Provision of integrated Primary Health Services in underserved areas in Afghanistan Project Summary :	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. Levels of malnutrition continue to rise while Afghanistan faces its second drought in the past four years and high levels of food insecurity. More than half of children under five (U5) faced malnutrition in 2021, with a 16 percent increase in cases of severe acute malnutrition (SAM). A recent multi-sector needs assessment (Annex 3) conducted by Relief International (RI) in February 2022 in four provinces, including Ghazni, across 745 households (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 12-month integrated health and nutrition project, RI aims to reduce these barriers and expand access to gender-responsive immediate and lifesaving primary health assistance by establishing 6 static health facilities and 1 mobile health and nutrition team (MHNT) in Ghazni and Kabul provinces. In Ghazni province, these health facilities will include: 1 basic health center (BHC), 1 sub-health center, and 1 MHNT in Qarabagh district 1 BHC in Nawa district, and 1 BHC in Ghazni city. In Kabul province, these health facilities will include: 1 BHC in Surobi district and 1 BHC in Char Asyab district. The targeted districts were selected based on the lists of white areas (i.e., areas without health services) provided by provincial public health departments (PPHDs) and Health partners in each Province and in the case of Ghazni province, are in line with findings from a RI rapid needs assessment in May 2022 (Annex 4). 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 restricted, unconditional cash transfers via cash-in-hand to cover the transportation costs for patients 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.