Provision of integrated primary healthcare and nutrition support for winter preparedness 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 and rising costs will have on the negative coping mechanisms of the most deprived population. Afghanistan faces high levels of food insecurity which may worsen during the winter months, which are also the country's lean season. More than half of children under five (U5) faced malnutrition in 2021, with a 16 percent increase in cases of severe acute malnutrition (SAM). The winter months are also expected to bring elevated risks of acute respiratory infections (ARIs), hypothermia, cardiovascular diseases, seasonal influenza, and other diseases (AHF RA3 2022 Allocation Strategy Paper).
Through the proposed 6-month health project, RI aims to reduce barriers to accessing nutrition and health care and expand access to gender-responsive immediate and lifesaving primary health assistance by supporting health facilities in Parwan province. In Parwan province, these health facilities will include 10 SHCs in Ghorband Siagird, Salang, Sheikh Ali, Surkh Parsa and Ghorband Shaniwari districts. In Parwan provinces, targeted districts were selected based on the Health Cluster's list of prioritized areas for intervention. The specific health facilities were identified by the selected provinces' PPHDs and Health partners. Services will be aligned with the Basic Public Health Service (BPHS) and will include integrated primary health and nutrition support to children U5 and pregnant and lactating women (PLW), as well as reproductive health (RH) and mental health and psychosocial support (MHPSS) in line with Health Cluster priorities and OCHA Standard Allocation guidelines. In addition, RI will provide unrestricted, conditional cash transfers via cash-in-hand to cover the transportation costs for SAM patients with medical complications who are referred to higher-level facilities for specialized treatments. 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 Health Cluster COVID-19 mitigation measures.
Finally, to ensure ongoing support and impact, medicine planned to be purchased under this project will seek to have an extended shelf-life, to ensure that impact can continue beyond the life of the project and ensure that procured medicine is not an ineligible cost, due to its expiration prior to the AHF supported project's completion. As with all of RI's projects, the procurement process will remain transparent and compliant with rules and best practices per RI's policies. RI will ensure proper storage conditions are in place, including cold chain if necessary. Furthermore, there will be no duplication of medicine and medical consumables in the AHF funded RA3 2022 project with other sources. In specific circumstances (outbreaks, delays in the procurement, etc), RI will seek prior approval from AHF and the Health Cluster for any in-kind donation of medicines and medical consumables from UN agencies/other resources.