Objective: To determine the association between health workforce capacity and quality of care in primary care facilities providing a basic package of health services (BPHS) in Afghanistan.
Methods: Since 2004, annual performance assessments were conducted nationally in >600 health facilities including district hospitals, on a sample of >2300 patients under five years, and >1300 health providers selected by stratified random sampling. The assessments included health system capacity measures for provider adequacy, knowledge and training, infrastructure, essential medicines, equipment and availability of clinical guidelines. Quality of care was defined as adherence to the WHO Integrated Management of Childhood Illness (IMCI) clinical guidelines. The findings presented in this study include data from 2005 to 2008.
Results: There was a progressive increase in workforce capacity over the study period, as more health facilities adhered to the BPHS standards for provider staffing Basic Health Centres 75.9% to 85.4% (p
Conclusions: Investments for enhancing the capacity and quality for health service delivery in Afghanistan have illustrated improved health system performance trends measured by the balanced score card since the inception of the basic package of health services. However, severe deficits in professional workforce, particularly in remote and unsecure areas, and the acceleration of internal and external migration, pose enormous challenges to sustaining the gains achieved in service quality and coverage. Aside from ensuring adequacy of the workforce, appropriate investments are required to improve opportunities for professional development and capacity-building, to ensure the competency and satisfaction of health providers delivering care in insecure and complex healthcare environments.
Edward, A.; Kumar, B.; Niayash, H.; Peters, D.H.; Burnham, G. Association between health workforce capacity and quality of care for children under five in Afghanistan. Presented at 28th ISQua Conference, Hong Kong. (2011) 5 pp.