Third party monitoring for health in Afghanistan: the good, the bad and the ugly

• Published in: BMJ global health Vol. 8; no. 12; p. e013470
• Main Authors: Alba, Sandra, Jacobs, Eelco, Kleipool, Elisabeth, Salehi, Ahmad, Naeem, Ahmad, Arab, Sayed Rahim, Van Gurp, Margo, Hamid, Nasir, Manalai, Partamin, Saeedzai, Sayed Ataullah, Safi, Sohrab, Paiman, Farhad, Siddiqi, Abdul Majeed, Gerretsen, Barend, Gari, Sara, Sondorp, Egbert
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 06.12.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Afghanistan; Balanced Scorecard; Government; Health facilities; health policy; Health Services; Health Services Accessibility; health services research; health systems; health systems evaluation; Humans; Pay for performance; Practice; Public health; Qualitative research; Reimbursement, Incentive; Third party; Afghanistan; health systems evaluation; health services research; health systems; health policy; public health
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2023-013470

Third party monitoring (TPM) is used in development programming to assess deliverables in a contract relationship between purchasers (donors or government) and providers (non-governmental organisations or non-state entities). In this paper, we draw from our experience as public health professionals involved in implementing and monitoring the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services (EPHS) as part of the SEHAT and Sehatmandi programs in Afghanistan between 2013 and 2021. We analyse our own TPM experience through the lens of the three parties involved: the Ministry of Public Health; the service providers implementing the BPHS/EPHS; and the TPM agency responsible for monitoring the implementation. Despite the highly challenging and fragile context, our findings suggest that the consistent investments and strategic vision of donor programmes in Afghanistan over the past decades have led to a functioning and robust system to monitor the BPHS/EPHS implementation in Afghanistan. To maximise the efficiency, effectiveness and impact of this system, it is important to promote local ownership and use of the data, to balance the need for comprehensive information with the risk of jamming processes, and to address political economy dynamics in pay-for-performance schemes. Our findings are likely to be emblematic of TPM issues in other sectors and other fragile and conflicted affected settings and offer a range of lessons learnt to inform the implementation of TPM schemes.