Perceived quality and factors influencing quality of mental health services at primary healthcare level in Kabul, Afghanistan. a qualitative exploratory study

Date of Award


Document Type


Degree Name

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


Community Health Sciences


More than three decades of devastating war, political tension, social insecurity, and drought have brought tremendous human suffering and considerable population displacement in Afghanistan. Because of this the mental health (MH) has become a major public health issue, and according to World Health Organization (WHO) around two million Afghans (6.67% of the population) suffer from mental disorders. In 2002, Ministry of Public Health (MoPH), with the collaboration of other stakeholders, developed a package of primary health care services under the name of Basic Package of Health Services (BPHS) to address the health problems with highest priority and ensure availability and access to basic health services at community level. MH became a part of BPHS in 2005 and integrated as community-based MH services to Primary healthcare (PHC) level. Due to this initiative, the availability and accessibility of MH services has significantly increased. This study was undertaken to explore the perception of stakeholders about quality of MH services and factors influencing quality of MH services at primary care level in capital Kabul. Purpose: This study aimed to explore perceived quality and factors influencing quality of MH services at PHC level in Kabul province. Methodology: This was a qualitative exploratory study. It was conducted from July to September, 2016 at PHC clinics in Kabul Province. A purposive sampling technique was used to select facilities; In-depth interviews (IDIs) were conducted with patients and patients' attendants at clinics. Furthermore, IDIs were conducted with health staff of clinics. Key informants interviews (KIN) were conducted with MH senior management staff at MoPH and implementing NGOs. In addition, desk review was also conducted for collection of information. Interviews were audio recorded, and transcribed. The data were triangulated and manually analyzed by using content analysis and thematic approach by organization of text, development of nodes, free nodes, categories, sub categories and themes. Open ended questions and semi-structured interview method were used. Results: The findings of this study can draw a connection between the main influences on the quality of MH in Kabul—specifically financial constraints, security problems, weak stewardship, corruption, poor management and limited public health capacity of the MH department. These were the significant barriers affecting the quality of MH services at the PHC level. Moreover, the lack of motivation and recognition of PHC staff, no referral system in place at the PHC level, medicalization treatment of mental illnesses, shortage of supplies, low quality of supplies, turnover of staff, high workload, no clear work schedule, low salaries and no transportation facilities for clinic staff were perceived to be the major reasons affecting the quality of MH services at the PHC level in Kabul, Afghanistan. Above all, fragile monitoring and evaluation system, weak coordination, low public awareness, and lack of community support, were found to be the major factors undermining the quality of MH clinics service at PHC in the country. Conclusion: The reconstruction of the Afghanistan health care system since 2002, provided prospect to integrate MH services into BPHS through the use of financial resources that became available. However, Improving the quality of MH services at PHC clinic to an acceptable level can be achieved: by insuring the availability of essential drugs and supplies, accelerating basic and comprehensive training for health care providers, documenting and strengthening referral and follow up system, upgrading supervision and monitoring system, and last but not the least, taking appropriate legal actions against those involve in corruption at different level of health system.

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