Standards Based Management Strategy—SBMR to Improve Quality of Reproductive care in Afghanistan

Introduction: HSSP has implemented a quality assurance (QA) intervention in Afghanistan to strengthen the health system, raise the quality of care, and improve poor reproductive health outcomes. Initial evaluation results are presented here.

Methods: The QA intervention was originally implemented in 23 health facilities in 5 provinces. Health workers and facility managers were trained to use data from periodic external and internal assessments to identify, analyze, and address service delivery problems using low-cost, local solutions. The assessments employed direct structured observations, role plays and simulations, record review, and interviews to determine whether the facility had achieved a series of preset service standards based on evidence-based practice recommendations. Three rounds of assessments were conducted approximately 7 months apart at each facility.

Results: The percent of standards met during the assessments can be used to measure health facilities' progress in improving the quality of care. That percentage has increased dramatically in family planning, rising from an average of 28% at the baseline, to 45% in the interim round, and 60% in the final assessment round. Comparable improvements were found for antenatal care (23%, 41%, 74%), postnatal care (30%, 48%, 64%), normal labor (29%,52%, 70%), complicated labor (33%, 52%, 71%), and newborn care (10%, 27%, 63%).

Recommendations: This QA intervention can help the Afghan government achieve its objective of rapidly expanding access to quality health services. HSSP is currently assisting the MoPH to scale up this intervention across 13 provinces receiving USAID support.