Provision of Primary Health Care in underserved areas of Afghanistan With over 18 million people in need of humanitarian assistance, the humanitarian situation in Afghanistan remains one of the worst worldwide, impacted by years of conflict, natural disasters and the COVID-19 pandemic. The recent changes in the country’s government have brought new uncertainty around the provision of life saving services and the impact that economic decline will have on the already highly at-risk population. Distance from health facilities and costs of pharmaceuticals remain among the key barriers to accessing health care services especially among rural communities, and this is expected to worsen in light of the impact that economic decline will have on the negative coping mechanisms of the most deprived population. Levels of malnutrition continue to rise while Afghanistan faces its second drought in the past four years. More than half of children under five faced malnutrition in 2021, with a 16 percent increase in cases of severe acute malnutrition (SAM) many nutrition services were interrupted during active fighting. 

A recent multi-sector needs assessment (Annex 1) conducted by Relief International (RI) in the targeted provinces across 745 HHs (45% female and 55% male respondents) shows that food and health assistance remain the highest needs among the local population. Distance from health facilities (59%) and costs of transportation (48%) remain key barriers to accessing health services. Through the proposed 6-month project, RI aims to reduce these barriers and expand access to gender-responsive immediate and lifesaving primary health assistance through the deployment of 7 integrated mobile health and nutrition teams (MHNTs) in Parwan and Ghazni Provinces. The districts covered by MHNTs in each province have been selected based on the lists of white areas provided by PPHDs and Health partners in each Province and are in line with findings from a multi-sectoral assessment in February 2022. Services will be aligned with the Basic Public Health Service (BPHS) and will include integrated primary health and nutrition support to children under 5 and pregnant and lactating women (PLW) as well as reproductive health and mental health and psychosocial support (MHPSS) in line with Health Cluster priorities and OCHA Reserve Allocation guidelines. In addition, RI will provide in-hand cash assistance to cover the transportation costs for patients who are referred to higher-level facilities for specialized treatments. The estimated transportation costs (USD 2,5 per trip for a max. of 3 trips per patient) are in line with the costs proposed by the Health Cluster in the approved Minimum Expenditure Basket (February 2022). Transportation costs will be covered based on referrals slips produced by MHNT doctors and the number of patients has been estimated at 6 per month per MHNT in line with similar projects run by RI in past years. 

Taking into consideration the high prevalence of GBV in Afghanistan and the need to protect survivors, GBV response will be mainstreamed into RI’s health programming through the capacity building of healthcare workers on protection principles, GBV and survivor-centered approaches, with a focus on confidentiality and the do-no-harm principle. RI will also train female staff in psychological first aid (PFA) in order to provide psychological support to women at-risk and survivors of GBV. 

All activities will reflect COVID-19 mitigation measures. Out of the total 49,000 beneficiaries targeted across all components, 20,580 will be women and 19,600 children.