Scheme for Establishing Health Service Accreditation Entity (AF0006)
Action Plan: Afghanistan Action Plan 2017-2019
Action Plan Cycle: 2017
Lead Institution: Ministry of Public Health (MoPH)
Support Institution(s): National Public Health Association, National Public Health Institute, Afghan Midwives Association, Association of Hospitals, Private Health Institutes Association, Pharmacies Association, other relevant CSOs that work on transparency and accountability in the public sector and international health organizations
Policy AreasCapacity Building, E-Government, Health, Legislation & Regulation, Public Participation, Public Service Delivery
What is the public problem that the commitment will address?: Recent reports show that there is limited access to tertiary health services, while citizens complain about deterioration in service delivery standards and inappropriate attitude of health staff. This situation has declined level of trust between health service providers and their beneficiaries, which, in turn, increases the number of persons who travel to neighboring countries for treatment.; What is the commitment?: Given the abovementioned challenges, Ministry of Public Health of Islamic Republic of Afghanistan committed, during consultative meetings of OGP, to develop the health centers accreditation scheme in partnership with relevant CSOs. MoPH will establish Health Service Accreditation Entity based on this scheme.
It is expected that development of this scheme and consequent establishment of the accreditation entity lead to increased access to tertiary health services in Afghanistan. This will, in turn, increase public trust with health service providers and decrease number of individuals who ought to travel to neighboring countries for treatment.; How will the commitment contribute to solve the public problem?: MoPH will develop Health Service Accreditation Scheme in partnership with CSOs, including Afghanistan National Public Health Association, Hospitals Association, Afghan Midwives Association, Association of Private Health Institutes, National Public Health Institute, Association of Pharmacies and other relevant organizations that work on transparency and accountability in the public sector.
It is expected that development of this scheme facilitate establishment of Health Service Accreditation Entity. The first step to implement the commitment is to define service delivery standards at national level and deliver training to health centers’ (management and technical) staff. Second, implementation of these standards at health centers will be monitored in order to ensure beneficiaries’ satisfaction with availability and quality of services in each monitored centers. Third, based on monitoring findings, health centers will be ranked by the quality level of their service. Consequently, a ranking results report will be prepared and shared with citizens annually.
This will encourage competition among public and private health centers and cause the quality of health service delivery to increase, followed by increased access of citizens to quality health services.;
Why is this commitment relevant to OGP values?: This commitment has relevancy with three values of Open Government Partnership: the health service delivery accreditation scheme is developed in partnership with relevant civil society organizations. On the other hand, conduction of beneficiary survey paves the way for public partnership and enhances transparency and accountability in health service delivery. The ministry of public health and evaluated health service providers will be mandated to make the ranking list of health service providers and fundamental health service standards accessible to public via their websites and through pamphlets.; Additional Information: The necessary fund for implementing this commitment will be provided from MoPH’s budget.
This commitment has relevancy with Goal 3 (ensure healthy lives and well-being) of SDGs.
This commitment is also relevant to Afghanistan National Peace and Development Framework.
IRM Midterm Status Summary
6. Developing and Implementing a Scheme for Establishing Health Service Accreditation Entity in Afghanistan
Language of the commitment as it appears in the action plan:
“Recent reports show that there is limited access to tertiary health services, while citizens complain about deterioration in service delivery standards and inappropriate attitude of health staff. This situation has declined level of trust between health service providers and their beneficiaries, which, in turn, increases the number of persons who travel to neighboring countries for treatment.
Given the abovementioned challenges, Ministry of Public Health of Islamic Republic of Afghanistan committed, during consultative meetings of OGP, to develop the health centers accreditation scheme in partnership with relevant CSO’s. MoPH will establish Health Service Accreditation Entity based on this scheme. It is expected that development of this scheme and consequent establishment of the accreditation entity lead to increased access to tertiary health services in Afghanistan. This will, in turn, increase public trust with health service providers and decrease number of individuals who ought to travel to neighboring countries for treatment.Milestone activities and verifiable deliverables
- Draft Health Service Accreditation Scheme which should include the criteria for evaluation of health service providers, fundamental health service standards and civil society monitoring mechanism of the scheme. The Health Service Accreditation Scheme will be made accessible to the public via ministry of public health website.
- Organize two consultative sessions with relevant civil society organizations to finalize Health Service Accreditation Scheme.
- Present the scheme for approval to the cabinet.
- Establish Health Service Accreditation Entity in Afghanistan. This entity will be mandated to evaluate the health service providers based on established criteria and rank them in terms of their quality of services and professionalism as well as make the ranking list available to the public.
- Register and accredit 20 health centers in the country based on the Health Service Accreditation Scheme.
- Deliver 20 training courses to the staff of registered centers with Health Service Accreditation Entity.
- The Health Service Accreditation Entity will publish and disseminate 10000 pamphlets on the fundamental health service standards to the public.
- Initiate a survey to assess beneficiaries level of satisfaction with services of health providers and publish the ranking list of the health centers.”
Start Date: January 2018
End Date: August 2019
Editorial Note: This is a partial version of the commitment text. For the full commitment text from the Afghanistan National Action Plan see: https://www.opengovpartnership.org/commitment/06-scheme-establishing-health-service-accreditation-entity
Context and Objectives
In collaboration with the non-governmental organizations that work in the health sector, the Ministry of Public Health (MoPH) plans to develop and implement a Scheme for Establishing Health Service Accreditation Entity in Afghanistan (the Entity), which has never before existed.
One of the main challenges in the health sector is the low level of trust citizens have on tertiary health service providers. Often mistaken diagnoses and wrong prescriptions have led citizens to not rely on these service providers.  As a result, many citizens opt to seek medical treatment in neighboring countries, particularly in India, which has turned into a hub for Afghan patients.  Like other public services in Afghanistan, MoPH started to rebuild the public health system in 2002. With support from international donors and NGOs, health services and indicators have substantially improved over the years, particularly in the area of maternal mortality and child health. As an example, in 2002, there were only 400 midwives in comparison to the 8000 that exist today. Likewise, there are 3,150 health service facilities in comparison to 300 in 2002.  Nevertheless, the quality of health care in Afghanistan continues to lag behind other countries in the region.  In 2015, MoPH published a five-year National Health Policy (2015-2020) taking into consideration the inauguration of the NUG and ongoing conflict in the country. 
The Entity will be developed as an independent and professional body, which will be certified by a reputable international organization in order to provide additional legitimacy to its functions in Afghanistan. The Entity will be composed of 12 individuals, half of which will represent non-governmental entities active in health sector.  It will develop a set of qualitative and quantitative criteria based on which they can assess and accredit health facilities (after providing them with 3-6 months of training on international best practices.)  The civil society representative considers this commitment an important step in improving and validating health services and standardizing medical practices, if implemented as planned. 
The ranking information will be made available to the public via the website of the MoPH, websites of other NGOs involved in the process as well as through media, supplemented with related dissemination activities and surveys. As such, this commitment is relevant to the OGP value of access to information. The commitment is relevant also to civic participation because of the role of CSOs and NGOs who are active in health care in developing the standard.
The milestones and activities of this commitment are overall specific enough to verify its completion. The main missing information, however, is a lack of clarity about the coverage. For example, the commitment does not specify if the 20 selected providers that would benefit from training and satisfaction surveys courses would be limited to those in the city of Kabul. The commitment also does not specify how the government will choose and target beneficiaries and the indicators that will be used by the survey to determine user satisfaction, and therefore ranking. The IRM Researcher considers the potential impact of this commitment to be minor in that it is a positive step towards improving quality of services delivered by health providers. However, it falls short to address other challenges that impact quality of health service providers. For example, the commitment does not fully address issues of quality and training of medical staff beyond the accreditation process. In addition, a civil society representative interviewed by the IRM researcher raised concern about the prevailing level of corruption in Afghanistan, as a serious impediment to this commitment. He expressed the risk of counterfeit documents or bribery from the side of health services (particularly the private sector) in order to gain accreditation by the Entity. He went as far as stating his apprehension that the Entity itself may become yet another center of corruption, particularly in the health sector where corruption has always been a serious issue.  In his view, the only solution ensuring Entity’s transparency rests in the involvement of CSOs in the Entity’s leaderships as well as throughout the process of its operations of evaluating health service providers.  The next action plan could have a provision where it states clearly the legal consequences for acts of corruption concerning this commitment. The government official interviewed by the IRM Researcher also stated the illegal role some powerful people may play in establishing non-standardized health facilities. A legal provision may serve as a deterrent step to acts of this nature. 
In the next action plan, the IRM Researcher suggests the government and CSO’s should undertake the following actions:
- The government could aim to include a public accountability component. For example, the government could establish a mechanism within the Entity through which citizens can express their dissatisfaction about health service providers who have been accredited by the Entity or more generally with legal consequences for failure to comply.
- To address the underlying trust deficit between the public and health service providers, trainings could be held for the latter on the accreditation criteria and the requirements for meeting them to ensure provision of quality care.
- To further increase transparency, the Entity could oblige health service providers to make health care information about themselves and their services (i.e. registered documentations showing their eligibility to practice, staff qualifications, product information and so on) publicly available via their websites or other means.
- CSOs’ involvement could benefit from going beyond those that are professional NGOs or institutions in the health sector. The commitment could benefit by involving at least one CSO with experience in the area of corruption and another with experience in the area of public outreach. CSO involvement should be in the Entity leadership and across its operations.
- The next action plan would benefit from more clearly specifying the commitment’s scope in terms of targeted areas and population, and the specific measures used to determine satisfaction levels by the public.
- Finally, the commitment would benefit from requiring the Entity to publish an annual report listing all its findings, including a baseline health service provider satisfaction survey, the accredited health services, their rankings, the result of public surveys, and all other relevant information.
Revise law on recruitment and authority of attorneys general
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Revise law on local government
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Establish anti-corruption commitment
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Draft beneficial ownership legislation
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Portal for processing legislative documents
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CSO monitoring of education
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Develop electronic complaint system for local government
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Reform and strengthen education data
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Participation in local budgeting
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Electronic revenue collection system
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Co-create university curriculum
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Reform promotion system for police officers
AF0025, 2019, E-Government
Monitoring framework for medicine wholesalers
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Monitoring of private and public health centers
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Participation in national budget
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Open justice for anti-corruption
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Women's empowerment plan
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Establishment of Women Grand Council
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Mechanism of Public Partnership in Inspection Process
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Law on Processing, Publishing and Enforcing Legislative Documents
AF0002, 2017, Legislation & Regulation
Courts to Address Violence Against Women
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Public-Police Partnership Councils
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Registering Assets of Government Officials
AF0005, 2017, Asset Disclosure
Scheme for Establishing Health Service Accreditation Entity
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Urban Improvement National Policy
AF0007, 2017, Infrastructure & Transport
Protection Policy for Women Under Conflict and Emergency Situations
AF0008, 2017, Gender
Civil Society Monitoring Plan for Education and Higher Education
AF0009, 2017, Education
Plan for the Establishment of a Joint Committee Overseeing the Implementation of the Anti-Corruption Strategy
AF0010, 2017, Anti-Corruption Institutions
Strengthen the Information Mechanism in 60 Governmental Agencies
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Implementing Open Contracting
AF0012, 2017, E-Government
Public Participation in Road Network Projects
AF0013, 2017, Infrastructure & Transport