Due to ongoing insecurity, the government of Afghanistan delivers health care to the country’s population by contracting out service delivery to non-governmental organization service providers (SPs). In 2018, major changes to SP contracts were introduced, resulting in a new pay-for-performance service delivery model called “Sehatmandi” to reduce the need to purchase health services from private providers and out-of-pocket expenditure. This study presents a narrative review of Sehatmandi’s key features as well as lessons learned during implementation.
It evaluates the difference between the rate of change in the volume of services delivered in provinces under the pay-for-performance mechanism relative to provinces that were not financed using pay-for-performance. Time trends in non-payment service indicators and service quality are also examined.