By: Mohammad Azeem Zmarial
As the presidential candidates competing in the upcoming election prepare to kick-off their election campaigns, millions of voters are eager to learn about the policies and reform agenda of these candidates. The candidate’s campaign agenda will be dominated by the policies on economic growth and reforms, international relations, peace and security, electricity, and job creation, but what would rarely get on the electoral campaign agenda is the healthcare related issues of the country which adversely affect the lives of the majority. Based on the evidence from the past elections, candidates competing for presidential and parliamentary elections rarely reflect their views on health issues (health infrastructure, financing, expansion, quality) that place people in worrisome situation. Despite the improvements in the health indicators since last several years, reports indicate that health sector still requires significant attention.
A good starting point for the candidates interested in including healthcare on the electoral agenda would be the introduction of policies to reduce inequalities in health, battle corruption in the health sector, provide opportunities for health professionals, expansion of health care services, improving the quality of health care services, addressing the health needs of population. By addressing the issue of health reforms in election campaigns would generate interest from voters and help candidates to connect with the voters.
Furthermore, there are several other key reasons that illustrate the need for having healthcare on the election campaigns agenda.
Major contribution to health sector comes from international community. The international community is decreasing their financial contribution to the government and the health sector (along with many others) is prepared to take the responsibility of supporting the healthcare system in both urban and rural areas of the country. The chances of losing the current gains in health sector is significantly high. If the candidates discuss the major issues related to health, and explore the means to maintain and sustain the delivery of healthcare services during their election campaigns through mobilization of local resources, it will not only attract votes and raise awareness, but the upcoming government will be expedient in tackling healthcare related problems and mobilize the necessary resources to reduce the dependency of health sector on the international organizations.
High out of pocket expenditures on health in the country is also a major issue. Shortage of experienced physicians, lack of updated technologies, and limited tertiary care services for large population living in rural areas in public health facilities of the country resulted in high out of pocket expenditures in Afghanistan. Reports indicate that Afghans spend 285 million dollars annually on seeking healthcare services outside of Afghanistan. This situation reflects the unpleasant situation of health condition in the country and may increase health inequalities. Addressing this issue in the contest of comprehensive plans for keeping the health spending inside the country would definitely be point of interest for voters. Establishing social insurance system in the country could be a way to tackle this emerging problem. Moreover, evidence has shown positive effects of establishing social insurance system on improvement of health indicators in Philippines, Thailand, India and Bangladesh. Afghanistan’s health sector lack comprehensive social insurance system. Having a plan for social insurance system and accommodating it in their five-year strategy will have positive implication on improvements of health indicators in Afghanistan. This will decrease inequalities in provision of health care services as well.
Adjusting health needs in the framework of political reforms and influencing health policy formulation based on evidence and tailoring it to the values and culture of society would definitely be something to be addressed in the election campaign and would be point of interest for voters. In addition, poor health services in rural areas where majority of population are looking for advanced health services could be addressed through comprehensive plan by fostering public-private partnership. In this case, political will is pivotal and only political commitment from political actors could gain tremendous achievements in health sector. Health and politics walks hand in hand, and political actors can priorities health needs of a community. In the article, Sandro Galea argues that health is politics, and mentions that political actors are able to shift the Overton window; claiming that political actors can shape the health condition of the people and can make a health issue to find its way to political policy. In the USA, UK, and recently in India, and other countries health issues have found its way to election campaigns. Voters are interested to learn about health schemes, health plans and policies affecting their health in the long term. Therefore, candidates in Afghanistan can have major health reforms topics as part of their health policies; and depart from state of insensitivity towards health reforms to actively include health reforms topics in their political debates and timely brief the population on the progress on their plans and accomplishments.
In conclusion, addressing health issues in election rallies and gatherings is interesting and important issue. It can bring the health policies and health problems to the main topic of election discussions that have been sidelined in political debates previously. However, creating a demand that can force politicians to address their health problems still lies in the hands of civil societies, academia, associations of health professionals, and lay audience. They can demand their health rights, advocate for better working conditions, accessible and affordable health services, and encourage health reforms through putting pressure on political actors. Candidates may share their plans for improving healthcare services that may be physically and mentally stimulating but if not stuck to their plans, it would accomplish nothing except the hatred of the population and people may question their tenure in higher office of the country.