Anbrasi Edward|Binay Kumar|Faizullah Kakar|Ahmad Shah Salehi|Gilbert Burnham|David H. Peters
Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years' Evaluation in Afghanistan
Johns Hopkins University|Public Health Foundation of India|Institute of Public Health|World Health Organization - Afghanistan|Ministry of Public Health|Johns Hopkins University|Johns Hopkins University
2004 afghanistan pioneered balanced scorecard bsc performance system manage delivery primary health care services study examines trends 29 key performance indicators 5year period 2004 2008independent evaluations performance six domains conducted annually 5500 patient observations exit interviews 1500 provider interviews 600 facilities selected stratified random sampling province generalized estimating equation gee models used assess trends bsc parameters progressive improvement national median scores scaled 0100 2004 2008 six domains patient community satisfaction services 653845 p00001 provider satisfaction 654792 p001 capacity service provision 474764 p00001 quality services 405674 p00001 overall vision propoor profemale health services 520526 financial domain also showed improvement 2007 844957 p001 user fees eliminated 2008 provinces achieved upper benchmark national median set 2004the bsc successfully employed assess improve health service capacity service delivery using performance benchmarking 5year period however scorecard reconfigurations needed integrate effectiveness efficiency measures accommodate changes health systems policy strategy architecture ensure continued relevance effectiveness comprehensive health system performance measure process bsc design implementation serve valuable prototype health policy planners managing performance similar health care contexts please see later article editors summary