Annual Report 2015

TABLE OF CONTENT
Preface3

Message from the CEO

4

We believe in working with Communities

5

Capacity Building of Midwives

6

Education Empowers the Society

7

School for Disabled Children

8

Providing Livesaving Care to the Poorest

9

Gender and Maternal Mortality

11

Bringing Basic Health Services closer to the Doorstep

12

Working with the People: Emergency Aid

13

Winterization Aid in Badakhshan

14

Challenges and Social Innovation

15

Global Advocacy

16

Fiscal Year 2015 in Review

172Preface
Following formal procedures, theorganization changed its namefrom
BakhtarDevelopment
Network Switzerland (BDN) to
Action for Development (AfD) in
October 2015. The reason for theorganization's registration in
Europe is threefold. Firstly, wewish to create closer links withinternational
partnerorganizations. Secondly, we aspire
to sourcing new funds fordeveloping
programsinAfghanistan. Finally, we believe
this move will allow us toassociateinternational
collaboration with grassroots
initiatives in education, health,and women empowerment.
Working at the grassroots level in
Afghanistan has enabled us tobetter understand the region's
needs, to maintain our closeworking relationship with thegovernment and with Afghan
organizations, and to preserve an
authentic
understandingofcommunities.
The separation process from BDN
Afghanistan necessitated somechanges of attributes, including
the organization’s name, which
has successfully been realizedwith re-registration in Geneva.

Vision: AfD sees a future worldof enabled communities working
towards a brighter future.
It is our wish that members ofcommunities be informed of theissues at hand and enabled so as
to competently select among thedifferent solutions.
We see the family as the basicsocial unit, and we believe
women are its cornerstone.
Therefore,
we put particularfocus on women’s issues, and ourultimate goal is to transform
communities through initiatives
supporting women and girls’
empowerment,
healthandeducation.

Mission: Assist communities toachieve their own developmental
goals.
We believe that development
must be organic. That is to saythat communities are thefundamental driving force ofdevelopment as well as its main
beneficiaries.
Community
members, local groups andinstitutions are the main actors
involved. AfD provides seeds tothe local community: initiatives,
innovative ideas and initialfinancial support to launch or reestablish self-renewing cycles.

To be self-sustaining, thecommunity must assume its roleas stakeholder and active
participant, hence our efforts to
involve it and its members at thegrass root level.
AfD's focus is particularly on
women's and girls' health andeducation.
Initiatives foradolescent girls are, as the UNFPA
observes, one of the "smartest
investments a country can make.
As parents, teachers and leadersof the next generation, they canhelp break the cycle of poverty,
strengthen the social fabric andcreate a sustainable future.“
Our initiatives are built on threepillars:

Sustainability Implementationoflonglasting, self-renewing effects
 Safeguarding beneficiaries andAFDparticipantsfromcollateral effects
Transparency
 Accountability
 Respecttowards
ourbeneficiaries,
stakeholders,
partners and staff

Innovation
 New ideas for old problems
 Creating opportunities

3

Message from the CEO
It gives me great pleasure to present the annual report and the audited financial
statements for 2015.
Action for Development (AfD) invests in women and children: they are Afghanistan's
future and they merit a helping hand to survive on the toughest days and to thrive in abrighter future. In 2015 we brought health awareness and family planning to 60,000
women. We brought full health care services, including medicine, to 21,000 mothers
and children.
AfD trained more than 120 midwives to provide quality care to over 960,000 people inthree provinces of Afghanistan. A particular focus was put on newborn babies, forwhom progress in reducing preventable deaths had stalled. Our community mobilizers
and health workers are trained and deployed to provide support in reducing childmortality and improving maternal health.

We continued our support of vocational training in the School for Disabled Children in
Kabul. We also led several emergency relief projects for internally displaced populations
and implemented specific, lasting and large-scale solutions to acute problems.
Through our capacity development program we boost the competence andprofessionalism of our own employees as well as those from community institutions,other NGOs and governments. Our overall objective is to enhance the knowledge, skills
and attitudes of the practitioners engaged in the country’s development in areas such as
health, education, gender advocacy and management.
It merits mention that all our programs are specifically designed to meet Afghanistan’s
development challenges, and to involve neighbourhoods, communities and their
institutions and government teams in providing local solutions to the country's current
challenges.

I commend our dedicated teams who have shown great courage and resilience in2015. My sincere thanks and appreciation for our volunteer staff, whose diverse
expertise and strong commitment helped us make sound decisions to steer the
programs. I would also like to thank our donors and our development partners for theircontinued support and recognition of our contribution: we are grateful for your support
and we hope you will invest in the future to make a difference for women and children.

Dr Qudratullah Abdul Razaq
Executive Director and Founder4

We believe in
Working with
Communities

Capacity Building of Midwives
Afghanistan has the 11th highest birth rate in the world [1], and ranks first in infant mortality.
Maternal mortality, though it has decreased tremendously since 2000 rates of >1100 1 [3], is stillamongst the highest in the world. Midwives are the first and most effective defense against thesemortalities. And though the number of midwives in Afghanistan has increased now at ~0.1/1000, 40x
more midwives are needed simply to bring the country up to the global average. Care for new mothers
and new-borns must clearly be a present and immediate focus: for AFD this has been, and continues
to be, a principle initiative for action. Further, the initiative addresses the first of UNFPA's four mosturgent needs [4] in Afghanistan.
AFD has an ongoing programme of midwife training: the strategy is train a group of master- midwives,
who will in turn train others midwives thus leveraging the time and resources to roll out knowledge
and experiences of updated care for postpartum mothers and newborns. It is based on the Community
Midwife Education (CME) curriculum. In 2015 the training focused on eclampsia, pre-eclampsia,
management of third stage of labour and post-partum haemorrhage, and on the care for the newborn. It has been accomplished for 21 midwifes (who were trained as trainers) and 105 midwives
trained through cascade training in Parwan, Kapisa and Kabul provinces.
1.

World Factbook (internet). CIA; 2015

2.

World Development Indicators: Health systems. World Bank; 2015

3.

Raja F: State of Afghanistan’s Midwifery 2014. 20145

Capacity Building ofMidwives

RESULT
2014
Herat Province:

Every other hour, an Afghan woman dies due to complications
during pregnancy or childbirth. The death of a mother can result incatastrophic consequences for her children and her family.
Hunger, malnutrition, death of young children, early marriages ofdaughters and harsh economical situations can often be
associated with a mothers' death.

• 10 Trainers• 86 midwives(cascade training)

In Afghanistan, 30 percent of health facilities do not have any
female staff. The available midwifery workforce is only 23 per centof the estimated need for skilled birth attendants, and 83 per centof maternal mortality deaths could be prevented through better
access to and quality of health care.

2015

In 2013, AfD had identified the dire need to enhance midwiferyskills and knowledge, in order to decrease maternal mortality in
Afghanistan. The needs were established through studies and datafrom health facilities. During this assessment, twelve areas ofknowledge gap requiring immediate attention were identified.

Parwan, Kapisa, Kabul
Provinces:• 21 Trainers• 105 midwives(cascade training)

Total Reached:With support from our partner, the Geneva Health University's(Haute Ecole de Santé Genève) department of midwifery, AfD
developed modules for further capacity building of the country's
midwives. During the last two years we have trained a total of 222
midwives in four provinces of Afghanistan.

222 Midwives

The midwives trained by this program have aided more than
150,000 women in 2015, offering assistance during delivery as
well as before and after childbirth.

31 trainers
191 midwives (cascade
training)
6

Education
Empowers theSocietyAfghanistan is a country where education is not fully available for all healthy children, not tomention the disabled ones. Managing to deliver quality skills training to disabled children is achallenge. We understand that overcoming our challenges makes us stronger. Therefore, AfD focuseson making a difference by educating disabled, disadvantaged, and isolated children.
An educated and empowered segment of a community – even though they have disabilities - canbring positive changes in their own lives and in the lives of their families.
Education is about empowerment, thus we aim to educate the children who are being ignored bytheir families and society, and prove that they can be turned into capable individuals in the future,
who are no longer a burden to their families, but rather become a support.

7

School for DisabledChildren
Almost 50 percent of disabled Afghans suffer fromwar injuries, mainly due to mines. The other half
suffer from mental retardation, cerebral palsy,
leprosy,deafness,blindness,and multiple
impairments [5]. Continuing conflict in Afghanistan
and displacement of its population as refugees haveincreased the difficulties of planning and providing
specific rehabilitation and education services for thedisabled [6].
According to a survey by Handicap International,
there were at least 200,000 Afghan children livingwith permanent disabilities (physical, sensory and/or
mental impairment) in 2005. As the country’s
situation remains unstable, it is assumed that the
number of disabled children is constantly rising.
Due to lack of resources, awareness and weak politicalsupport, Afghan schools do not have even minimal
facilities for disabled children’s education. Children
with disabilities are often marginalized from society
and their families, and live in poverty. About 75
percent of disabled children do not go to school.
Young disabled Afghans have very limited
opportunities for employment and the means toleading a dignified life.

The Rahyab school in Kabul provides basic education,
food and transportation for boys and girls who areblind, deaf and/or speech-impaired. Girls make up 40
percent of its student body.
The education is specially designed to teach children
braille, sign language and other communication skills.
The school also provides psychological therapy toovercome trauma and vocational training to enhancechildren’s self-sufficiency. The school employs 36
specially trained teachers who are often disabled
themselves, and thus understand the real needs ofdisabled children. Up to now, 15 former student havefound jobs.
With generous funds from our donors, AfD provides
lunch to most of the school's students, which for someis the only regular meal of the day.

4. Coleridge P: Development, Cultural Values and Disabilities: The example ofAfghanistan. The Disability Press; 1999:149–167.
5. Nasir JA, Chanmugham P, Tahir F, Ahmed A, Shinwari F: Investigation of theprobable causes of specific childhood disabilities in eastern Afghanistan(preliminary report). Cent. Eur. J. Public Health 2004, 12:53–57

8

Providing
Lifesaving CareTo the Poorest

In 2013 a health facility was established in Quasaba
district, upon discussion with elders and community
leaders. Out of three projects proposed (electricity,water and health) the last emerged as the mostdesired and required by the community. The
surrounding area faced a lack of access to healthservices.
When the health facility was established in late 2013,
it reduced the time patients had to spend travelling
and lowered health care expenditure. The program isembedded at the community and patient level. It
offers periodical training to young doctors andcommunity health workers. Focusing on the provisionof quality health care, it is at the heart of healtheducation and family planning.

women and children. 3,810 patients were females
over 5 years old, 1,842 were children below 5 yearsof age, and the remaining patients were men.
Patients also benefit from an ultrasonography
section, a laboratory and immunization units. In
2015, approximately 600 ultrasound examinations
and over 5,100 vaccinations of children 0-5 years old
were performed. Furthermore, 339 pregnant and
701 non-pregnant women received anti-tetanus
vaccines.
Aware of the critical need for family planning andcounselling, the clinic has provided family planning
services to over 500 women (ranging from oral andinjectable contraceptives to insertion of intrauterine
devices).

Led by an internal medicine specialist, a gynecologist
and 3 other health professionals, the clinic served
10,251 patients during the past year, an average of
770 patients per month. It is focused above all on
9Bringing Initiatives into the Health
System Funding
In Afghanistan, 75 percent of health expenses
are paid by households, 18 percent are coveredby donors, and only 6 percent by thegovernment. Afghanistan needs to establish asystem of financial support for health carein order to decrease the burden on households,
as well as to be prepared for funding
shortcomings in case of international healthfunding withdrawal.
The health facility implements the Basic
Package of Health Services (BPHS) created by
Afghanistan's Ministry of Public Health (MOPH)
to address the country's most pressing healthissues. It does so with funds from the Ferdows
Social Foundation (FSF) and through apartnership agreement with AfD.
A community-run health system is being piloted
at the health facility, in which communities
participate in the financial support for thehealth services they receive. The system
focuses on building community leadership skills
and enabling members to take decisions about
various health issues in their community.
The clinic treats patients for 50 Afs (about
0.80USD) per visit. The medicine required by
the patients is provided free of charge at thehealth facility. The amount of money collectedfrom the fees is reinvested in medicine
purchased in bulk. The list of medicine available
at the health facility is established through the
MOPH's Essential Medicine list guidelines,
which includes all required medicine for acomprehensive health center.
The clinic has introduced a system that provides
free visits for very poor community members
and for families with a woman as their head ofhousehold.

10

Gender andMaternal Mortality

Social, cultural and gender practices immensely affect women and children health. In
Afghanistan, particularly in rural areas, women have no voice and lack of education to makedecisions about issues such as breast feeding, supplementary feeding of a newborn, vaccination
or family planning. Early girl-child marriages are another phenomenon that causes high maternal
deaths. Pregnancy and child-birth are major causes of deaths, especially at a young age. Almost
one third of maternal deaths could be avoided if women would have access to contraception andcould make informed choices.[6] A recent study indicates that reducing girl-child marriage by
one-tenth result in 70 per cent decline in maternal mortality in 97 countries [7], Afghanistanbeing one of them. Thus educating young women and girls and giving them freedom of choice iscritical factor in the reduction of maternal and child mortality rates.
6. WHO, www.who.int/topics /millennium_development_goals/maternal_healt
7. Raj A & Boehmer U (2013) Girl child marriage and its association with national rates of HIV, maternal health andinfant mortality across 97 countries, Violence Against Women, April 2013 (19:536-51)

11

Bringing basic health Services
Closer to the doorstep

BUILDING ON
OUR STRENGHTS
1.Community involvement

Training community health workers (CHW) is
another activity AfD has undertaken. These
young lay community members, both womenand men, receive a six-week basic healthtraining over the course of four and a halfmonths.
In 2015, a total of 32 volunteers were trained
through AfD's health facility's community
health unit, and became primary sources ofhealth information in their communities.
With a basic health kit received at the end of
their training, they are able to provide
treatment according to the MOPH'sguidelines for CHW services.
Yearly training sessions have been held since2013, and so far 60 volunteers have been
trained.

The community is a partner, as well
as stakeholder, and contributes
financially to the health center’s
operations by renting the building.
2. Capacity building of youth
The training received by community
health workers helps them develop askill for the future. Through further
training, this knowledge can be built
upon to establish a profession which
can be the basis of a stable income
stream.
3. Costs reduction
Expenses are further reduced by
employing recent graduates who canbe recruited at a reasonable cost.
Their work at the health facility
allows them to gain experience
working under an accomplishedphysician's supervision.

12

Working with the People:
Emergency Aid
Relief Service for Survivors of Avalanche
Panjsher, Afghanistan

ACTIONIn February 2015, scores of avalanches hit the northern
province of Panjsher. The area was struck again in March.
These were the worst avalanches in several decades, killing
and wounding hundreds of people. Many decided to seek
refuge in the neighbouring province of Parwan.
Initially aiming to provide food and medical support tovictims, AfD launched a fundraising campaign in March 2015.
Thanks to private donors and communities who supported
the initiative and responded to the call with humanitarianspirit and dedication, we were able to collect a modest
amount of CHF 7,600.

The strength of the organization
lies in its close direct contact with
communities.
Community
mobilizers and volunteers on the
ground approached community
elders once the funds to support
the survivors were available, andthe families who had been
relocated to a safe area wereconsulted. They had fled theprospective of new avalanches
and the danger of future floods.
Indeed, many villages of the area
get damaged by floods in thesummer due to heavy snowfalls.
The families identified safe
drinking water as the mostpressing need because their camp
was located in a desert lying
between the two provinces. The
closest water source was locatedin two walking hours away.
Respecting
thecommunity'spriority needs, AfD initiated theprocess of identification andconstruction of a well. It was built
90m deep and has an attachedtanker powered where thefetched water is collected.
Approximately 400 households
currently benefit from the well'swater.

13

Working with the People:
Emergency Aid
Winterization aid
Badakhshan, Afghanistan
Badakhshan is one of Afghanistan's 34 provinces, located in
the farthest northeastern part of the country, between
Tajikistan and northern Pakistan. In May 2014, multiple
landslides struck districts of Badakhshan, causing significant
loss of life and widespread damage to about 350 households,
leaving families homeless. Around 1,000 families are thought
to have been affected, and officials declared that nearly
2,500 people were killed, with many injured and many
missing. The villages affected by the landslide are in thepoorest regions of the country and face severe winters,
including extremely cold temperatures and heavy snowfall.
The surviving population of the area was in urgent need offood, water and temporary shelter. In order to help them,
AfD launched a project to provide winterization assistance by
distributing heaters and wood. We aimed to improve theliving conditions of people and reduce their vulnerability toseasonal extremes during winter.

ACTIONTo fund the initiative, we launcheda fundraising campaign. Global
Giving,communities
andindividuals were approached.
Thanks to the positive response
from our supporters (Marie deMeyrin, and individuals) the
project was implemented in theJurm district of Badakhshan
province.
In total, 96 households, orapproximately
700
people,benefitted from the initiative.
Each household received 210 kg ofwood and a locally produced,
multipurpose heater which can beused for heating, cooking andboiling water for up to 3 or 4
years. It is important to note thatwesourcedonly
local
manufacturers to supply theheaters. This was done to help not
only those affected by thedisaster, but also to empower
Afghanmanufacturers
byproviding them with work
opportunities.
We believe that this initiative will
improve the living conditions of
those forced into informal
settlements
in
Badakhshan,
reducing their risk of illnesses anddeath as a result of exposure to
extreme winter conditions.

14

Challenges &Social Innovation
In Partnership with Geneva Graduate Institute
AfD looked into existing resources in the watersector to assess the possibility of involving
successful technology and education-driven
solutions in safe water systems in communities
that have an immediate need.

opportunity for the students of Graduate Institute,but also to find a reasonable solution to a social
problem.

Together with students from Graduate Institute of
Geneva, AfD attempted to overcome the drinking
water challenge which persists in various
settlements of Afghanistan.

“How can we design a water treatment facility for
Kabul's Comprehensive Health Centre whileconsidering the local context and the constraints ofa small NGO?”Run by students, Collaborate for Social Impact(C4SI) makes the concept of experiential educationa reality. Taking on real world challenges, AfD
aimed not only to provide an educational

The students developed a detailed design for awater treatment solution and a plan for its
implementation.

The challenge looked into the following:More information can be found here at the c4si site and in the c4si Program Report 2015.

15

Global
Advocacy

Action for Development made its debut in international
advocacy this year by organizing a panel event at the United
Nations 30th Human Rights Council in September 2015.
AfD, along with our project implementation partner, theMidwifery School at the Haute École de Santé Genève,
showcased the successes of our 2014-2015 midwifery
training projects in Afghanistan.
Entitled "Human Rights-based Approaches to Eliminating
Preventable
Maternal
Mortality
andMorbidity:
Implementation in Practice", the panel examined maternalmortality as a human rights issue and highlighted existing
good practices and challenges to eliminating preventablematernal mortality.

Carl Reaich, Permanent Mission of New
Zealand to the United Nations

A particular focus was on investment in midwifery training inorder to reduce rates of maternal mortality and disability.
Training midwives:
I)Promotes the human rights of patients by ensuring thembetter quality health care;II)Improves gender equality by educating men and women
about their sexual and reproductive health;
III)Educates and empowers women by providing midwives
professional skills which they can in turn pass on to other
health practitioners and patients.
The event was sponsored by the Permanent Missions of
Afghanistan, Burkina Faso, Colombia and New Zealand as
well as UNFPA and the World Health Organization.

Panel speaker and project partner Michelle
Pichon, Haute École de Santé Genève

16Fiscal year 2015 in Review
Communede Meyrin
4%

Global Giving
5%

Geneva Communes
9%Ville deGenève4%

Communedu Grand
Saconnex
1%

Fundaraising
Activities
1%
Interantional
Solidarity Service
31%

Funding Sources

Mohamed Farsi
Foundation
7%
Ferdows Social
Foundation
47%

Expenses & Changes
in Fund Balance
Annual Report
IncomeContracts & Grants

70680

Procurement of partnership agreement

72759

Fund raising activities

7470
150909

Expenses
Total

144464

AssetsCash, Bank Guarantee, Debtors
Creditors

Surplus of funds at year end

24695,84
11011

13684,84

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1211 Genève -2
Switzerland actfordev.org
Email: info@actfordev.org
Telephone: 0041 22 347 92 17