BSC in Afghanistan


In a country ruined by war, no one would expect to find any initiatives such as the implementation of a Balanced Scorecard performance management system. Though, the Afghan Ministry of Public Health Balanced Scorecard, implemented in 2004 is considered a truly successful and remarkable story. According with The Globe (2010), while the BSC served for years in the healthcare system it had never before served as a management tool for a country’s entire health system.


With a healthcare system in collapse, after the fall of the Taliban regime in 2002, and with health conditions among the worst in the world,  the Afghan health care services were relying  more than 80% of the help provided by non governmental agencies  such as UNICEF, or Red Cross.  


In order to better coordinate the healthcare services provided by the different NGOs, but also to build the backbone of a new national healthcare system which could provide efficient and effective basic health care services, the Afghan Ministry of Public Health decided the implementation of a Balanced Scorecard system. The Ministry of Public Health supported by several international bodies such as European Commission, UNICEF or World Bank contracted a team of researchers from the John Hopkins Bloomberg, School of Medical Health, and the Indian Institute of Health Management Research to implement the Balanced Scorecard system (The Globe, 2010).


"The Afghan Balanced Scorecard"

"The Afghan Balanced Scorecard" was envisaged as a management tool “to strengthen the delivery of sustainable, quality accessible health services, especially targeted at women, through planning for and the effective and efficient implementation of the basic health services package”


The Balanced Scorecard built around this major overarching strategic objective comprised of  6 critical perspectives and 29 indicators. For each indicator achievable benchmarks are set according with the country realities.  The data for the Balanced Scorecard is subtracted from a random selection of 600 health facilities, 1700 health workers and 5800 patient provided interactions (Hansen et al, 2008)


afghanistan_bsc_-_bsc20_761Source: The Global, 2010

The benefits of the Balanced Scorecard

Since its deployment in 2004, the Balanced Scorecard has become the cornerstone of the government’s monitoring and evaluation system, being adopted also internally by many of the NGOs providing health care services (The Globe, 2010).


According with the latest Balanced Scorecard report from 2008, the Afghan healthcare system registered massive improvement, making the BSC implementation a tremendously successful story.  As the report shows:

  • the national median score across all indicators has improved from 50% in 2004 to 72% in 2008
  • nearly 20% improvement in the patient and community domain
  • over 25% improvement in service provision, and
  • 28 % increase in capacity for service provision (The Globe, 2010)


For a complete overview of the Afghan Ministry of Public Health Balanced Scorecard implementation history and results, you can follow the reports listed below:



BSC in practice : By country


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