Exploring quality of mental health services in Nangarhar Province, Afghanistan

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Background: Over three decades, the mental health of the Afghan population has suffered due to persistent internal and external conflicts in the country. In order to fulfill the mental health needs of the population the Ministry of Public Health (MoPH) and donor agencies in Afghanistan have made efforts to integrate mental health services into the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services (EPHS). The purpose of this is to increase access to mental health services, improve utilization at primary, secondary and tertiary levels of care and to avert further deterioration of mental health status of the population. This study was undertaken to ascertain the impact of these efforts by assessing the quality of mental health services in a province where the mental health program was instituted in 2009. Study Aim: This study aimed to explore various obstacles in the provision of quality mental health services at primary, secondary and tertiary levels of health care in Nangarhar province Afghanistan and formulate evidence-based recommendations to improve existing services. Methods: Using descriptive case study design with concurrent mixed methods strategy with purposive sampling to select facilities at each level of care, interviews were conducted with one doctor and two clients at each health facility (HF). Furthermore, at each facility, an audit of resources was conducted as well as an observation of provider client interaction. For the qualitative component; interviews were taped, transcribed and analyzed using NVivo 10.0 by organization of text, development of codes/nodes, free nodes, categorization, sub themes and themes. For quantitative component, data was double entered to excel spreadsheet and then for statistical analysis transferred to SPSS 19.0, for frequencies and proportion. Findings: Most of the respondents were satisfied with the quality of mental health services available at the HFs, including the availability of health care providers and drugs. Clients affirmed that the care provided encouraged them to continue seeking treatment. Both providers and clients perceived that, regular supervision and monitoring, vailability of quality essential drugs, availability of male and female psychosocial counselor's at all three levels of care, availability of modern diagnostic equipment at the HFs and protection of clients' privacy and confidentiality during examination would have a positive effect on quality of care and mental health services utilization. Conclusion: In a short period of 3 years, the MoPH has been able to upscale mental health services to all levels of care in Nangarhar province with substantial gains in availability and utilization of care. The challenge now is to improve the quality of the care provided by increasing numbers of trained MH practitioners, building on the training and supervision of existing staff and improving referral chain mechanisms.

This document is available in the relevant AKU library