Lessons From the Health Sector in Afghanistan

Too good to be true? An assessment of health system progress in Afghanistan, 2002–2012

“…The inevitable implementation gaps encountered in local implementation are inconsistent with the public accounts of progress, but the gap between The very high official figures for contracting coverage (often mistaken for health service coverage), reaching beyond 80% Loevinsohn and Sayed 2008;IRA/ANDS 2008) are contested in practice, on the grounds of loose definitions of 'coverage', significant under-reporting of incomplete implementation or outright health facility closures caused by insecurity (Jones et al 2006;Simmonds and Ferozuddin 2008), lack of resources or corruption (ACBAR 2011) and insufficient consideration of the actual use of public health services. The debates confirm Palmer and Mills' (2005) contention that contracting-out primary care services is of low measurability, but high contestability.…”

“…Recurrent reports of continuous progress in the health field (Bousquet 2005a;Waldman, Strong and Wali 2006;Loevinsohn and Sayed 2008;The Globe 2011;Newbrander, Waldman, and Shepherd-Banigan 2011) contrast with the observed failure to achieve peace (Giustozzi 2009) and the involution of the new state built by modernizers sponsored by foreign powers (Suhrke 2007;Giustozzi 2008).…”

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

“…The United States Agency for International Development (USAID), European Union (EU), and World Bank (WB; along with other donors) have collectively supported the Afghan MoPH through a number of targeted initiatives, including the establishment, financial support and implementation of the BPHS. While directing these policies with an infusion of international financial support, the MoPH prioritised service delivery as well as monitoring and evaluation of health sector performance through a series of household surveys, health facility assessments and development of an extensive health management information system (Loevinsohn & Sayed, 2008). Loevinsohn and Sayed (2008) describe the BPHS in detail.…”

“…While directing these policies with an infusion of international financial support, the MoPH prioritised service delivery as well as monitoring and evaluation of health sector performance through a series of household surveys, health facility assessments and development of an extensive health management information system (Loevinsohn & Sayed, 2008). Loevinsohn and Sayed (2008) describe the BPHS in detail. In 2008, approximately 57% of the population lived within walking distance of a BPHS facility, as reported in the National Risk and Vulnerability Assessment (NRVA).…”

“…Historically, contracting-out has been popular in a variety of country contexts, especially where making important health services quickly and widely available is critical (Jacobs et al, 2010;Loevinsohn & Sayed, 2008;Meessen, Kashala, & Musango, 2007;Meessen, Musango, Kashala, & Lemlin, 2006;Soeters & Griffiths, 2003;Soeters, Habineza, & Peerenboom, 2006). Using an alternative WB-financed model, the MoPH has led and managed health service delivery in three Afghan provinces (Kapisa, Panjshir and Parwan) under a contracting-in initiative entitled Strengthening Mechanisms (SM) since 2005.…”