Designing a Model for Health System Policy Implementation in Afghanistan
Keywords:
policy implementation, health system, Afghanistan, health governance.Abstract
Afghanistan’s health system, due to its specific political, security, economic, and social conditions, faces serious challenges in the implementation of health policies. The gap between policy formulation and realization at the operational level, weaknesses in managerial structures, shortage of financial resources, inadequacy of infrastructure, and limited human resource capacity highlight the need to design an indigenous model for the effective implementation of health policies. The present study was conducted with the aim of designing and explaining a model for health system policy implementation in Afghanistan. In terms of approach, this research was qualitative, and in terms of purpose, it was applied. The statistical population of the study consisted of experts, policymakers, executive managers of the health system, service providers, and scholars familiar with the issues of Afghanistan’s health system, who were selected using purposive sampling. The research data were collected through semi-structured interviews and continued until theoretical saturation was reached. The coding process and MAXQDA software were used to analyze the data. The findings showed that barriers to health policy implementation in Afghanistan can be classified into three main categories: structural-managerial challenges, economic-infrastructural challenges, and educational-content-related challenges. The results indicate that the successful implementation of health policies in Afghanistan requires smart decentralization, strengthening of governance and accountability systems, human resource empowerment, sustainable financing, improvement of health service infrastructure, localization of training programs, and establishment of a data-driven monitoring and evaluation system. Accordingly, the proposed model of the study can be used as an applied framework for reducing the gap between the formulation and implementation of health policies in Afghanistan.
References
[1] P. A. Sabatier, Theories of the Public Policy Process. Saffar Publications (in English), 2017.
[2] W. N. Dunn, Public Policy Analysis: An Integrated Approach. Tehran: SAMT Publications (in English), 2024.
[3] S. M. Alvani and F. Sharifzadeh, The Process of Public Policy-Making. Tehran: Allameh Tabataba'i University Press (in English), 2024.
[4] A. Monavarian, Implementation and Evaluation of Public Policy. Tehran: Ketab-e Mehraban (in English), 2022.
[5] A. Buzogany and H. Pulzl, "Top-Down and Bottom-Up Implementation," in Handbook of Public Policy Implementation: Edward Elgar Publishing, 2024, pp. 116-126.
[6] H. B. Shahi, "Significance of Bottom-Up Approach for Policy Implementation," (in English), PAAN Journal, vol. 30, no. 1, pp. 1748-1752, 2024, doi: 10.3126/paanj.v30i1.66101.
[7] J. Kjaerulff, "Discretion and the Values of Fractal Man: An Anthropologist's Perspective on Street-Level Bureaucracy," (in English), European Journal of Social Work, vol. 23, no. 4, pp. 634-644, 2020, doi: 10.1080/13691457.2018.1553150.
[8] G. M. Nagra, A. Nawaz, M. Imran, M. Javed, and G. Mustafa, "People, Politics, and Society: A Historical Analysis of Afghanistan," (in English), Remittances Review, vol. 9, no. 2, pp. 539-556, 2024.
[9] A. Qarizadeh, "The Evolution of the Management of Basic Health and Hospital Services in Afghanistan," (in English), Jami University Scientific-Research Quarterly, pp. 21-32, 2024, doi: 10.61438/jsrqj.v7i4.11.
[10] S. Arif, K. F. Rezaie, S. Madadi, and S. H. Mousavi, "Afghanistan's Healthcare under Taliban: What Are the Challenges?," (in English), Medicine, Conflict and Survival, vol. 39, no. 1, pp. 93-99, 2023, doi: 10.1080/13623699.2023.2170576.
[11] M. Basij-Rasikh, E. S. Dickey, and A. Sharkey, "Primary Healthcare System and Provider Responses to the Taliban Takeover in Afghanistan," (in English), BMJ Global Health, vol. 9, no. 2, 2024, doi: 10.1136/bmjgh-2023-013760.
[12] A. Lamberti-Castronuovo et al., "Exploring Barriers to Access to Care Following the 2021 Socio-Political Changes in Afghanistan: A Qualitative Study," (in English), Conflict and Health, vol. 18, no. 1, p. 36, 2024, doi: 10.1186/s13031-024-00595-4.
[13] A. Paterson, J. Palmer, and E. Sondorp, "Health System Governance Cooperation with Unrecognised Health Authorities: A Political Economy Analysis in Afghanistan and Northwest Syria," (in English), Conflict and Health, vol. 19, no. 1, p. 30, 2025, doi: 10.1186/s13031-025-00669-x.
[14] N. Hegazy et al., "The Availability and Distribution of Health Services and Resources across Different Regions in Afghanistan," (in English), Frontiers in Public Health, vol. 12, p. 1371104, 2025, doi: 10.3389/fpubh.2024.1371104.
[15] S. Ibrahimi, S. Yeo, K. Yusuf, Z. Akrami, and K. Roy, "Factors Hindering Access and Utilization of Maternal Healthcare in Afghanistan under the Taliban Regime: A Qualitative Study with Recommended Solutions," (in English), Healthcare, vol. 13, no. 9, p. 1006, 2025, doi: 10.3390/healthcare13091006.
[16] F. Maruf, H. Tappis, R. Augustin, T. van den Akker, and Y. Tam, "Potential Impact of Maternal and Newborn Health Improvements in Afghanistan: Projection of Mortality to 2030," (in English), Maternal and Child Health Journal, pp. 1-8, 2025, doi: 10.1007/s10995-025-04108-4.
[17] M. Y. Essar, A. Siddiqui, and M. G. Head, "Infectious Diseases in Afghanistan: Strategies for Health System Improvement," (in English), Health Science Reports, vol. 6, no. 12, p. e1775, 2023, doi: 10.1002/hsr2.1775.
[18] M. Shahid et al., "Cancer Screening in Afghanistan: A Narrative Review of Feasibility, Barriers, and Evidence-Based Strategies for Low-Resource Settings," (in English), Cureus, vol. 18, no. 1, 2026, doi: 10.7759/cureus.101346.
[19] C. N. Ugwu et al., "Sustainable Development Goals (SDGs) and Resilient Healthcare Systems: Addressing Medicine and Public Health Challenges in Conflict Zones," (in English), Medicine, vol. 104, no. 7, p. e41535, 2025, doi: 10.1097/MD.0000000000041535.
[20] V. Percival et al., "The Lancet Commission on Peaceful Societies through Health Equity and Gender Equality," (in English), The Lancet, vol. 402, no. 10413, pp. 1661-1722, 2023, doi: 10.1016/S0140-6736(23)01348-X.
[21] B. Singh, "Reimagining Human Rights: Harnessing the Power of Law for Global Health and Sustainable Development Goals," (in English), Human Rights in the Global South, vol. 2, no. 2, pp. 93-105, 2023, doi: 10.56784/hrgs.v2i2.65.
[22] L. Bahrami, "Analyzing the Implications of a Rights-Based Approach to Policy-Making in Women's Health," Doctoral dissertation in Management, Tarbiat Modares University, Faculty of Humanities, 2024.
[23] A. R. Sari, "The Impact of Good Governance on the Quality of Public Management Decision Making," (in English), Journal of Contemporary Administration and Management (ADMAN), vol. 1, no. 2, pp. 39-46, 2023, doi: 10.61100/adman.v1i2.21.
[24] M. A. Kiani, "Designing a Semi-Centralized Governance Model for the Health System in Iran," Doctoral dissertation in Geography, Political Geography, University of Tehran, Faculty of Geography, 2025.
[25] M. I. Harrison and S. M. Shortell, "Multi-Level Analysis of the Learning Health System: Integrating Contributions from Research on Organizations and Implementation," (in English), Learning Health Systems, vol. 5, no. 2, p. e10226, 2021, doi: 10.1002/lrh2.10226.
[26] G. Van der Weert, K. Burzynska, and J. Knoben, "An Integrative Perspective on Interorganizational Multilevel Healthcare Networks: A Systematic Literature Review," (in English), BMC Health Services Research, vol. 22, no. 1, p. 923, 2022, doi: 10.1186/s12913-022-08314-6.
[27] M. J. Esmaeili Seraji, K. Sina, and T. Enayati, "Designing a Model for Implementing Health Policy in the Administrative System with Emphasis on Conflict of Interest Management," (in English), Razi Medical Sciences, vol. 30, no. 6, pp. 248-256, 2023.
[28] H. Nematian Saghi, "Pathology of the Implementation of Nursing Service Tariff-Setting Policy in Human Resource Management," Master's thesis in Public Administration, Human Resource Development, Payame Noor University of South Khorasan Province, Birjand Payame Noor Center, 2025.
[29] M. S. Abolhasani, M. Ziaeddini, and M. A. Nikbakhsh, "Identifying and Prioritizing Measures to Reduce the Failure of Health-System Policy Implementation Based on Failure Mode and Effects Analysis and Fuzzy TOPSIS," (in English), Occupational Medicine Quarterly, vol. 16, no. 1, pp. 11-30, 2024.
[30] R. Mbau et al., "Analysing the Efficiency of Health Systems: A Systematic Review of the Literature," (in English), Applied Health Economics and Health Policy, vol. 21, no. 2, pp. 205-224, 2023, doi: 10.1007/s40258-022-00785-2.
[31] A. Aghaei Hashjin, M. H. Ghafoori, M. Ghane, and B. Darvishi Teli, "Financial Challenges in Iran's Healthcare System Arising from Migrant Populations: Evidence from Two Hospitals in Yazd Province," (in English), BMC Health Services Research, 2026, doi: 10.1186/s12913-025-13755-w.
[32] L. Agustin and M. Y. Solikin, "Analysis of SMEs Credit Restructuring Policy in Economic Recovery during the COVID-19 Pandemic," (in English), Jurnal Muara Ilmu Ekonomi dan Bisnis, vol. 5, no. 2, pp. 405-416, 2021, doi: 10.24912/jmieb.v5i2.13087.
[33] J. Ye, L. He, and M. Beestrum, "Implications for Implementation and Adoption of Telehealth in Developing Countries: A Systematic Review of China's Practices and Experiences," (in English), NPJ Digital Medicine, vol. 6, no. 1, p. 174, 2023, doi: 10.1038/s41746-023-00908-6.
[34] M. Chen et al., "Implementation Pathways of a Health Services Delivery Redesign Model to Improve Maternal and Newborn Outcomes in Kenya," (in English), BMJ Global Health, vol. 11, no. 1, 2026, doi: 10.1136/bmjgh-2024-018240.
[35] E. Ahmadi and P. Aftabi, "Examining the Position of Social Participation in the Process of Conservation and Management Policy-Making for World Heritage Cities," (in English), Bagh-e Nazar, vol. 19, no. 115, pp. 69-80, 2022.
[36] E. M. Varimach, "Explaining Policy Development and Implementation Challenges of Afghanistan's Tourism Programs," Master's thesis in Tourism, Tourism Marketing, University of Science and Culture, Faculty of Tourism Sciences, Tehran, 2025.
[37] U. Botobekov, "How Central Asian Salafi-Jihadi Groups Are Exploiting the COVID-19 Pandemic: New Opportunities and Challenges," in Religious Studies, vol. 21, 2021, p. 107.
[38] M. Touchton, H. Arreola-Ornelas, K. A. Arizmendi-Barrera, V. V. Enciso, and F. M. Knaul, "Drivers and Barriers for the Implementation of Value-Based Healthcare in Latin America: A Cross-Country Qualitative Policy Analysis," (in English), The Lancet Regional Health - Americas, vol. 53, 2026, doi: 10.1016/j.lana.2025.101307.
[39] G. Maisarah and R. Yusran, "Exploring the Key Factors in the Implementation of the GERMAS Policy: A Public Management Perspective Using the Mazmanian and Sabatier Framework," (in English), Journal of Educational Management Research, vol. 4, no. 4, pp. 1870-1879, 2025, doi: 10.61987/jemr.v4i4.1144.
[40] C. Flores, "A Qualitative Phenomenological Study of Military Veterans' Lived Experiences with the Cultural Transition Process: Navigating from the Military Culture to Civilian Life," 2025.
[41] F. G. M. Yar, "Analysis of Challenges and Opportunities for Improving the Health System in Afghanistan: Innovative Approaches and Sustainable Solutions," (in English), Jurnal Sosial Teknologi, vol. 4, no. 10, pp. 923-941, 2024, doi: 10.59188/jurnalsostech.v4i10.27615.
[42] N. Eskandari Nia, K. Daneshfard, and A. Faghihi, "The Public Policy-Making Palette: An Integrated Study Using Meta-Synthesis and the Delphi Technique," (in English), Public Policy-Making in Management, vol. 11, no. 4, 2020.
[43] A. Hodoudi, M. H. Asadi Davoudabadi, and A. Roshanaei, "Sociology of Social Issues in Iran in the Field of Health," (in English), Journal of Mashhad University of Medical Sciences Faculty of Medicine, vol. 65, no. 1, pp. 521-544, 2022.
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Copyright (c) 2025 Mutiullah Sharq (Author); Vahid Araei (Corresponding author); Mohammad Reza Rabiee Mandejin, Hasan Givarian (Author)
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