Impact of a Health Governance Intervention on Provincial Health System Performance in Afghanistan

  • By: Mahesh Shukla and Paul Crystal
  • Published Date: September 2017
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Although there is wide recognition that weak health governance contributes to poor health outcomes, donors have been reluctant to invest in governance interventions. This is primarily because there is no clear body of evidence linking such interventions to better health systems performance. To fill this gap and inform future directions for governance programming, USAID’s Leadership, Management, and Governance (LMG) Project conducted a study in Afghanistan to examine the causal impact of a health governance intervention on the performance of provincial health systems.

The six-month health governance intervention comprised three phases: (1) facilitator-led workshops to perform baseline measurement of governance and participatory development of health systems governance development action plans by provincial public health coordination committees (PPHCCs) in 16 of Afghanistan’s 34 provinces; (2) action plan implementation and monitoring by the PPCHCCs; and (3) evaluation workshops held primarily to assist the PPHCCs in measuring provincial health systems governance post-intervention.

Eight months following the intervention, an LMG Project study team compared nine essential health system performance indicators between the 16 intervention provinces and the 18 remaining provinces where the intervention did not occur. Finding a statistically and practically significant impact of the intervention on six of the nine indicators, the research team concluded that a provincial health governance intervention has the potential to positively impact health system performance. However, given the limitations of the study, it could not be determined if positive impact would be experienced every time such interventions are implemented or when they are implemented at different levels of a health system. Thus, while interventions of this type are certainly worthy of consideration, they need to be studied more and results should be documented more systematically.