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Capstone Project Critique: Public Health in Afghanistan Essay

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Updated: Jul 22nd, 2021


In the field of healthcare, it is crucial to assess the quality of research investigations since their results can have a direct impact on people’s wellbeing. The work under examination is the research proposal by Achakzai (2014) titled “Research Proposal for Assessing Patient Safety Culture in Public Hospitals Under the Essential Package of Hospital Services (EPHS) in Afghanistan.” The text is concerned with the current state of the patient safety culture in Afghanistan.

The main goal of the study is to see whether a translated version of Hospital Survey on Patient Safety Culture will yield viable results about the hospitals in Afghanistan. This survey was developed by the Agency for Healthcare Research and Quality (AHRQ) (Westart, Sorra Yount, Famolaro, & Gray, 2019). Furthermore, the author aims to use the results of the study for a comparison with the survey’s findings in the United States and Iran. The evaluation of this research reveals a thought-out proposal for a new approach to patient safety culture in Afghanistan that acknowledges the problems and gaps in contemporary research while also providing suitable arguments for the survey’s implementation.


The discussed proposal is organized according to the standards of academic research works. First, it briefly presents the issue of patient safety and patient safety culture, investigating the origins of the research sphere and its development into a separate discipline (Achakzai, 2014). The structure of public hospitals in Afghanistan is explained as well – it differs from other countries due to its history as well as government-regulated nature. The introduction also describes the Hospital Survey on Patient Safety Culture (later named SOPS Hospital Survey) and describes its contents.

Second, the author presents a literature review of the discipline’s background as well as scholarship related to the subject of the investigation. Various patient safety-focused studies are discussed with the implementation of the AHRQ Hospital Survey and its use in multiple countries (Achakzai, 2014). Then, the author presents the factors that affect health care in Afghanistan – the impact of the ongoing war, poor economic state, and the aim of the government to provide public healthcare.

The chapter presenting the research methods returns to the contents of the SOPS Hospital Survey, detailing the changes of the survey to fit the national context. The quantitative study design is discussed; sampling procedures and estimations are provided. The author suggests using convenience sampling of physicians, nurses, management, and lab technicians from seven hospitals on the three levels of care – regional, provincial, and district (Achakzai, 2014).

The number of respondents is expected to be about 350 completed surveys, based on the calculations recommended by the AHRQ. Furthermore, Achakzai (2014) elaborates on the ways of data collection and management. Finally, the proposed analysis strategies are described, and ethical considerations are addressed. For example, the issue of respondent anonymity is central to the discussion, and the author explains how anonymization of the results will protect staff from the influence of adverse outcomes.

The last chapter deals with the scheduling and possible management issues of the research study itself. The time scale accounts for ethical approval, personnel hiring and training processes, data collection, analysis, and the writing of the final report (Achakzai, 2014). Then, the author suggests professional areas where this study may be useful, also describing the path to data dissemination – the Afghanistan Journal of Public Health is named as a potential publisher to reach the desired audience (Achakzai, 2014). Finally, the scholar concludes the proposal, outlining the primary purpose of the study as well as its necessity for national healthcare.


To understand the weaknesses and strengths of this proposal, the following review will consider each criterion of a study and provide its overview. To start, the author’s aim for this investigation is clearly stated – to prove the effectiveness of the SOPS Hospital Survey for assessing patient safety culture in Afghanistan’s public hospitals (Achakzai, 2014). As the discussed paper is a proposal, the outcome of this aim cannot be seen.

However, one may see the potential contribution of the paper to the scholarship. The author suggests that the current amount of knowledge about this issue in non-Western countries is lacking (Achakzai, 2014). Indeed, the scarcity of studies concerning the measurement of patient safety in Afghanistan and neighboring countries supports this statement (Phaghizadeh & Asoori, 2015). The health system on Afghanistan follows a set of specific standards and pays great attention to the medical side of health care delivery.

As can be seen in the report prepared by the Islamic Republic of Afghanistan Ministry of Public Health (2005), patient safety is addressed briefly in regards to physical barriers, waste management, and emergency situations. The issue of safety culture, however, is not brought up in the official document.

In contrast, the US and European countries have been developing studies in the sphere of patient safety for more than a decade, to which the report “To Err is Human” is a testament (World Health Organization, 2017). Therefore, this text is a substantial contribution to the research of patient safety in non-Western countries, providing a translated survey sample and showing the initial results of the nation’s hospitals. Programs focused on education and better feedback channels for staff are at the center of discussions by contemporary researchers (Qarani, Jan, Saeed, & Khymani, 2018). Such initiatives are crucial for improving the state of healthcare delivery in Afghanistan.

Furthermore, the research connects itself to the other countries by aiming to compare the results of the survey with similar questionnaire findings from Iran and the US. Although this decision allows the author to immediately compare the results of the examination to those from other nations, it also separates the study’s aim into several topics. First, the scholar aims to determine whether the results of a SOPS Hospital survey are suitable for Afghanistan, thus focusing on the adaptability of the system for the nation.

At the same time, the author seems to be interested in comparing the state of healthcare in Afghanistan and other countries. While this question is as important as the first one, it may undermine the initial idea of confirming the survey’s usefulness and the consistency of its numbers between different staff and hospital types.

The methodology is the next major part of the proposal, and its detailed and thorough description strengthens the validity of future analyses. The use of the quantitative approach is the most appropriate for investigating the effectiveness of the survey and its result’s consistency (Waterson, 2014). The author proposes to use the results of the five-point Likert scale for several examinations – to assess the culture of patient safety in the country and, with additional demographic data, to see the similarity between reports from hospitals and staff members (Achakzai, 2014).

As a result, one can see that the selected strategy fully aligns with the aim, and the hypotheses proposed by the author make the expected results transparent. Quantitative research methodologies are more objective than qualitative ones due to their reliance on calculations (Parker, Wensing, Esmail, & Valderas, 2015). Moreover, the author’s focus on interpreting the findings according to the standards of two organizations – the World Health Organization (WHO) and AHRQ – further lowers the possibility of bias.

The detailed investigation into the validity of the SOPS Hospital Survey is another strength of the proposal. The author presents several reasons why this particular framework is suitable for hospitals in Afghanistan and shows examples of its use in other non-Western countries. For instance, the scholar cites the comparison of the test being implemented in the US, the Netherlands, and Taiwan and finds that the AHRQ’s survey provides viable results that can be used both for internal and external comparison (Achakzai, 2014).

Furthermore, the author acknowledges the differences in culture and healthcare delivery between the nations, which may act as a barrier to the test’s implementation. To address these concerns, Achakzai (2014) presents the findings from Iran, explaining the outcome of the survey as well as the lack of issues rooted in Iran’s cultural background differences. A recent example of a non-Western country successfully using the AHRQ’s survey is the report by Farhat (2019) who assesses patient safety culture in the United Arab Emirates. The scholar builds a concrete action plan based on the questionnaire which further proves the suitability of the survey. Thus, the argument for using SOPS seems to be consistent with the purpose of the investigation, and its structure makes the proposed research highly valuable.


The analyzed research proposal provides an in-depth investigation into the state of patient safety culture in Afghanistan, offering a tool for measuring its quality. The instrument suggested by the author is well-researched and discussed – Achakzai is transparent in explaining the reasons behind the choice of the SOPS Hospital Survey, its benefits and potential pitfalls for the country. While the researcher’s aims shift their focus in some areas of investigation, the overall goal of the study remains clear. Moreover, the review of the present literature supports the potential impact on non-Western studies that this research can have.


Achakzai, H. (2014). Research proposal for assessing patient safety culture in public hospitals under the essential package of hospital services (EPHS) in Afghanistan (Master’s thesis, Georgia State University, Atlanta, GA). Web.

Farhat, R. (2019). Hospital survey on patient safety culture: Feedback results. Dubai, UAE: United Arab Emirates Ministry of Health & Prevention.

Islamic Republic of Afghanistan Ministry of Public Health. (2005). . Web.

Parker, D., Wensing, M., Esmail, A., & Valderas, J. M. (2015). Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care. European Journal of General Practice, 21(sup1), 26-30.

Phaghizadeh, S., & Asoori, M. (2015). Assessment of nurses viewpoints on patient safety culture in Amol hospitals in Iran, 2012. Preventive Care in Nursing & Midwifery Journal, 4(2), 45-55.

Qarani, W. M., Jan, R., Saeed, K. M., & Khymani, L. (2018). We need higher education: Voice of nursing administration from Kabul, Afghanistan. Nursing Open, 5(3), 317-322.

Waterson, P. (Ed.). (2014). Patient safety culture: Theory, methods and application. Burlington, VT: Ashgate.

Westart, R., Sorra, L., Yount, N., Famolaro, T., & Gray, L. (2019). . Web.

World Health Organization. (2017). . Web.

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IvyPanda. 2021. "Capstone Project Critique: Public Health in Afghanistan." July 22, 2021. https://ivypanda.com/essays/capstone-project-critique-public-health-in-afghanistan/.


IvyPanda. (2021) 'Capstone Project Critique: Public Health in Afghanistan'. 22 July.

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