Examining the changes in health care quality for children under five in Afghanistan between 2004 and 2005

Since the events of 2001, the Ministry of Public Health and the international community have made considerable investments to reconstruct the health infrastructure in Afghanistan. To achieve optimal results for the predominantly rural population with some of the poorest health indicators the Basic Package of Health Services (BPHS) was introduced to improve access to and quality of health care. In 2004, MOPH in partnership with the Johns Hopkins University and the Indian Institute of Health Management Research, through funding from the World Bank, instituted national performance assessments on the BPHS which are conducted annually. Stratified random sampling methodology was used to select the health facilities which included district hospitals, comprehensive health centers and basic health centers. More than 600 facilities were selected in the 30 provinces in 2004 and 2005 to perform the health facility assessments. Results: Assessment of danger signs and presenting symptoms had improved significantly as demonstrated by the assessment index; 34.4 to 43.9. Provider performance for counseling the caretaker had also improved as measured by the counseling index (40.4 to 46.9). Cadre and gender differences in quality of care varied between health facilities but there was an overall improvement in performance index between 2004 and 2005. Assessments of provider knowledge on IMCI conditions also indicated significant improvements. Although the results illustrate improved knowledge and performance of providers for clinical management of sick children, performance still remains suboptimal and further efforts are needed to improve health care quality. The findings demonstrate the evidence for policy toward continued investments for improving health system capacity.