Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies

Inadequate Revenue Threatens Afghanistan’s Stability

If Afghanistan is to maintain some semblance of stability in 2014 and beyond it must prepare for a substantial donor funding reduction and seek to grow its domestic revenue. Funding for the Afghan government’s operating expenses as well as further development projects is heavily dependent on donor support. Unfortunately for Afghanistan, its fiscal position is eroding as domestic revenues decline, expenses rise, and donor aid falls. Security gains as well as public services and economic development are at risk due to this mismatch. Afghanistan’s challenge in the coming years will be how to deal with this mismatch without fueling instability. It cannot simply assume that donor funding will continue to cover its funding gap. This paper assesses Afghanistan’s deteriorating fiscal situation and concludes with some observations on what the Afghan government and the donor community must do, preferably in concert, to address it. It assumes that Afghanistan and the United States will ultimately sign a bilateral security agreement allowing a continued coalition military presence, without which the country’s fiscal situation could rapidly deteriorate

Impact of conflict and displacement on risk behaviours amongst people who inject drugs in Kabul, Afghanistan

BACKGROUND: Theoretical work posits that drug-related risk behaviour increases during armed conflict; however, few studies have been conducted in conflict settings. The objective of this analysis is to determine whether conflict or local displacement impact risk behaviours among people who inject drugs (PWID) in Kabul, Afghanistan. METHODS: Consenting PWIDs aged ≥18 years completed interviews at 3, 6, 9, 12, 18, and 24 months of follow-up. Quarters with peak conflict or local displacement exposure were defined and associations with injecting drug use and sexual risk behaviours analysed with generalized estimating equations. RESULTS: Of 483 PWID enrolled, 385 completed ≥1 follow-up visit (483.8 person-years) between 2007 and 2009. All participants were male, with 35% initiating injecting as a refugee. Sharing syringes (Odds Ratio (OR))=8.53, 95% Confidence Interval (CI): 2.58 – 28.2) and sexually transmitted infection (STI) symptoms (OR=1.72, 95% CI: 1.00 – 2.96) increased significantly during peak conflict quarters, while odds of STI symptoms (OR=0.06, 95% CI: 0.02 – 0.20) and arrest (OR=0.61, 95% CI: 0.40 – 0.93) were significantly lower during periods of displacement. CONCLUSION: Syringe sharing significantly increased during peak conflict periods amongst PWID in Kabul. Programming should include instruction for coping with conflict and prepare clients for harm reduction needs during conflict