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Throughout this report, the above question will be answered through consideration of two contrasting countries the United Kingdom and Afghanistan.
Firstly, however, a definition of the title is required. Quality means "the degree or standard of excellence"1, while health provision may be defined as "a complete state of physical, mental and social well-being, not merely in the absence of disease and infirmity."10 (WHO). Provision means "something that is supplied or provided"1, while MEDC stands for "More Economically Developed Country", e.g. UK, and LEDC stands for "Less Economically Developed Country," e.g. Afghanistan.
Therefore, the title may be interpreted as the degree to which the country, and indeed the sole individual, is provided with the required healthcare, on a physical, mental, social and spiritual level. A range of factors will be considered, from the provision of healthcare, to how this affects the quality of life present, reflected by indicators such as life expectancy and infant mortality rate. Regional variations in the UK will also be considered.
The UK is the MEDC of choice due to the availability of healthcare information, and the ease with which this information can be interpreted and related to. Afghanistan is the preferred LEDC, mainly because of the political issues that arise from how the healthcare is affected by the extreme fundamentalist government (the Taliban) that are in power there(a). Furthermore, Afghanistan contrasts with the UK in terms of wealth (GNP), quality of life, and ultimately, the quality of healthcare provision. Write my Essay on Compare and contrast the quality of health provision in an MEDC and an LEDC of your choice.
Within the United Kingdom, the most widely used healthcare service is the National Health Service, NHS, predominantly because it provides healthcare free at the point of use funded by taxation - irrespective of gender, race or religion. It was set up in 145, and is recognised by the World Health Organisation as being one of the best health services in the world. 10
Almost any medical ailment can be dealt with; emergencies are treated immediately, and the whole service utilises the expertise of educated and trained professional medical staff. There is private healthcare available in the United Kingdom for a fee; this is covered later in this report.
The National Health Service is not without fault; for several years it has come under criticism for being unable to provide sufficient beds for patients, and having inconveniently long waiting lists for high demand operations. This is a problem that is difficult to resolve, however, because of successive Governments' reluctance to raise extra funding through tax increases. Furthermore, demands for treatment are rising, due to an increasingly elderly population (a result of low birth and death rates, see graph ). The elderly require more frequent treatment than younger members of the population, and the Government is finding it difficult to provide for them.
Indeed, this criticism is not isolated to members of the public; the Government itself recognises the faults, and is attempting to rectify the situation "The NHS is a 140s system operating in a 1st century world. It has a lack of national standards, old-fashioned demarcations between staff and barriers between services, a lack of clear incentives and levers to improve performance, over-centralisation and disempowered patients". The March 000 budget has provided the NHS with money that will allow it to grow by one-third in real terms in just five years (see box, right of graph 1).
There are regional variations in the level of healthcare within the UK, which are covered in diagrams 1-6.
The UK's level of healthcare, despite its faults, can be described as being infinitely more developed and advanced than that provided in Afghanistan. While being 'free', the Taliban regime has restricted the healthcare available, especially to women.
Women in Afghanistan are considered second-rate citizens, who are not allowed to work unless in the health sector (even this is being phased out), must veil themselves in the presence of men, and may not venture outdoors unless accompanied by a male. This inferior status has led to them receiving poor quality healthcare in comparison to men.
As of May 18, only 0% of hospital medical and surgical beds dedicated to adults were available for women. 5 Besides shutting female patients out of the hospitals, the Taliban also banned female hospital personnel, including physicians, nurses, pharmacists, and technicians, from working in any of Kabuls hospitals. 5 This gender discrimination is taken a step further by the Taliban stopping women from working at all, which means that their children cannot be provided for in single-parent families, which causes many health implications including starvation.
The effect these differences have on the life-expectancy figures can be seen in graph 1. Graphs 1- give our birth/death rates, and life expectancy, compared to that of Afghanistan.
Diagram 7, below, shows how this compares on a world scale; and, as can be seen, generally only tropical Africa has a life expectancy as low as Afghanistan the rest of its region has a higher life expectancy.
Despite their preferential treatment, even the healthcare available to men under the Taliban Afghanistan is underdeveloped. There are 17,58 people per doctor 14, compared with 77 in the UK7. The education is poor, with a combined adult literacy rate of 1% (males 47%, females 15%)11, compared with a combined literacy rate of .45%11 in the United Kingdom. Furthermore, girls over the age of 1 are barred from attending school. This lack of education results in poorly trained doctors, working in hospitals devoid of modern machinery due mainly to the lack of money available (Afghanistan GNP per capita 70 US$, world GNP rank 101, UK ,0 US$, world GNP rank 4)&4, creating a healthcare service that produces the results seen previously in graph 1 a life expectancy generally 0-40 years lower than that of the United Kingdom. Graph demonstrates the difference between the birth and death rates of Afghanistan compared with the United Kingdom
a. As can be seen, the birth rate is considerably higher in Afghanistan (4 per 1000 as compared to 1 per 1000 in the UK). Indeed, the fertility rate in Afghanistan is 5.87 children born per woman, in comparison to 1.74 children per woman in the UK. The death rate is also considerably higher (1 per 1000 as opposed to 11 per 1000 in the UK), as a result of the lack of health provision. (see graph , next page)
It is also worth noting that in Afghanistan, one in four children die before their fifth birthday5, and more women die during childbirth than in any other country in the world5. Refugee camps sited on the Afghanistan/Pakistan border house 4 million Afghans who fled famine, war, drought, and above all the Taliban1. They live on the most part without electricity, water and acceptable sanitation. Water-borne disease is rife, as well as starvation; and even general illness cannot be appropriately treated.
Furthermore, in Afghanistan, diseases such as TB and cholera are common; while in the UK, illnesses such as cancer and heart disease (diagrams 1-6) are more frequent.
With regard to private healthcare, none is provided in Afghanistan, and it is debatable that enough of the population would have the wealth to warrant its provision. Furthermore, the Taliban would not consider the use of private healthcare, because in doing so, they would be admitting that their healthcare system is inadequate, which they would not accept. However, despite this, 80% of medical resources in Afghanistan are provided by foreign aid agencies15, which shows that not enough is being done by the Taliban, but also means that health services are less accessible and permanent.
In the United Kingdom, however, private healthcare is available to all who wish to pay for it. The most prominent of many private healthcare services offered to UK citizens is the British United Provident Association, or BUPA (footnote "b", bottom of page). BUPA offers a similar level of care to the NHS, however, there are no waiting lists for operations, and beds are always available for those who want to pay, their operation will take place without delay. 6
b. BUPA employs 40000 UK staff, working in 6 hospitals, 4 health screening centres, care homes and 54 retirement homes.6
In conclusion, there are many differences, and few similarities, between the healthcare provision in the UK and Afghanistan.
The UK is much more advanced with regard to healthcare. This stems from many reasons, all equally important. Firstly, the UK has a GNP per capita over 80 times greater than Afghanistan. This shows that the UK is more affluent, which in turn allows for greater levels of education, and the purchase of the most recent advances in medical technology. In contrast, Afghanistan cannot afford to offer this.
Politically, a fundamentalist government who restrict the basic human right to healthcare, especially to women, rules Afghanistan. Their education inhibitions on girls over 1 prevents them from obtaining any form of higher education, while even the education provided to men is poor, producing a low male literacy rate in comparison to the UK. No such restrictions are imposed in the UK, and as a result, there are professionally trained and fully educated doctors who cannot restrict healthcare on any social ground. Both the UK and Afghanistan have a free healthcare system, however the NHS is 'free' on a social level (available to all), not just on a monetary level.
Finally, also on a political level, because women are prevented form working in Afghanistan by the Taliban, they cannot provide for their children if they are the sole parent, which leads to starvation and goes some way to explain the high infant mortality rate in comparison to the UK.
Each of these factors are critical to the level of healthcare provided, and explain the vast gap that exists between the UK and Afghanistan, and in summary, both health services struggle to keep up with the demand, however they contrast in the levels of success as a result of these factors.
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