Good Governance Improves Health in Afghanistan: One Village’s Story

This post originally appeared on the Management Sciences for Health website.

Safiullah Sadiq, a community health worker from the Nangarhar Province, Afghanistan, is one of 14 residents who sits on his village’s health shura. (Shuras are councils that engage local leaders, health care providers, and other community members to improve the community’s health.) Sadiq’s village had identified that low utilization of health services was something that they wanted to address. But, the shura hadn’t understood how it could intervene.

That changed two years ago when the shura members received a governance training from the USAID-funded Leadership, Management, and Governance (LMG) Project, led by Management Sciences for Health (MSH).

Good governance is an often overlooked but crucial component of health system strengthening. The LMG-Afghanistan Project works with the Ministry of Public Health to improve the governance capacity of Provincial Public Health and District Health Coordination committees and community health shuras.

Sadiq’s shura organized meetings with clinic leaders to see how they could help improve the utilization of health services. Through these meetings, they realized one of the barriers: the clinic didn’t have a female doctor. Because of this, women would leave the village to get health services in other communities with female doctors.

The shura members had learned from the governance guides that it was their role and responsibility as a health shura to improve accessibility and quality of services, so they organized with another community to bring in a female doctor to their clinic. They also worked with community health workers to tell the community which health services were available at the clinic and how to access them.

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The training transformed the way Sadiq’s shura interacts with the community health clinic. Sadiq says the sections about effective governing practices and how to conduct meetings helped his shura the most in learning how to govern themselves.

The LMG-Afghanistan Project developed the governance guides based on four governing domains — cultivating accountability, engaging stakeholders, setting a shared strategic direction, and stewarding resources — with the goal of improving the coordination, monitoring, and supervision of service delivery at the local level. The guides were piloted in three provinces and eleven districts from April to October 2013. The project also developed and piloted governance guidelines and a manual specifically for health shuras in Afghanistan, which the Ministry of Public Health has endorsed for nationwide use.

Sadiq’s shura now applies good governance practices and organizes itself better. Says Sadiq:

If there is a problem that can be solved by our health shura, we always intervene. We are more prepared to do so because of the governance training.

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