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. 2013 Jul;25(3):270-6.
doi: 10.1093/intqhc/mzt013. Epub 2013 Mar 12.

Afghanistan's national strategy for improving quality in health care

Mirwais Rahimzai  1 , Mirwais Amiri, Nadera Hayat Burhani, Sheila Leatherman, Simon Hiltebeitel, Ahmed Javed Rahmanzai
Affiliations

Afghanistan's national strategy for improving quality in health care

Mirwais Rahimzai et al. Int J Qual Health Care. 2013 Jul.

Abstract

Quality problem or issue: When the Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan began reconstructing the health system in 2003, it faced serious challenges. Decades of war had severely damaged the health infrastructure and the country's ability to deliver health services.

Initial assessment: A national health resources assessment in 2002 revealed huge structural and resource disparities fundamental to improving health care. For example, only 9% of the population was able to access basic health services, and about 40% of health facilities had no female health providers, severely constraining access of women to health care. Multiple donor programs and the MoPH had some success in improving quality, but questions about sustainability, as well as fragmentation and poor coordination, existed.

Plan of action: In 2009, MoPH resolved to align and accelerate quality improvement efforts as well as build structural and skill capacity.

Implementation: The MoPH established a new quality unit within the ministry and undertook a year-long consultative process that drew on international evidence and inputs from all levels of the health system to developed a National Strategy for Improving Quality in Health Care consisting of a strategy implementation framework and a five-year operational plan.

Lessons learned: Even in resource-restrained countries, under the most adverse circumstances, quality of health care can be improved at the front-lines and a consensual and coherent national quality strategy developed and implemented.

Keywords: Afghanistan; developing countries; national health programs; quality of health care.

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Figures

Figure 1
Figure 1
Proportion of vaginal deliveries for which a partograph was completed, June 2009–October 2011, 12 health facilities, Kunduz Province.
Figure 2
Figure 2
Proportion of mothers who know at least two maternal and newborn danger signs, Parwan, Bamyan and Herat provinces, August 2010–October 2011.
Figure 3
Figure 3
Proportion of births for which three elements of active management of the third stage of labor were performed, in five hospitals, Kabul Province, April 2010–February 2012.
See this image and copyright information in PMC

References

    1. Ministry of Health Transitional Islamic Government of Afghanistan, Management Science for Health (MSH), Health and Development Services (HANDS) Kabul: 2002. Afghanistan National Health Resources Assessment.
    1. World Bank. Afghanistan National Reconstruction and Poverty Reduction–The Role of Women in Afghanistan's Future. Washington, DC: World Bank; 2005.
    1. World Bank. Afghanistan State Building, Sustaining Growth, and Reducing Poverty: A Country Economic Report. Washington, DC: World Bank Poverty Reduction and Economic Management Sector Unit, South Asia Region; 2004.
    1. World Food Program (WFP), Ministry of Rural Rehabilitation and Development (MRRD) Kabul: 2004. National Risk and Vulnerability Assessment (NRVA) 2003 in rural Afghanistan: report on findings.
    1. ICON Institute. Kabul: 2009. National Risk and Vulnerability Assessment 2007/8: a profile of Afghanistan.

MeSH terms