … Alawi, S. A. (2016). Quality of child healthcare at primary healthcare facilities: A national assessment of the integrated management of childhood Illnesses in Afghanistan. International Journal for Quality in Healthcare, 29(1), 55-62. Web.

Massahikhaleghi, P., Tehrani-Banihashemi, A., Saeedzai, S. A., Hossaini, S. M., Hamedi, S. A., Moradi-Lakeh, M., … Mokdad, A. H. (2018). Burden of diseases and injuries in Afghanistan, 1990–2016: Findings from the global burden of disease 2016 study. Archives of Iranian Medicine, 21(8), 324-334.

Najafizada, S. A. M., Bourgeault, I. L., & Labonte, R. (2017). Social determinants of maternal health in Afghanistan: A review. Central Asian Journal of Global Health, 6(1), 240-258. Web.

Trani, J.-F., Kuhlberg, J., Cannings, T., & Chakkal, D. (2016). Multidimensional poverty in Afghanistan: who are the poorest of the poor?Oxford Development Studies, 44(2), 220-245. Web.

Abstract

In the field of healthcare, it is crucial to assess the quality of research investigations since their results can have a direct impact on people’s wellbeing. The work under examination is the research proposal by Achakzai (2014) titled “Research Proposal for Assessing Patient Safety Culture in Public Hospitals Under the Essential Package of Hospital Services (EPHS) in Afghanistan.” The text is concerned with the current state of the patient safety culture in Afghanistan.

The main goal of the study is to see whether a translated version of Hospital Survey on Patient Safety Culture will yield viable results about the hospitals in Afghanistan. This survey was developed by the Agency for Healthcare Research and Quality (AHRQ) (Westart, Sorra Yount, Famolaro, & Gray, 2019). Furthermore, the author aims to use the results of the study for a comparison with the survey’s findings in the United States and Iran. The evaluation of this research reveals a thought-out proposal for a new approach to patient safety culture in Afghanistan that acknowledges the problems and gaps in contemporary research while also providing suitable arguments for the survey’s implementation.

Summary

The discussed proposal is organized according to the standards of academic research works. First, it briefly presents the issue of patient safety and patient safety culture, investigating the origins of the research sphere and its development into a separate discipline (Achakzai, 2014). The structure of public hospitals in Afghanistan is explained as well – it differs from other countries due to its history as well as government-regulated nature. The introduction also describes the Hospital Survey on Patient Safety Culture (later named SOPS Hospital Survey) and describes its contents.

Second, the author presents a literature review of the discipline’s background as well as scholarship related to the subject of the investigation. Various patient safety-focused studies are discussed with the implementation of the AHRQ Hospital Survey and its use in multiple countries (Achakzai, 2014). Then, the author presents the factors that affect health care in Afghanistan – the impact of the ongoing war, poor economic state, and the aim of the government to provide public healthcare.

The chapter presenting the research methods returns to the contents of the SOPS Hospital Survey, detailing the changes of the survey to fit the national context. The quantitative study design is discussed; sampling procedures and estimations are provided. The author suggests using convenience sampling of physicians, nurses, management, and lab technicians from seven hospitals on the three levels of care – regional, provincial, and district (Achakzai, 2014).

The number of respondents is expected to be about 350 completed surveys, based on the calculations recommended by the AHRQ. Furthermore, Achakzai (2014) elaborates on the ways of data collection and management. Finally, the proposed analysis strategies are described, and ethical considerations are addressed. For example, the issue of respondent anonymity is central to the discussion, and the author explains how anonymization of the results will protect staff from the influence of adverse outcomes.

The last chapter deals with the scheduling and possible management issues of the research study itself. The time scale accounts for ethical approval, personnel hiring and training processes, data collection, analysis, and the writing of the final report (Achakzai, 2014). Then, the author suggests professional areas where this study may be useful, also describing the path to data dissemination – the Afghanistan Journal of Public Health is named as a potential publisher to reach the desired audience (Achakzai, 2014). Finally, the scholar concludes the proposal, outlining the primary purpose of the study as well as its necessity for national healthcare.

Critique

To understand the weaknesses and strengths of this proposal, the following review will consider each criterion of a study and provide its overview. To start, the author’s aim for this investigation is clearly stated – to prove the effectiveness of the SOPS Hospital Survey for assessing patient safety culture in Afghanistan’s public hospitals (Achakzai, 2014). As the discussed paper is a proposal, the outcome of this aim cannot be seen.

However, one may see the potential contribution of the paper to the scholarship. The author suggests that the current amount of knowledge about this issue in non-Western countries is lacking (Achakzai, 2014). Indeed, the scarcity of studies concerning the measurement of patient safety in Afghanistan and neighboring countries supports this statement (Phaghizadeh & Asoori, 2015). The health system on Afghanistan follows a set of specific standards and pays great attention to the medical side of health care delivery.

As can be seen in the report prepared by the Islamic Republic of Afghanistan Ministry of Public Health (2005), patient safety is addressed briefly in regards to physical barriers, waste management, and emergency situations. The issue of safety culture, however, is not brought up in the official document.

In contrast, the US and European countries have been developing studies in the sphere of patient safety for more than a decade, to which the report “To Err is Human” is a testament (World Health Organization, 2017). Therefore, this text is a substantial contribution to the research of patient safety in non-Western countries, providing a translated survey sample and showing the initial results of the nation’s hospitals. Programs focused on education and better feedback channels for staff are at the center of discussions by contemporary researchers (Qarani, Jan, Saeed, & Khymani, 2018). Such initiatives are crucial for improving the state of healthcare delivery in Afghanistan.

Furthermore, the research connects itself to the other countries by aiming to compare the results of the survey with similar questionnaire findings from Iran and the US. Although this decision allows the author to immediately compare the results of the examination to those from other nations, it also separates the study’s aim into several topics. First, the scholar aims to determine whether the results of a SOPS Hospital survey are suitable for Afghanistan, thus focusing on the adaptability of the system for the nation.

At the same time, the author seems to be interested in comparing the state of healthcare in Afghanistan and other countries. While this question is as important as the first one, it may undermine the initial idea of confirming the survey’s usefulness and the consistency of its numbers between different staff and hospital types.

The methodology is the next major part of the proposal, and its detailed and thorough description strengthens the validity of future analyses. The use of the quantitative approach is the most appropriate for investigating the effectiveness of the survey and its result’s consistency (Waterson, 2014). The author proposes to use the results of the five-point Likert scale for several examinations – to assess the culture of patient safety in the country and, with additional demographic data, to see the similarity between reports from hospitals and staff members (Achakzai, 2014).

As a result, one can see that the selected strategy fully aligns with the aim, and the hypotheses proposed by the author make the expected results transparent. Quantitative research methodologies are more objective than qualitative ones due to their reliance on calculations (Parker, Wensing, Esmail, & Valderas, 2015). Moreover, the author’s focus on interpreting the findings according to the standards of two organizations – the World Health Organization (WHO) and AHRQ – further lowers the possibility of bias.

The detailed investigation into the validity of the SOPS Hospital Survey is another strength of the proposal. The author presents several reasons why this particular framework is suitable for hospitals in Afghanistan and shows examples of its use in other non-Western countries. For instance, the scholar cites the comparison of the test being implemented in the US, the Netherlands, and Taiwan and finds that the AHRQ’s survey provides viable results that can be used both for internal and external comparison (Achakzai, 2014).

Furthermore, the author acknowledges the differences in culture and healthcare delivery between the nations, which may act as a barrier to the test’s implementation. To address these concerns, Achakzai (2014) presents the findings from Iran, explaining the outcome of the survey as well as the lack of issues rooted in Iran’s cultural background differences. A recent example of a non-Western country successfully using the AHRQ’s survey is the report by Farhat (2019) who assesses patient safety culture in the United Arab Emirates. The scholar builds a concrete action plan based on the questionnaire which further proves the suitability of the survey. Thus, the argument for using SOPS seems to be consistent with the purpose of the investigation, and its structure makes the proposed research highly valuable.

Conclusion

The analyzed research proposal provides an in-depth investigation into the state of patient safety culture in Afghanistan, offering a tool for measuring its quality. The instrument suggested by the author is well-researched and discussed – Achakzai is transparent in explaining the reasons behind the choice of the SOPS Hospital Survey, its benefits and potential pitfalls for the country. While the researcher’s aims shift their focus in some areas of investigation, the overall goal of the study remains clear. Moreover, the review of the present literature supports the potential impact on non-Western studies that this research can have.

References

Achakzai, H. (2014). Research proposal for assessing patient safety culture in public hospitals under the essential package of hospital services (EPHS) in Afghanistan (Master’s thesis, Georgia State University, Atlanta, GA). Web.

Farhat, R. (2019). Hospital survey on patient safety culture: Feedback results. Dubai, UAE: United Arab Emirates Ministry of Health & Prevention.

Islamic Republic of Afghanistan Ministry of Public Health. (2005). The essential package of hospital services for Afghanistan. Web.

Parker, D., Wensing, M., Esmail, A., & Valderas, J. M. (2015). Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care. European Journal of General Practice, 21(sup1), 26-30.

Phaghizadeh, S., & Asoori, M. (2015). Assessment of nurses viewpoints on patient safety culture in Amol hospitals in Iran, 2012. Preventive Care in Nursing & Midwifery Journal, 4(2), 45-55.

Qarani, W. M., Jan, R., Saeed, K. M., & Khymani, L. (2018). We need higher education: Voice of nursing administration from Kabul, Afghanistan. Nursing Open, 5(3), 317-322.

Waterson, P. (Ed.). (2014). Patient safety culture: Theory, methods and application. Burlington, VT: Ashgate.

Westart, R., Sorra, L., Yount, N., Famolaro, T., & Gray, L. (2019). AHRQ hospital survey on patient safety culture version 2.0: User’s guide. Web.

World Health Organization. (2017). Patient safety: Making health care safer. Web.

Education in Afghanistan is one of the most frequently discussed problems that require certain time and investigations. Many sources admit that the policies of the Taliban were so horrible and strict that any girl could not get a chance to study and enlarge own level of knowledge on the same level with boys. The point is that many female students just could not continue their education, because the chosen programs were too horrible and war-oriented that females did not find it helpful and necessary to visit schools.

The impact of the Taliban on boys and girls’ education in Afghanistan was really great: different educative strategies and concentration on war affairs deprived girls of the opportunity to get education on the same level as boys could do it; this is why the fall of that movement led to positive changes in the sphere of education and promoted girls’ desire to study just like it was described in Seierstad’s The Bookseller of Kabul.

Contrary to popular belief, the Taliban never officially banned the education for females. Girls under the ages of nine were allowed to attend school and share a classroom with boys of the same age. However, once a girl reached the age of ten, she lost the right to attend the school.

The Taliban put a suspension on female education until a segregated education system could be completely organized and implemented. Abdul Hai Muthmahien, the Taliban chief spokesman, admitted that their movement was going to spend more then $ 1 million in order to build schools and provide students with the necessary equipment “Taliban are not against education” (Baker para.2), and even girls should have a chance to study.

The students, who were fortunate enough to attend the schools that remained open, were taught a curriculum, centered on violence and religion.

At the first grade, children, who were six years old, learned the alphabet not by animals, fruits, or joys, like it was inherent to the vast majority of schools all over the world, but by means of religious and war-like terminology: “’J’ was for Jihad, ‘M’ was for Muhjahed, and ‘T’ was for Talib” (Fassihi para.1).

First graders were also taught simple arithmetic like counting bullets. The fourth grade of education turned out to be crucial for many students, because they got a chance to teach more complex math word problems.

These tasks involve the following: “If a bullet travels 800 meters per second, and the distance between a Russian and a muhjahed is 3,200 meters, then how many seconds will it take for the bullet to hit the Russian between the eyes?” (Fassihi para. 5)

Each year, a student could advance to a new grade, texts, lessons, and homework became even more graphic; the seventh grade promotes students to study the “jihad manual”, the manual that was laden with instructions for bomb making, gun and weapon descriptions and diagrams, and even how-to’s for killing Islam’s enemies (Fassihi para. 6).

Students were subjected to this style of learning until the Taliban fell after a five year reign. “Belqisa could even continue her education if she wanted…Now it was allowed, but she forbade herself” (Seierstad 175-181). So, a child of any sex could get education, the question is whether the child wants to get such education.

In November 2001, since the fall of the Taliban, Afghanistan faced numerous troubles because of the period of reconstruction and its demands (UNESCO 137). The sphere of education underwent certain challenges and changes as well: schools all across the country held registrations for both males and females.

In Jalalabad, the new minister of education, Abdul Ghani Hidayat, hoped for the turnout at registration and believed that nearly eighty percent of the city’s eligible male and females would register. Despite the lack of text books, furniture, and writing utensils and supplies, Mr. Hidayat was eager to commence the planning and implementation of a new curriculum for the children in order to present them an opportunity to enlarge their level of knowledge and have the same rights as other people on the world have (Witter para. 8).

In spite of Mr. Hidayat’s enthusiasm and desire to support children and their families, it was not enough to make children return to the schools and continue education. The Taliban’s conditions were so strict and repressive that even their leaving did not help to return female students.

The development of innovative computing technologies, the status of English as an international level, and other changes in curriculums require considerable work in the sphere of education (Moreno 398). Wars, which take place in Afghanistan, have serious effect on education in this country: many teachers are killed in actions, many children prefer to go for a war but not to spend time at schools, and many schools have been already destroyed.

All this damage, created as a result of the war, influences education indicators considerably and increases brain drain. Teachers do not find it effective to stay in the country and train children under such terrible conditions. Those, who decide to stay and protect own native land, face such problems like lack of knowledge or experience.

Some teachers do not even have any pedagogic practice, and make use of every day problems to create new tasks and train students. Lack of education leads to wrong perception of information and interpretation of numerous psychological, social, and philosophical concepts. Even if the fall of the Taliban promotes the development of the educational sphere in Afghanistan, students still face numerous problems and do not have chances to cope with them.

Nowadays, education is available for any citizen of Afghanistan. It does not matter whether you are a boy or a girl. The point is that the attitude to education may be different in each family, and the head of one family cannot accept the idea that his women should spend much time alongside men (Seierstad 262), and the head of the other family is eager to help his women to study new material and be smart.

In general, education for boys and girls in Afghanistan sees considerable changes before and after the reign of the Taliban. The sources prove that in fact the Taliban movement did not prevent education for girls; certain conditions may cause some restrictions, but as a whole, girls got the right to visit schools and enlarge their knowledge.

Of course, war conditions deprive a lot of boys and girls of the opportunity to study, this is why numerous school reforms and additional help should be provided day by day. Maybe, this lack of education and attention to social norms and attitude to this life serve as a serious reason of the war. It is high time to think about the ways of how to educate the Afghan people and explain them how wrong and horrible their comprehension of this life can be.

Works Cited

Fassihi, Farnaz. “2 Bullets + 2 Bullets =?: That Was Math in the Textbooks Used in Taliban-Era Schools.” Newhouse News Service.

Moreno, Juan, M. “Secondary Education in Afghanistan: A Portray of Post-Conflict Education Reconstruction.” Revista Espanola de Educacion Comparada 11 (2005): 381-406.

Seierstad, Asne. The Bookseller of Kabul. London: Virago Press Ltd., 2004. Print.

UNESCO. Education for all by 2015: Will We Make It? New York: Oxford University Press US, 2008. Print.

Witter, Willis. “Afghan Girls Giddy over Return to School.” The Washington Times. (21 Nov. 2001).