Scaling up primary health services for improving reproductive, maternal, and child health: a multisectoral collaboration in the conflict setting of Afghanistan

Das, Jai K; Akseer, Nadia; Mirzazada, Shafiq; Padhani, Zahra Ali; Noorzada, Omarwalid; Armstrong, Corinne; Mukhtar, Kashif; Naeem, Ahmed Jan; Bhutta, Zulfiqar A

doi:10.1136/bmj.k4986

Cited by 13 publications

(23 citation statements)

References 20 publications

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“…These findings are not surprising as other studies have also reported on stagnant contraception rate and decreasing ANC and vaccination rates [2,16]. A study reported low coverage of RMNCAH&N services among less wealthy households and stated that only half of the women were benefiting from it [2]. The study also showed that conflict significantly impacted health service delivery, as the coverage of most RMNCAH&N services through the continuum of care was significantly lower in provinces which had ongoing conflict and insecurity compared to provinces which were relatively free of conflict.…”

Section: Discussionsupporting

confidence: 75%

“…The stagnant coverage of the use of contraceptives can also be linked to cultural norms, insecurity, illiteracy among women and socio-economic status of the people. These findings are not surprising as other studies have also reported on stagnant contraception rate and decreasing ANC and vaccination rates [2,16]. A study reported low coverage of RMNCAH&N services among less wealthy households and stated that only half of the women were benefiting from it [2].…”

Section: Discussionmentioning

confidence: 65%

“…Regardless, Afghanistan is a case study in resilience [14] and our analysis shows the gains made by indigenous innovations [2]. The investments made early on in establishing core services such as the BPHS and EPHS and run by NGOs (both contracting in and out models) has ensured availability of health services in both rural and urban areas of the country.…”

Section: Discussionmentioning

confidence: 92%

“…Afghanistan is a landlocked country located between the Middle East, Central and South Asia, with 34 provinces and an estimated population of 31,575,018 [1]. The health services of Afghanistan are overseen by the Ministry of Public Health (MoPH) which caters to the health needs of the country, which has been in the throes of conflict for well over four decades [2]. Conflict in Afghanistan has severely compromised the provision of services by the public and private sectors in areas of economics, health, education, livelihood, agriculture and livestock amongst others.…”

Section: Introductionmentioning

confidence: 99%

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Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan

Mirzazada¹,

Padhani

Jabeen

et al. 2020

Confl Health

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Introduction: Since decades, the health system of Afghanistan has been in disarray due to ongoing conflict. We aimed to explore the direct effects of conflict on provision of reproductive, maternal, newborn, child and adolescent health and nutrition (RMNCAH&N) services and describe the contextual factors influencing these services. Method: We conducted a quantitative analysis of secondary data on RMNCAH&N indicators and undertook a supportive qualitative study to help understand processes and contextual factors. For quantitative analysis, we stratified the various provinces of Afghanistan into minimal-, moderate-and severe conflict categories based on battle-related deaths from Uppsala Conflict Data Program (UCDP) and through accessibility of health services using a Delphi methodology. The coverage of RMNCAH&N indicators across the continuum of care were extracted from the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Survey (MICS). The qualitative data was captured by conducting key informant interviews of multi-sectoral stakeholders working in government, NGOs and UN agencies. Results: Comparison of various provinces based on the severity of conflict through Delphi process showed that the mean coverage of various RMNCAH&N indicators including antenatal care (OR: 0.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan

Mirzazada¹,

Padhani

Jabeen

et al. 2020

Confl Health

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“…In the remaining three provinces, health services are provided directly by the Afghan government, under the Strengthening Mechanism Project [6].…”

Section: Introductionmentioning

confidence: 99%

Comprehensive primary health facilities are more efficient in delivering primary care: Efficiency analysis of primary healthcare facilities in Afghanistan

Farewar¹,

Saeed²,

Foshanji³

et al. 2020

Preprint

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Background: The Afghan health system is unique in that primary healthcare is delivered by donor-funded implementing partners, not the government. Given the wide range of implementers providing the basic package of health services, there may exist performance differences in primary healthcare. This study assessed the relative efficiency of different levels of primary healthcare services and explored its determinants in Afghanistan. Method: Data on personnel and capital expenditure (inputs) and the number of facility visits for six primary healthcare services (outputs) were obtained from national health information databases for 1,263 healthcare facilities in 31 provinces. Data envelopment analysis was used to assess the relative efficiency of three levels of primary healthcare facilities (comprehensive, basic, and sub health centers). Bivariate analysis was conducted to assess the correlation of various elements with efficiency scores. Regression models were used to identify potential factors associated with efficiency scores at the health facility level. Results: The average efficiency score of health facilities was 0.74, when pooling all 1,263 health facilities, with 102 health facilities (8.1%) having efficiency scores of 1 (100% efficient). The lowest quintile of health facilities had an average efficiency score of 0.36 while the highest quintile had a score of 0.96. On average, efficiency scores of comprehensive health centers were higher than basic and sub health centers by 0.108 and .071 respectively. In addition, the difference between efficiency scores of facilities in the highest and lowest quintiles was highest in facilities that offer fewer services, so that they have the largest room for improvement. Conclusions: Our findings show that public health facilities in Afghanistan that provide more comprehensive primary health services, use their resources more efficiently, and that smaller facilities have more room for improvement. A more integrated delivery model would help improve the efficiency in providing primary healthcare in Afghanistan.

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Association of Exposure to Civil Conflict With Maternal Resilience and Maternal and Child Health and Health System Performance in Afghanistan

et al. 2019

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Scaling up primary health services for improving reproductive, maternal, and child health: a multisectoral collaboration in the conflict setting of Afghanistan

Abstract: Jai Das and colleagues present an innovative and evolutionary model of multistakeholder and multisectoral collaboration in scaling up coverage of health services in Afghanistan

Cited by 13 publications

References 20 publications

Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan

Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan

Comprehensive primary health facilities are more efficient in delivering primary care: Efficiency analysis of primary healthcare facilities in Afghanistan

Association of Exposure to Civil Conflict With Maternal Resilience and Maternal and Child Health and Health System Performance in Afghanistan

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