This quasi-experimental study conducted in Afghanistan examines the causal impact of a provincial health governance intervention on the provincial health system’s performance. It compares health system performance indicators between 16 intervention provinces and 18 nonintervention provinces using a difference-in-differences analysis to draw inference. The intervention consisted of governance action planning, implementation of the governance action plan, and self-assessment of governance performance before and after the intervention. The intervention had a statistically and practically significant impact on six indicators.

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