Management capacity in the Afghan Ministry of Public Health pre-Taliban: A mixed-methods study of political and socio-cultural issues

Abstract

Background: The importance of management capacity in the health sector has been increasingly recognized. After decades of conflict one of the main obstacles facing the Afghan health system was the limited ‘management/leadership capacity.’ To effectively build capacity it is important to understand the underlying issues.

Methods: A mixed-methods study, conducted in 2017/18, before the Taliban takeover, was carried out in all directorates of the Ministry of Public Health (MoPH) to explore the management/leadership capacity. Interviews were conducted with 12 staff; data were analyzed thematically. A quantitative survey was also conducted covering directors of 30 departments, it was analyzed using descriptive statistics.

Results: Our research identified four main factors in the MoPH affecting management and leadership capacity; insufficient support, uncoordinated capacity building, political and socio-cultural issues, and lack of transparency/accountability. This paper focuses on one aspect - the perceptions of the MoPH employees about the impact of political/socio-cultural issues on capacity. Overall, management capacity was weak. Key appointments including directors were subject to political interference and many directors appointed by politicians lacked the required management skills. Consequently, those directors were not able to support employees appropriately or to create a healthy work environment. Overall, there were strong socio-cultural influences such as nepotism and favoritism. Due to these problems employees believed they were not treated consistently or fairly. This was compounded by overly complex administrative systems.

Conclusion: Being able to strengthen management and leadership capacity in the Afghan health system depends largely on the implementation of (existing) anti-corruption strategies.