Physician-to-population ratios and geographic disparities in Afghanistan’s healthcare system

Abstract Background Equitable access to healthcare depends not only on the overall availability of medical professionals but also on their fair geographic distribution. Physicians are central to patient care and health system development. This study aimed to assess the physician-to-population ratio and analyze the geographic distribution of physicians across Afghanistan, highlighting existing disparities. Methods This cross-sectional study uses data from a comprehensive national health workforce assessment in Afghanistan conducted in 2023 by WHO and KIT Royal Tropical Institute. The parent study utilized a multi-stage census-style count followed by facility-level verification across health facilities in the public and private sectors. For this analysis, physician data was extracted and analyzed disaggregated by province, specialization, sector, and gender. Geographic inequities in physician distribution were assessed using Gini coefficients and Lorenz curves for all 34 provinces. Results In 2023, Afghanistan had 13,155 active physicians, including 8,099 general practitioners (GPs) and 5,056 specialists. This corresponds to 3.93 physicians per 10,000 population—2.42 GPs and 1.51 specialists per 10,000 people. The overall shortage is exacerbated by unequal geographic distribution, as reflected by a Gini coefficient of 0.357 representing provincial physician-to-population ratios, indicating moderate inequality. Kabul has 9.31 physicians compared to Badakhshan 1.04 per 10,000 population. Conclusion Afghanistan faces a substantial shortage of physicians, compounded by significant gender disparities and pronounced geographic inequities. Addressing these gaps is critical for improving equitable access to healthcare services.