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BMC Health Services Research
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Natasha Howard, Aniek Woodward, Dhrusti Patel, Ahmad Shafi, Lisa Oddy, Annemarieter Veen, Nooria Atta, Egbert Sondorp, Bayard Roberts

Published in: BMC Health Services Research | Issue 1/2014

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Abstract

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.
Appendix
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Metadata
Title
Perspectives on reproductive healthcare delivered through a basic package of health services in Afghanistan: a qualitative study
Authors
Natasha Howard
Aniek Woodward
Dhrusti Patel
Ahmad Shafi
Lisa Oddy
Annemarieter Veen
Nooria Atta
Egbert Sondorp
Bayard Roberts
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/1472-6963-14-359

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