In Schematics: Afghanistan Performance-Based Financing of Non Government Organizations and its Health Facilities

This schematic illustrates the way Afghanistan has been working with NGOs through performance-based partnership agreements (PPAs).

In 2008, a new round of PPAs was commenced which was an opportunity to further evolve the performance based payment system in Afghanistan. It was found that though conditions to provide quality of care had improved; there was still an underutilization of services which the Ministry of Public Health (MOPH) wanted to address. For that reason, performance payments were also made available for the volume of services conditional on the quality of care (similar to the PBF scheme in Rwanda). It was furthermore felt that the incentives should trickle down from the implementing NGO to the Health Facilities (HF) in the province to improve actual performance in service delivery quantity and quality.

This scheme graphic illustrates the revised scheme whereby the HF submits a report on the quantity of services provided while the Provincial Health Office (PHO) quarterly scores the quality for each HF. A third party independent firm is contracted to counter-verify on quarterly basis that patients exist and received the services reported. Following reconciliation of the NGO report on the number of services provided (by the HFs in their province) with the third party results and the quality scoring submitted by the PHO, payment is made from the Health Economics and Finance Department (HEFD), formerly known as the General Contract Management Unit (GCMU), in the MOPH to the NGO. The NGO in turn, pays the health facility based on their performance. The PHO contracted to carry out the quality scoring is also paid on a quarterly basis by the GCMU. The annual HF assessment carried out by the third party counter verifies the PHOs quality reports submitted. A difference of more than 10% between the annual average of scoring by the PHO and the third party HF assessment requires the PHO to reimburse on an annual basis.