Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study.

Howard, N; Woodward, A; Patel, D; Shafi, A; Oddy, L; Ter Veen, A; Atta, N; Sondorp, E; Roberts, B; (2014) Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study. BMC health services research, 14 (1). p. 359. ISSN 1472-6963 DOI:

Text - Published Version

Download (438kB) | Preview


BACKGROUND Contracting-out non-state providers to deliver a minimum package of essential health services is an increasingly common health service delivery mechanism in conflict-affected settings, where government capacity and resources are particularly constrained. Afghanistan, the longest-running example of Basic Package of Health Services (BPHS) contracting in a conflict-affected setting, enables study of how implementation of a national intervention influences access to prioritised health services. This study explores stakeholder perspectives of sexual and reproductive health (SRH) services delivered through the BPHS in Afghanistan, using Bamyan Province as a case study. METHODS Twenty-six in-depth interviews were conducted with health-system practitioners (e.g. policy/regulatory, middle management, frontline providers) and four focus groups with service-users. Inductive thematic coding used the WHO Health System Framework categories (i.e. service delivery, workforce, medicines, information, financing, stewardship), while allowing for emergent themes. RESULTS Improvements were noted by respondents in all health-system components discussed, with significant improvements identified in service coverage and workforce, particularly improved gender balance, numbers, training, and standardisation. Despite improvements, remaining weaknesses included service access and usage - especially in remote areas, staff retention, workload, and community accountability. CONCLUSIONS By including perspectives on SRH service provision and BPHS contracting across health-system components and levels, this study contributes to broader debates on the effects of contracting on perceptions and experiences among practitioners and service-users in conflict-affected countries.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Distance Learning
Academic Services & Administration > Distance Learning

Faculty of Public Health and Policy
Research Centre: The International Centre for Evidence in Disability
International Centre for Eye Health
ECOHOST - The Centre for Health and Social Change
Related URLs:
PubMed ID: 25167872
Web of Science ID: 341786900001


Download activity - last 12 months
Downloads since deposit
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item