Towards sustainable delivery of health services in Afghanistan: options for the future
B Sabri, S Siddiqi, AM Ahmed, FK Kakar, J Perrot
Volume 85, Number 9, September 2007, 712-718
Table 2. Comparison of contractual arrangements and approaches adopted by the three major donors funding basic health services in Afghanistan
| Ministry of Public Health/World Bank |
USAID |
European Commission |
||
|---|---|---|---|---|
| Contracting out | Ministry of Public Health Strengthening Mechanism | Contracting out | Contracting out | |
| Overall approach | Outsourcing to national and international NGOs | Internal contracts with provincial health directorate of the public health ministry | Outsourcing to national and international NGOs | Outsourcing to national and international NGOs |
| Population covered (million) | 3.6 | 1.1 | 6.7 | 4.0 |
| Provinces and clusters covered | 8 provinces and 7 clusters | 3 provinces and 1 cluster | 13 | 10 |
| Provincial/cluster approach | Mainly province-wide | Mainly province-wide | Cluster approach (covers limited areas in province) | Mainly province-wide |
| Performance incentives | Yes | Yes | No | No |
| Contracting channel | Through the Grants and Contracts Management Unit in the public health ministry | Through the Grants and Contracts Management Unit in the public health ministry | Subcontracted through Management Sciences for Health. Currently, funds are channelled through WHO | Directly contracted with NGOs by the European Commission |
| No. of grant contracts | 15 | 1 | 30 | 13 |
| Contracting focus | Output-based lump-sum service delivery contract | Output-based lump-sum service delivery contract | Input-based grant with robust focus on results | Input-based grant with ideas to phase in elements of performance |
| Grant funds allocated (US$) | 47.0 million | 55.0 million | 32.0 million | |
| Annual per-capita cost (US$) | 3.78 | 4.10 | 4.28 | 5.12 |
| Monitoring system | Third-party evaluation by JHUSPH/IIHMR through balance scorecard, nation-wide baseline and follow-up surveys | Third party evaluation, also developed own tools LQAS, (FFSDP) | By third party, through an external evaluation team | |
| Balanced scorecard performancea | ||||
| Year 2004 | 52.3 | 53.7 | 53.4 | 54.2 |
| Year 2005 | 64.4 | 61.8 | 63.6 | 57.7 |
FFSDP, fully functional service delivery point assessment; JHUSPH/IIHMR; John Hopkins University Bloomberg School of Public Health and Indian Institute of Health Management and Research; LQAS, lot quality assurance sampling assessment; NGO, nongovernmental organization; USAID, United States Agency for International Development.a Source: Afghanistan Health Sector Balanced Scorecard Assessment, Ministry of Public Health, JHUSPH and IIHMR scored performance of all donor contracts.