219388 Performance Improvement in Afghanistan's Health Sector: Evidence of Trends from 2004 to 2008

Tuesday, November 9, 2010 : 8:50 AM - 9:10 AM

Anbrasi Edward, PhD, MPH, MBA , International Health, Johns Hopkins University, Baltimore, MD
David H. Peters, MD, MPH, DrPH , International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Binay Kumar, MSc , International health, University of Leeds, Leeds, United Kingdom
Gilbert M. Burnham, MD, PhD , International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Efforts for reconstruction and capacity building of Afghanistan's health sector have been ongoing since 2002. To effectively manage the performance of a basic package of health services, the Ministry of Public Health instituted the Balanced Scorecard comprising of 29 key performance indicators to provide a comprehensive measure of system preparedness and quality of care. Using stratified random sampling, over 5500 patient observations and patient interviews were conducted in approximately 600 health facilities in 33 provinces, annually. Results: Significant improvements were evident in national median scores in five scorecard domains between 2004 and 2008; Patient and Community satisfaction (65.3 to 84.5, p<0.001), Provider Satisfaction (65.4 to 79.2, p<0.01), Capacity for Service Provision (47.4 to 76.4, p<0.001), Quality of Service Delivery (40.5 to 67.4, p<0.001), financial management (84.4 (2004) to 95.7 (2007), p<0.01), Overall vision for pro-poor and pro-female services (51.9 to 52.6). Provincial variations in performance were evident as health resource allocation also varies between provinces. The rapid changes in the health system landscape will necessitate further modifications in the scorecard strategy. Despite the evidence of improved capacity of health facilities and improved service quality ensuring equity of service delivery, additional investments are needed to improve coverage and ensure optimal quality of care to the rural poor to achieve the targets set for the MDG's in Afghanistan.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1.Demonstrate performance trends in 29 core indicators of health system capacity and quality of care 2.Describe the management utility and limitations of the scorecard performance assessment for health systems in other low and middle income countries.

Keywords: Health Service, Health Care Quality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I provided oversight to the design and operations of the evaluation study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.