Substance use disorder treatment centers and services needs assessment Afghanistan

S. Sayeedy, Y. Hashimi. Drug Demand Reduction of Afghanistan, Afghanistan

Drug demand reduction conducted this assessment to identify the gaps and needs for treatment of substance use disorders and rehabilitation services in four provinces: Jalalabad, Laghman, Balk and Kunar. The specific objectives of this assessment are:

1. to understand communities' perceptions of and attitudes toward people with substance use disorders;
2. to identify the context of substance use, types of services available, perceptions of the accessibility and quality of services, treatment facility-level policies and regulations, vulnerable populations and community perception of substance use trends; and
3. to share recommendations based on the needs assessment with different stakeholders and actors for better designing MHPSS programs on substance use disorders, treatment and rehabilitation services at the community and treatment facility levels.

Methods

The assessment's methodology relies on both qualitative and quantitative data collection and analysis, including a desk review; 4Ws (who, what, when, where) MHPSS service mapping; FGDs and KIls with the heads of substance use disorder treatment centers and with the head of the provincial DDRP; FDs with patients in treatment facilities and their caregivers on the context of substance use, types of services available and relevant substance use disorder treatment centers; assessing the available services; identifying vulnerable populations and assessing the perceptions of substance use in the community, including relevant community activities existing in the setting. A total of 10 key informants (eight males and two females) were interviewed, and 15 FGDs (a total of 105 individuals 49 females and 56 males) were conducted for the data collection during this assessment.

Results

A report by the MoPH show that more than 2.5 million' people suffer from substance use disorders in the country, with the number increasing- based on data from 2005 to 2015-and treatment centers/services decreasing. At least 44 of the 104 substance use disorder treatment centers operating in the country are out of service. This can be attributed to unpaid staff salaries and the lack of medical, food and hygiene supplies for inpatients. Previously, there were 16 centers in Kabul, but only four continue to provide services as supporting donors stopped funding. In Kunar province, there is no active treatment center due to the lack of funds. In Laghman, there is a 20-bed center providing services for males, but there is no such space for women and youth. The MoPH report shows high demand for substance use disorder treatment services for females.

Background

Forty years of war, recurrent natural disasters, poverty, drought and the COVID-19 pandemic have left more than 24 million people in Afghanistan in need of humanitarian assistance. 3 Afghanistan's population is estimated to be 32.9 million for 2020-2021, based on the Population Statistics Department of the National Statistics and Information Authority (NSIA),4 with 71.13% of the population living in rural areas, 24.32% living in urban areas and 4.32% estimated to be nomadic. Females comprise 49% of the total population. Afghanistan also has one of the youngest and fastest-growing populations in the world. Almost half (48%) of the population is under 15, while adults aged 65 or older represent only 3.7% of the population. The overall literacy rate is 31.74%, with females less literate than males (17.61% vs. 45.42%) due to cultural obstacles that prevent women from accessing education.