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Implementing a Sustainable Capacity Building Plan in Afghanistan’s Health Economics and Financing Directorate


Afghanistan's nascent Health Economics and Financing Directorate (HEFD) within the Ministry of Public Health should increase its capacity to implement activities and services that will build a sustainable and efficient health system. Capacity building programs are often ineffective because they are externally driven, and local counterparts are passive recipients rather than active and critical participants. Through USAID's Health Systems 20/20 project, Deloitte is using a distinctive approach to build the capacity of HEFD that is internally driven, draws on adult learning theory to inform strategies and activities, and addresses individual, organizational, and systemic aspects of capacity.

The Challenge

In post-conflict settings such as Afghanistan, where health indicators are among the poorest in the world, building and implementing a sustainable health system is a significant challenge. Afghanistan's per capita spending on health is extremely low, the health system is largely donor-funded, and there are limited health economics-related data for decision-making. Health economists can play a critical role in identifying, gathering, analyzing, and presenting information required for the Government of Afghanistan to make short and long term decisions and policies for the health sector. Building the capacity of health economists is essential to the effectiveness and sustainability of Afghanistan's health system. The project team was tasked with helping equip the Health Economics and Financing Directorate with the range of knowledge, skills, and staff to implement activities and services needed by the Ministry of Public Health in the short run and over the long term.

How We Helped

A participatory process was used to introduce HEFD to capacity building approaches, facilitate a capacity assessment, develop a capacity building strategy, and create a capacity building workplan. Deloitte supported HEFD staff to create individual learning plans and set performance goals; conduct short courses to meet prioritized technical capacity gaps; enroll seven HEFD staff in a formal Masters degree program in Health Economics; conduct workshops and capacity building sessions; design and implement operational systems and processes; and deliver one-on-one and group coaching and mentoring sessions.

Deloitte's approach to capacity development and technical assistance involves an educational component that utilizes teaching aides to convey information and build skills, and job aides that HEFD staff can refer to in the absence of the technical assistance (TA) provider. A joint approach to planning, implementation, and evaluation establishes clear roles and responsibilities for the TA provider and HEFD counterpart. An institutionalization plan includes strategies to orient and teach others and a “curricula” of information, tools, resources, and other materials developed through the TA process that HEFD can use in disseminating technical skills and knowledge. Capacity building activities incorporate four adult education theories --Transformational Learning Theory; Theory of Margin; Theory of Experiential Learning; and Self-directed Learning Model --to facilitate understanding, application, and institutionalization of new knowledge, skills, and processes.


Technical assistance and capacity building programs can be delivered in a way that facilitates government agencies driving their own organizational change and internally motivating staff and stakeholders, even in post-conflict and limited resource settings. When the decision for institutional development comes as a process of self-realization and self-direction, and addresses both organizational and individual capacity, there is increased likelihood of institutionalizing a high capacity culture that can continue to improve over time. Using a combination of participatory approaches and adult education methods, Deloitte was able to support HEFD to take ownership over its capacity development process for more immediate and measurable results that are sustainable. Monitoring and evaluation activities indicate that Deloitte's innovative approach has already yielded measurable changes in HEFD's capacity: progress against workplan deliverables, changes in attitude, increased knowledge and skills, and functional systems, processes and tools in place.

Deloitte’s work in Mozambique under the Health Systems 20/20 Project is carried out under a subcontract with Abt Associates Inc., prime contractor for the Health Systems 20/20 cooperative agreement. Health Systems 20/20 is funded through the generous support of the American people through the U.S. Agency for International Development (USAID). Health Systems 20/20 helps USAID-supported countries address health system barriers to the use of life-saving priority health services. In the process, the project works to strengthen health systems through integrated approaches to improving financing, governance, and operations, and building sustainable capacity of local institutions.

As used in this document, ‘Deloitte’ means Deloitte Consulting LLP, a subsidiary of Deloitte LLP. Please see for a detailed description of the legal structure of Deloitte LLP and its subsidiaries. Certain services may not be available to attest clients under the rules and regulations of public accounting.

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