Health Systems 20/20 (HS 20/20)

Speeches Shim


The Health Systems 20/20 project, which closed in September 2012, supported the Ministry of Public Health (MoPH) to identify and address financing, governance, operational, and capacity constraints in the health system.  USAID worked closely with the MoPH’s Health Economics and Financing Directorate (HEFD) to reach the goal of ensuring that Afghan citizens have access to high-quality, affordable health care and have sufficient health financing options.  


  • MoPH Capacity: The project assessed the capacity of MoPH systems in order to implement and institutionalize health economics and financing activities. 
  • National Health Accounts (NHA): The project refined collection methodology for data on household out-of-pocket expenditures and used this methodology to: design a five-year implementation plan; develop seminars and workshops for the Ministry of Finance (MoF), non-governmental organizations (NGOs), provincial health officers, and other related parties; and, train a cadre of experts.
  • Non-Governmental Organization (NGO) Capacity: The project provided training and support to strengthen NGO program monitoring, in the hopes of ensuring greater data accuracy for planning, implementation, evaluation, and decision-making.  The project also improved financial management systems and reporting.
  • Efficient Resource Use and Allocation: The project explored revenue-generating options and built MoPH capacity in proposal development, needs assessment, costing of services, and data analysis.
  • Risk Protection Mechanisms: The project investigated the appropriateness of traditional and hybrid insurance models within the context of Afghanistan and developed a road map to ensure that required capacity exists in the future to monitor insurance frameworks.
  • Incentive Programs: The project helped research the connections between cash incentives and community health worker incentives and community awareness.


  • Completed the first Afghanistan National Health Accounts for years 2008-2009.
  • Partnered with Chulalongkorn University in Thailand to allow select HEFD staff to pursue advanced degrees in health economics.
  • Assessed Basic Package of Health Services (BPHS) costs in 2010, building on a 2005 study.
  • Signed and began enforcing fuel tax legislation in 2011, which led to increased revenue through fee collection.
  • The MoPH formally endorsed the Revenue Generation Strategy and piloted user fees at select sites.
  • Developed a Health Financing Policy for 2012-2020 that includes parameters for implementing a successful insurance framework in Afghanistan.
  • Developed the Expenditure Management Information System (EMIS) in collaboration with MoPH, which reduced the time needed to produce expenditure reports from 10 days to less than 1 hour.  

Last updated: May 07, 2019

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