• Balanced Scorecard;
  • Afghanistan;
  • performance assessment;
  • hospitals


Objectives: An assessment of provincial hospitals in Afghanistan was carried out in 2007 to measure performance against the national standards and guidelines in the Essential Package of Hospital Services. Methods: Assessment instruments were developed through consultation with the Ministry of Public Health and key stakeholders. Teams of six persons spent three days at each of the 30 provincial hospitals. Results are displayed using a balanced score card approach. Results: Considerable variation exists across hospitals. Administrative management domains, patient satisfaction and community involvement tended to be higher scoring. Financial systems, quality and safety, and ethics and value domains and indicators were lower. Discussion: This assessment demonstrates a wide range of performance of provincial hospitals nationally. This may reflect the diversity of funding, funding levels, and characteristics of facilities. Despite these challenges the level of performance in many hospitals is surprisingly good. Conclusion: Assessment of hospital performance when displayed using the balanced score card approach can provide meaningful information for policy formulation and assist hospital management in improvement of services.