Reproductive and maternal health services remain central to Afghanistan’s broader health system performance. Despite structured implementation of the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS), persistent structural and operational challenges continue to affect service quality, equity, and measurable maternal outcomes.
As a public health specialist working in Afghanistan, I have observed that improvements in infrastructure alone are insufficient. Sustainable progress requires systemic performance management, workforce development, and strengthened accountability mechanisms across provincial and district levels.
1. Current Gaps in RMNCH Service Delivery
Rural and underserved provinces continue to experience disparities in skilled birth attendance, emergency obstetric care access, and postnatal follow-up services. Geographic barriers, workforce shortages, and inconsistent supervision limit continuity of care. While facility coverage has expanded, quality assurance mechanisms are not uniformly applied.
Addressing RMNCH gaps requires strengthening referral pathways, ensuring availability of essential reproductive health commodities, and reinforcing technical capacity among midwives and facility-based staff.
2. Performance Management and Monitoring Systems
Monitoring frameworks such as HMIS, QQC, and performance-based financing (P4P) are designed to improve accountability and measurable outputs. However, data quality concerns, delayed reporting cycles, and limited feedback loops reduce their full potential.
Monitoring must evolve from a reporting obligation into a performance improvement instrument. Data interpretation training and structured performance review committees are essential to translate indicators into corrective action.
3. Health Systems Strengthening Strategies
Sustainable reproductive health improvement requires multi-level systems strengthening:
- Continuous professional development for frontline health workers
- Integrated supply chain monitoring to prevent stockouts
- Supportive supervision models focused on mentorship rather than inspection
- Alignment between donor reporting frameworks and contextual realities
Health systems strengthening should be adaptive, data-informed, and locally responsive rather than administratively driven.
4. Policy-Level Recommendations
Policymakers and implementing partners must prioritize evidence-based decision-making, strengthen provincial-level governance structures, and institutionalize accountability frameworks that incentivize measurable quality improvements. Reproductive health system resilience depends not only on funding but on coordinated leadership, data integrity, and sustained technical oversight.
Read related analysis: Monitoring & Evaluation Challenges in BPHS and EPHS Implementation
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