Monitoring and evaluation (M&E) systems are foundational to ensuring accountability, transparency, and measurable performance within Afghanistan’s Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS). While structured frameworks such as HMIS, QQC, TPM, and P4P exist to guide performance oversight, operational and systemic challenges continue to limit their effectiveness in translating data into improved service delivery outcomes.
1. Structural Gaps in Health Management Information Systems (HMIS)
HMIS remains the primary data backbone for decision-making across provincial and national levels. However, discrepancies between reported data and ground realities are not uncommon. Contributing factors include limited technical capacity at facility level, inconsistent verification mechanisms, and delays in data consolidation. In high-burden or remote districts, heavy workloads and workforce shortages further reduce reporting accuracy.
Without systematic data audits and feedback loops, monitoring systems risk becoming administrative exercises rather than strategic tools for quality improvement.
2. Performance-Based Financing and Accountability Constraints
Performance-based financing (P4P) and quality assurance tools such as QQC were introduced to incentivize measurable service improvements. However, field implementation frequently encounters logistical and contextual constraints. Facilities in hard-to-reach areas face supervision gaps, delayed performance reviews, and limited corrective action follow-up.
Effective monitoring requires more than checklists; it demands continuous mentorship, leadership engagement, and real-time problem solving aligned with contextual realities.
3. Supervisory System Limitations
Supportive supervision is essential for maintaining reproductive, maternal, neonatal, and child health (RMNCH) standards. However, transportation limitations, security constraints, and limited technical staffing reduce the frequency and depth of supervisory visits in several provinces.
Where supervision becomes compliance-driven rather than improvement-driven, opportunities for system strengthening are missed.
4. Strategic Recommendations for Strengthening Monitoring Systems
Sustainable improvement requires multi-level interventions:
- Routine data quality audits and triangulation mechanisms
- Capacity building in digital reporting and data interpretation
- Stronger integration between donor reporting frameworks and field realities
- Institutionalized performance review committees with actionable follow-up
Monitoring and evaluation systems should function as adaptive governance tools rather than static reporting requirements. Strengthening accountability mechanisms directly contributes to improved maternal and reproductive health outcomes and enhances resilience within Afghanistan’s broader health system.
Read related analysis: Strengthening Reproductive Health Systems in Afghanistan
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