Provision of Lifesaving Health Services including Winterization Support in the hard to reach areas in Dulaina and Charsada districts of Ghor Province The healthcare system of Afghanistan is dealing with serious challenges with decreasing number of health workers, lack of maintenance of health facilities, stockouts of essential medicines and a deteriorating economy with increased food insecurity, meaning the community does not have the resources to pay for private services. Nearly a quarter of Afghanistan's population does not have access to primary health care. Afghanistan has one of the highest maternal and infant mortality rates in the world. According to recent epidemiological data, there are outbreaks of measles, acute watery diarrhea (AWD) dengue fever, AHF and continued Acute Respiratory Infections (ARI) and COVID-19. As winter approaches with people living in cramped and crowded conditions and limited ventilation and smoky environment due to wood and charcoal burning stoves for warmth there is a risk of an outbreak of influenza or ARI. Access routes to health facilities will be hampered by weather and snow, so ongoing chronic and opportunistic diseases will not be treated. Women will still need to give birth, and the need will continue for sexual reproductive health services and nutrition services for infants and pregnant and lactating women.

According to the Multi-Sector Rapid Needs Assessment analysis conducted by WVA in March 2022, access to health services averages one and half hours coupled with additional challenges, in Ghor 47% said they had no access to facilities, and 21% said the health facilities did not have enough medicines, Even at the end of winter 27% of children had ARI in the previous 2 weeks and only about 58% of children were vaccinated. The 2021 malnutrition figures from UNICEF indicate that 19% of children and 25% of pregnant and lactating women were malnourished. The 2022 SMART survey is not completed for Ghor but based on other results for other provinces it is expected to be similar to last year (the preliminary but not verified rates are 10.3% GAM (95% CI 8.1-15.3%) and 2.3% SAM (95% CI 1.3-4.1%). This puts the district at medium but with the confidence interval makes it very high).

In line with the AHF 3rd Reserve Allocation for 2022, the proposed project aims to improve access to primary health care services including reproductive and child health care services as well as mental health and psychosocial support services (MPHSS) and health education through supporting Mobile Health and Nutrition teams (MHT) in Ghor, and providing buffer stocks of medications for severe cases of acute respiratory infections and training of health workers in prevention, care and treatment of ARI and other winter related risks. In addition, winterization kits of warm clothes and blankets will be distributed to pregnant and lactating women and children lt2 who have malnutrition or severe illness.  These will be sourced from WHO and UNICEF.

World Vision will work in close coordination with the WHO, UNICEF, DoPH, AADA and other health players in the respective e provinces working to expand the coverage of the primary lifesaving health services to the white areas of Dolayna and Charsada in Ghor province.