Recorded presentation

Laurence Laumonier Ickx, MD¹, Dr. Iqbal Pakzad, MD², and Feroz Ferozuddin, MD¹. (1) Management Sciences for Health, 165 Allandale Road, Boston, MA 02130-3400, 617-524-7799, llickx@msh.org, (2) Rural Expansion of Afghanistan's Community-based Health Care (REACH), Management Sciences for Health, House No. 24, Dar-ul-Aman Street, Ayub Khan Mina, Kabul, Afghanistan

Afghanistan is implementing innovative performance based contracts between the Ministry of Health and NGOs to deliver primary health care services. Through funding from USAID, Management Sciences for Health (MSH) is providing technical assistance to the Government of Afghanistan to strengthen the health system which includes developing the capacity to contract NGOs to deliver a basic package of services.

A nationwide survey of health facilities identified districts with limited service availability and assessments of population characteristics identified barriers to access faced by households. Through this process, 40 districts were identified in 13 provinces for support from USAID to deliver services by contracting 20 NGOs. Other donors are supporting a similar strategy in other areas of the country. Contracted NGOs conduct baseline surveys of health status and utilization in the areas they serve that establish baseline data to create performance targets. The Ministry of Health is developing a Health Management Information System to monitor performance. One of the conditions of contracts with NGOs is that they provide periodic data to the HMIS.

Through this process, access to essential services has increased. NGOs have received technical assistance to develop their capacity to deliver services and are being rewarded for their efforts with contracts that pay for performance. The Ministry of Health is being transformed into a strategic purchaser of services with the ability to contract and monitor performance. Performance based payment is a powerful approach to expanding access to essential health services to underserved populations.

Learning Objectives:

• The experience of Afghanistan shows how contracting NGOs based on agreed performance indicators can enhance access and improve health indicators in a challenging environment.

Keywords: Performance Measurement, Access and Services

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation