Afghanistan: Management of Services

In 2002, The Ministry of Public Health in Afghanistan – with input from other organizations – designed a Basic Package of Health Services (BPHS) intended to encompass all basic PHC needs. The six components of the BPHS were maternal and newborn health, child health and immunization, public nutrition, communicable diseases, mental health, disability, and regular supply of essential drugs.1 National Health Service Performance Assessments were initiated by the Ministry of Public Health in 2004 to measure the performance of the BPHS.2 Evaluations were based on a balanced scorecard (BSC) performance system which included a comprehensive list of performance indicators that measured both process and outcomes of the program. The BSC system was initially developed to evaluate industry performance and has been adapted for use in health. For five years, data from patient observations, exit interviews, and provider interviews were collected from 25 facilities. These data were incorporated into the BSC, and there was evidence of consistent improvement in patient and provider satisfaction, service provision, quality of services, equity, and financial system over the study period. The tool enabled facilities to identify emergent needs for allocation of resources and innovations and helped facilities learn how to adapt based on findings from data. While the BSC may be useful for performance benchmarking and strategic management, the authors noted that its continued utility will depend on stakeholders’ ability to adapt the tool to future changes in health systems. A BSC template can be found on the Institute for Healthcare Improvement website.

Learn more about Afganistan's post-conflict PHC reforms here.


  1. Newbrander W, Ickx P, Feroz F, Stanekzai H. Afghanistan’s basic package of health services: its development and effects on rebuilding the health system. Glob Public Health. 2014;9 Suppl 1:S6-28.
  2. Edward A, Kumar B, Kakar F, Salehi AS, Burnham G, Peters DH. Configuring balanced scorecards for measuring health system performance: evidence from 5 years’ evaluation in Afghanistan. PLoS Med. 2011 Jul;8(7):e1001066.