The role of contractual arrangements in improving health sector ...

Afghanistan
3) Greater emphasis could be placed on either contracted-in or contracted-out health
services through establishment of performance-based partnership agreements between
the Ministry of Public Health and nongovernmental organizations which would allow
the Ministry of Public Health to utilize existing nongovernmental organization capacity
to deliver services while still maintaining control over the strategic direction of the
health sector.
The Basic Package of Health Services
The government has committed itself to ensuring that the BPHS is delivered to all
Afghans, regardless of location, ethnicity or gender, as soon as possible. The government will
continue to pursue this over-arching goal as its first priority, as a means to provide a peace
dividend to Afghans and to achieve the Millennium Development Goals (MDGs). The BPHS
was defined in early 2003 with the assistance of WHO. The key elements included: those
services which would have the greatest impact on the major health problems; services that
were cost-effective in addressing the problems faced by many people; and services which
could be delivered to give equal access to both rural and urban populations.
The BPHS has two purposes: to provide a standardized package of basic services which
forms the core of service delivery in all primary health care facilities; and to promote a
redistribution of health services by providing equitable access, especially in underserved
areas. The BPHS provides a comprehensive list of services: maternal and newborn health;
child health and immunization; public nutrition; communicable disease control; mental health
care; and disability. It also includes a supply of essential drugs to be offered at four standard
levels of health facility: the health post, basic health centre comprehensive health centre, and
district hospital. These facility categories replace a number of different nomenclature systems,
and will help create a more uniform system of classifying and denoting health facilities.
Once the current content of the BPHS has been successfully delivered to all Afghans,
the government intends to broaden the scope of the BPHS to include additional services such
as mental health, community care for the disabled, and prevention of HIV/AIDS. This will
likely be implemented in 2010, but could begin earlier if progress continues at current rates.
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