Political economy analysis of the performance‐based financing programme in Afghanistan

Abstract Background Performance-based financing (PBF) has attracted considerable attention in recent years low and middle-income countries. Afghanistan’s Ministry of Public Health (MoPH) implemented a PBF programme between 2010 2015 to strengthen the utilisation maternal child health services primary facilities. This study aimed examine political economy factors influencing adoption, design implementation Afghanistan. Methods Retrospective qualitative research methods were employed using semi structured interviews as well desk review policy documents. Key informants selected purposively from national level ( n = 9), province 6) facility 15). Data analysis was inductive deductive guided by framework explore that influenced adoption programme. Thematic content used analyse data. Results The global context, experience other LMIC, shaped its introduction MoPH saw promise additional resources needed rebuild country’s system after period conflict. support for also linked their past positive performance-based contracting. Power dynamics interactions actors process. established centralised management structure which strengthened donor ability manage programme, but overlooked key stakeholders, such provincial offices non-state providers. However, had limited input design, resulting not tailored setting. Conclusions shows programmes need be designed adapted according local involving all relevant cycle. Future studies should focus on conducting empirical only understand multiple effects performance systems main influence different stages