The Balanced Scorecard Report
The Balanced Scorecard Report
Basic Package of Health Services 2015
September 2015
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 .......................................................................................................................6 Revisions to BPHS Balanced Scorecard over time ...................................................7 Description of domains, instruments, scoring ...........................................................7 Ethical approval .....................................................................................................................9 NATIONAL RESULTS...............................................................................................................10
Afghanistan Health Sector BPHS Balanced Scorecard 2015 - National Medians ...................................................................................................................................10
Afghanistan Health Sector BPHS Balanced Scorecard 2015 - Provinces Meeting Lower Benchmark ..............................................................................................12
Afghanistan Health Sector BPHS Balanced Scorecard 2015 - Provinces Meeting Upper Benchmark ..............................................................................................14 Afghanistan Health Sector BPHS Balanced Score Card 2015 by Province ...16 NATIONAL LEVEL FINDINGS...............................................................................................19 Domain A: Client and Community ................................................................................19 Indicator 1: Overall Client Satisfaction and Perceived Quality of Care Index ......... 19 Indicator 2: Community Involvement and Decision Making Index ................................. 20 Indicator 3: Health Post Status Index ................................................................................................ 21 Domain B: Human Resources ........................................................................................21 Indicator 4: Revised Health Worker Satisfaction Index.......................................................... 22 Indicator 5: Health Worker Motivation Index ................................................................................ 23 Indicator 6: Salary Payment Current .................................................................................................. 24 Indicator 7: Revised Staffing Index...................................................................................................... 25 Indicator 8: Provider Knowledge Score ............................................................................................. 26 Indicator 9: Revised Staff Training Score ........................................................................................ 27
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Domain C: Physical capacity...........................................................................................27 Indicator 10: Equipment Functionality Index ................................................................................ 28 Indicator 11: Pharmaceutical and Vaccines Availability Index........................................... 29 Indicator 12: Laboratory Functionality Index ................................................................................ 30 Indicator 13: Clinical Guidelines Index .............................................................................................. 30 Indicator 14: Infrastructure Index ........................................................................................................ 31 Domain D: Quality of service provision......................................................................32 Indicator 15: Client Background and Physical Assessment.................................................. 32 Indicator 16: Client Counselling Index............................................................................................... 33 Indicator 17: Universal Precautions ..................................................................................................... 34 Indicator 18: Time Spent with Clients ................................................................................................ 35 Domain E: Management systems .................................................................................36 Indictor 19: Revised HMIS Use Index................................................................................................. 36 Indicator 20: Financial System Index ................................................................................................. 37 Indicator 21: Health Facility Management Functionality Index ......................................... 37 Domain F: Overall mission ..............................................................................................38 Indicator 22: New Outpatient Visit Concentration Index....................................................... 39 Indicator 23: Client Satisfaction Concentration Index............................................................. 39 Recommendations at the National Level ...................................................................41 PROVINCIAL LEVEL FINDINGS...........................................................................................43 BADAKSHAN PROVINCE FINDINGS..............................................................................45 BADAKSHAN PROVINCE FINDINGS BY CONTRACT ...............................................47 BADGHIS PROVINCE FINDINGS ....................................................................................49 BAGHLAN PROVINCE FINDINGS....................................................................................51 BALKH PROVINCE FINDINGS..........................................................................................53 BAMYAN PROVINCE FINDINGS ......................................................................................55 BAMYAN PROVINCE FINDINGS ......................................................................................57 DAYKUNDI PROVINCE FINDINGS .................................................................................59 FARAH PROVINCE FINDINGS .........................................................................................61 FARYAB PROVINCE FINDINGS .......................................................................................63 GHAZNI PROVINCE FINDINGS.......................................................................................65 GHAZNI PROVINCE FINDINGS.......................................................................................67 GHOR PROVINCE FINDINGS ...........................................................................................70 HELMAND PROVINCE FINDINGS ...................................................................................72
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HERAT PROVINCE FINDINGS..........................................................................................74 JAWZJAN PROVINCE FINDINGS ....................................................................................76 KABUL PROVINCE FINDINGS..........................................................................................78 KABUL PROVINCE FINDINGS..........................................................................................80 KANDAHAR PROVINCE FINDINGS ................................................................................82 KAPISA PROVINCE FINDINGS ........................................................................................84 KHOST PROVINCE FINDINGS .........................................................................................86 KUNAR PROVINCE FINDINGS.........................................................................................88 KUNDUZ PROVINCE FINDINGS......................................................................................90 LAGHMAN PROVINCE FINDINGS ...................................................................................92 LOGAR PROVINCE FINDINGS .........................................................................................94 NANGARHAR PROVINCE FINDINGS .............................................................................96 NIMROZ PROVINCE FINDINGS ......................................................................................98 NURISTAN PROVINCE FINDINGS................................................................................100 PAKTIKA PROVINCE FINDINGS....................................................................................102 PAKTIYA PROVINCE FINDINGS....................................................................................104 PANJSHIR PROVINCE FINDINGS .................................................................................106 PARWAN PROVINCE FINDINGS ...................................................................................108 SAMANGAN PROVINCE FINDINGS..............................................................................110 SARIPUL PROVINCE FINDINGS....................................................................................112 TAKHAR PROVINCE FINDINGS.....................................................................................114 URUZGAN PROVINCE FINDINGS.................................................................................116 WARDAK PROVINCE FINDINGS ...................................................................................118 ZABUL PROVINCE FINDINGS........................................................................................120 APPENDIX I: NATIONAL HEALTH SERVICES PERFORMANCE ASSESSMENT SAMPLING FRAME, 2004 ? 2015.....................................................................................121 APPENDIX II: NUMBER OF CHWS INTERVIEWED, 2004 ? 2015........................122 APPENDIX III: BASIC PACKAGE OF HEALTH SERVICES SAMPLE, 2015 .........123 APPENDIX IV: COMPARISON OF BPHS BALANCED SCORECARD INDICATORS USED IN 2004 TO 2013 WITH INDICATORS USED IN 2015................................124 APPENDIX V: LIST OF ITEMS INCLUDED IN E ACH INDICATOR FOR THE 2015 BPHS BALANCED SCORECARD.........................................................................................126 APPENDIX VI: CHANGE IN RANK ORDER OF PROVINCES BETWEEN 2012/13 AND 2015, ON THE BASIS OF OVERALL MEAN SCORE..........................................135
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APPENDIX VII: NUTRITION COUNSELLING, NUTRITION KNOWLEDGE, HIV KNOWLEDGE, HIV ATTITUDE AND HCWM WEIGHTED PROPORTIONS WIGHTED SIMILAR TO BPHS BSC INDICATORS: STAFF-RELATED INDICES BASED ON STAFF CATEGORY AND THE REST BASED ON FACILITY TYPE .....136
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