(Ivanhoe Newswire) — After a basic package of health services was introduced by Afghanistan’s Ministry of Public Health, the development and performance of Afghanistan’s health care services improved dramatically in many areas between 2004 and 2008, particularly in health service capacity and delivery of care. However, researchers warn of the dangers of security issues for health staff and patients, which is seriously hampering progress, and argue that the likelihood of Afghanistan emerging from its fragile status is far from certain.
A study led by Anbrasi Edward from the Johns Hopkins Bloomberg School of Public Health in Baltimore, USA, shows thorough implementation of a balanced scorecard system””an integrated tool used to measure and manage the performance of health systems and services use””that over the five year period there was a progressive improvement in national average scores (scored 0-100) in six areas: patient and community satisfaction with services; provider satisfaction; capacity for service provision; quality of services; overall vision for pro-poor and pro-female health services; and financial systems.
In each year of the study, the authors selected a random sample of up to 25 health facilities. At each facility, 5 consultations involving children aged 5 and under, and 5 consultations involving patients older than 5, were observed, resulting in 5000 patient observations, 5000 interviews with patients or their caregivers on discharge, and 1500 health provider interviews over 5 years. The authors used this information to evaluate the key performance indicators in the balanced scorecard. By 2008, all provinces achieved the upper range of national average set in 2004. The authors used this information to evaluate the key performance indicators in the balanced scorecard. By 2008, all provinces achieved the upper range of national average set in 2004.
The authors found that use of the balanced scorecard helped to show the effects of investments, facilitate policy change, and create a more evidence-based decision-making culture in Afghanistan’s primary healthcare system. However, the authors warn that the continuing success of the balanced scorecard in Afghanistan will depend on the ability of this tool to be revised to accommodate changes in health systems policy.
“Emerging from decades of war and continued insecurity, Afghanistan has successfully pioneered the integration of the [balanced scorecard] BSC at the national and provincial levels, to improve the delivery of basic health services,” the authors were quoted as saying. “Despite the promising results so far, the successful execution of the [balanced scorecard] will depend on its adaptive ability and sustained efforts of the [Ministry of Public Health] leadership to accommodate dynamic and complex changes in the health care environment.”
SOURCE: PLoS, published online July 26, 2011