Afghanistan Basic Package of Health Services (BPHS) Study: Cost-Efficiency, Quality, Equity and Stakeholder Insights into Contracting Modalities

The study aimed to investigate the cost, quality, and equity of BPHS services under two contracting modalities: contracting-out to nongovernmental organizations (NGOs) and the MoPH-Strengthening Mechanism (SM) model (contracting-in). The study was conducted by the Centre for Development and Population Activities (CEDPA), Health Policy Project, with funding from the U.S. Agency for International Development (USAID). The study used a mixed-methods approach, combining quantitative and qualitative data to analyze the BPHS indicators, costs, and quality of services under the two contracting modalities. The study found that there were differences in BPHS indicators between the two contracting modalities. The MoPH-Strengthening Mechanism (SM) model showed higher relative cost-efficiency measures compared to the NGO model. However, the study also found that the NGO model had higher quality of services, as measured by the number of antenatal care visits and infant mortality rates. The study also investigated the equity of service utilization among income quintiles of Afghanistan households. The results showed that there was a correlation between contracting mechanisms and equity in service utilization. The MoPH-Strengthening Mechanism (SM) model showed higher equity in service utilization, with greater access to health services among lower-income households. The study identified several factors that contributed to the differences in BPHS indicators and equity of service utilization between the two contracting modalities. These factors included the level of autonomy and flexibility in service delivery, the capacity of the implementing partners, and the level of community engagement and participation. The study made several recommendations to improve the BPHS services under the two contracting modalities. These recommendations included increasing the autonomy and flexibility of the implementing partners, strengthening the capacity of the MoPH and its implementing partners, and improving community engagement and participation in service delivery. The study also highlighted the importance of continued monitoring and evaluation of the BPHS services under the two contracting modalities. This would enable policymakers and program managers to identify areas for improvement and make data-driven decisions to enhance the quality and equity of BPHS services. The study's findings and recommendations have implications for the design and implementation of health service delivery systems in Afghanistan and other low-income countries. The study's emphasis on the importance of contracting modalities, capacity building, and community engagement highlights the need for a more nuanced understanding of the complex factors that influence health service delivery outcomes.