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Various reforms have been applied worldwide in health systems, since 1940s. The most recent reforms in developing countries started in 1990s. The important ingredient of these reforms comprises of re-organization of health systems, user charges for public services, public-private partnership and contracting-out of health services. The MoPH of Afghanistan started to contract-out health services in 2003. This study tends to assess the effects of contracting-out of BPHS on quality of health care and patients satisfaction in Afghanistan. This study indicates the contracting-out of health services as a viable option for the MoPH to expand the health services and improve the quality of care. NGOs required lesser amount of grants for the provision of BPHS with better outcome. Decentralization nurtures, quality of care improved and patients feel satisfied. The MoPH should draw lessons from the study for wider implementation and improvement of quality of care.