A cost and technical efficiency analysis of two alternative models for implementing the basic package of health services in Afghanistan

Abstract

Since 2003, the Afghan Ministry of Public Health (MoPH) and international partners have directed a contracting-out model through which non-governmental organisations (NGOs) deliver the Basic Package of Health Services (BPHS) in 31 of the 34 Afghan provinces. The MoPH also managed health service delivery in three provinces under an alternative initiative entitled Strengthening Mechanisms (SM). In 2011, under the authority of the MoPH and Delegation of the European Union to Afghanistan, EPOS Health Management conducted a cost and technical efficiency study of the contracting-out and SM mechanisms in six provinces to examine economic trade-offs in the provision of the BPHS. The study provides analyses of all resource inputs and primary outputs of the BPHS in the six provinces during 2008 and 2009. The authors examined technical efficiency using Data Envelopment Analysis (DEA) at the BPHS facility level. Cost analysis results indicate that the weighted average cost per BPHS outpatient visit totalled $3.41 in the SM provinces and $5.39 in the NGO-led provinces in 2009. Furthermore, the data envelopment analyses (DEAs) indicate that facilities in the three NGO-led provinces scored 0.168 points higher on the DEA scale (0-1) than SM facilities. The authors conclude that an approximate 60% increase in costs yielded a 16.8% increase in technical efficiency in the delivery of the BPHS during 2009 in the six provinces.

Bypassing Primary Care Facilities for Childbirth: Findings from a Multilevel Analysis of Skilled Birth Attendance Determinants in Afghanistan

“…Each nongovernmental organization is expected to operate all primary care facilities in the province or cluster of districts within a province by providing a core set of services under the supervision of donor contract managers and proviancial health offices. Contracts vary slightly across the donor agencies, particularly with respect to inclusion of performance‐based elements, monitoring and evaluation mechanisms, and centralization or decentralization of essential drug and supply procurement …”

Efficiency analysis of primary healthcare facilities in Afghanistan

“…In the remaining three provinces, health services are provided directly by the Afghan government under the Strengthening Mechanism Project [ 4 ]. Previous research has revealed potential inefficiency in the NGO-run provinces (31) compared to the three provinces in which the Afghan government provides services directly [ 5 ]. The struggle to reduce inefficiencies in the health sector is not unique to Afghanistan.…”

An assessment of the barriers to accessing the Basic Package of Health Services (BPHS) in Afghanistan: was the BPHS a success?

“…The rapid scale up of the BPHS has been attributed to the successful implementation of the NGO contracting mechanism [9]. The BPHS is delivered by NGOs in 31 of the 34 Afghan provinces and by the MOPH in three provinces using a contracting-in initiative entitled Strengthening Mechanisms (SM) [12]. …”