The Balanced Scorecard Report - Royal Tropical …
The Balanced
Scorecard Report
Basic Package of Health Services 2018
November 2018
CONTENTS
CONTENTS ....................................................................................................................................i
ABBREVIATIONS ........................................................................................................................ v
DEFINITION OF COMMON TERMS USED IN BSC .........................................................vi
HOW TO READ THE BSC EXPLAINED IN LAY LANGUAGE ...................................... viii
EXECUTIVE SUMMARY ............................................................................................................ix
BACKGROUND ............................................................................................................................ 1
METHODOLOGY .......................................................................................................................... 5
Sampling Frame ..................................................................................................................... 5
Data Collection and Quality Assurance ......................................................................... 6
Revisions to BPHS Balanced Scorecard Over Time .................................................. 7
Description of domains, instruments, scoring ........................................................... 7
Ethical approval ................................................................................................................... 10
NATIONAL RESULTS ............................................................................................................... 11
Afghanistan Health Sector BPHS Balanced Scorecard 2018 - National
Medians ................................................................................................................................... 11
Afghanistan Health Sector BPHS Balanced Score Card 2018 by Province ... 17
NATIONAL LEVEL FINDINGS ............................................................................................... 20
Domain A: Client and Community ................................................................................ 20
Indicator 1: Overall Client Satisfaction and Perceived Quality of Care Index ................ 21
Indicator 2: Community Involvement and Decision Making Index .............................. 23
Indicator 3: Health Post Status Index..................................................................... 24
Domain B: Human Resources ........................................................................................ 25
Indicator 4: Revised Health Worker Satisfaction Index ............................................. 26
Indicator 5: Health Worker Motivation Index ........................................................... 27
Indicator 6: Salary Payment Current ...................................................................... 28
Indicator 7: Revised Staffing Index ........................................................................ 29
Indicator 8: Provider Knowledge Score ................................................................... 30
Indicator 9: Revised Staff Training Score ................................................................ 31
Domain C: Physical capacity ........................................................................................... 32
Indicator 10: Equipment Functionality Index ........................................................... 33
Indicator 11: Pharmaceutical and Vaccines Availability Index .................................... 34
Indicator 12: Laboratory Functionality Index ........................................................... 35
Indicator 13: Clinical Guidelines Index ................................................................... 36
i
Indicator 14: Infrastructure Index ......................................................................... 37
Domain D: Quality of service provision ...................................................................... 38
Indicator 15: Client Background and Physical Assessment ........................................ 39
Indicator 16: Client Counselling Index .................................................................... 40
Indicator 17: Universal Precautions........................................................................ 41
Indicator 18: Time Spent with Clients .................................................................... 42
Domain E: Management systems ................................................................................. 43
Indicator 19: Revised HMIS Use Index ................................................................... 44
Indicator 20: Financial System Index ..................................................................... 45
Indicator 21: Health Facility Management Functionality Index ................................... 46
Indicator 22: New Outpatient Visit Concentration Index ........................................... 48
Indicator 23: Client Satisfaction Concentration Index ............................................... 49
Recommendations at the National Level ................................................................... 50
Sensitivity analysis ............................................................................................................. 51
PROVINCIAL LEVEL FINDINGS ........................................................................................... 54
BADAKSHAN PROVINCE FINDINGS.............................................................................. 56
BADGHIS PROVINCE FINDINGS .................................................................................... 58
BAGHLAN PROVINCE FINDINGS.................................................................................... 60
BALKH PROVINCE FINDINGS.......................................................................................... 62
BAMYAN PROVINCE FINDINGS ...................................................................................... 64
DAYKUNDI PROVINCE FINDINGS ................................................................................. 66
FARAH PROVINCE FINDINGS.......................................................................................... 68
FARYAB PROVINCE FINDINGS ....................................................................................... 70
GHAZNI PROVINCE FINDINGS ....................................................................................... 72
GHOR PROVINCE FINDINGS ........................................................................................... 74
HELMAND PROVINCE FINDINGS ................................................................................... 76
HERAT PROVINCE FINDINGS.......................................................................................... 79
JAWZJAN PROVINCE FINDINGS .................................................................................... 81
KABUL PROVINCE FINDINGS.......................................................................................... 83
KANDAHAR PROVINCE FINDINGS ................................................................................ 85
KAPISA PROVINCE FINDINGS ........................................................................................ 87
KHOST PROVINCE FINDINGS ......................................................................................... 89
KUNAR PROVINCE FINDINGS ......................................................................................... 91
KUNDUZ PROVINCE FINDINGS...................................................................................... 93
ii
LAGHMAN PROVINCE FINDINGS ................................................................................... 95
LOGAR PROVINCE FINDINGS ......................................................................................... 97
NANGARHAR PROVINCE FINDINGS ............................................................................. 99
NIMROZ PROVINCE FINDINGS .................................................................................... 101
NURISTAN PROVINCE FINDINGS ................................................................................ 103
PAKTIKA PROVINCE FINDINGS.................................................................................... 105
PAKTIYA PROVINCE FINDINGS .................................................................................... 108
PANJSHIR PROVINCE FINDINGS ................................................................................. 110
PARWAN PROVINCE FINDINGS ................................................................................... 112
SAMANGAN PROVINCE FINDINGS .............................................................................. 114
SARIPUL PROVINCE FINDINGS.................................................................................... 116
TAKHAR PROVINCE FINDINGS..................................................................................... 118
URUZGAN PROVINCE FINDINGS ................................................................................. 120
WARDAK PROVINCE FINDINGS ................................................................................... 122
ZABUL PROVINCE FINDINGS ........................................................................................ 124
APPENDIX I: NATIONAL HEALTH SERVICES PERFORMANCE ASSESSMENT
SAMPLING FRAME, 2004 ¨C 2018 ..................................................................................... 125
APPENDIX II: NUMBER OF CHWS INTERVIEWED, 2004 ¨C 2018 ........................ 127
APPENDIX III: BASIC PACKAGE OF HEALTH SERVICES SAMPLE, 2018.......... 128
APPENDIX IV: COMPARISON OF BPHS BALANCED SCORECARD INDICATORS
USED IN 2004 TO 2013 WITH INDICATORS USED SINCE 2011/12 ................. 130
APPENDIX V: LIST OF ITEMS INCLUDED IN EACH INDICATOR FOR THE 2018
BPHS BALANCED SCORECARD ......................................................................................... 132
APPENDIX VI: CHANGE IN RANK ORDER OF PROVINCES BETWEEN 2017 AND
2018, ON THE BASIS OF OVERALL MEAN SCORE .................................................... 140
APPENDIX VII: NUTRITION COUNSELLING, NUTRITION KNOWLEDGE, HIV
KNOWLEDGE, HIV ATTITUDE AND HEALTHCARE WASTE MANAGEMENT
WEIGHTED SCORES ............................................................................................................. 141
APPENDIX VIII: CLUSTERWISE BPHS BSC TABLES FOR PROVINCES DIVIDED
INTO CLUSTERS..................................................................................................................... 143
APPENDIX IX CONFIDENCE INTERVALS....................................................................... 148
APPENDIX X RESULTS PER PROVINCE BEFORE 2011/2012 ................................ 169
APPENDIX XI NATIONAL RESULTS BEFORE 2011/2012 ........................................ 204
APPENDIX XII SENSITIVITY ANALYSIS: NATIONAL MEDIANS EXCLUDING
PANJSHIR, PARWAN AND KAPISA PROVINCES ......................................................... 206
APPENDIX XIII SENSITIVITY ANALYSIS: PROVINCIAL RESULTS EXCLUDING
REPLACEMENT FACILITIES ................................................................................................ 208
iii
APPENDIX XIV REPLACEMENT OF HEALTH FACILITIES BY PROVINCE ............ 211
APPENDIX XV PHARMACEUTICALS AND VACCINES AVAILABILITY INDEX ......... 212
APPENDIX XIV BPHS INDICATORS MAPS.......................................................................... 213
REFERENCES: ......................................................................................................................... 214
iv
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