GAVI –HSS Current Intervention & Achievements November 2 nd Dr. Najla Ahrari

1. GAVI –HSS Current Intervention & Achievements November 2nd Dr. Najla Ahrari Ministry of Public Health

2. New GHIs ( GAVI & GF HSS) All inline with ANDS objectives • GAVI - HSS • CSO - Type A • CSO - Type B • GFATM - HSS

3. GAVI-HSS Objective 1. Improved access to quality health care particularly Immunization and MCH Objective 2. Increased demand for and utilization of health care Objective 3. Improve ability of MOPH at various levels to fulfill its Stewardship Responsibility

4. Activity 1.1 and 1.2: Establishing Sub-centers and Mobile health team in under served areas 121 out of 121 SC established and 26 MHTs are functional, operating in most remote areas of the country (Steps are taken to hand over all sub-center and MHT to BPHS implementers)

5. Activity 1.1 and 1.2: Establishing Sub-centers and Mobile health team in under served areas • All SHCs and MHTs registered in the HMIS system, data reporting on quarterly basis. • Quarterly reporting and feedback system in place. • 87 out of 120 have at least one female health worker (Q4 1389 HMIS FSR on six monthly basis reported) • Avg. utilization per facility per month (SHC - 789) (MHT-870)- source HMIS 1389.

6. Comparison of indicators in three consecutive years 2008-2009-2010

7. MHT Evaluation findings: Source: ACTD MHT evaluation report

8. Activity 1.3. Expanded IMCI to community level • First round 3 zones (north, center, east )(9225 CHW in 17 province) • Trained so far 8407 CHWS/CHSs. 45.1% female • Second round 2 zones (north east, south east) (4991 CHW and CHS in 8 provinces)

9. Activity 1.4. Develop an in-service training program to be implemented for BPHS primary health care program • Due to duplication with HSSP – USAID funded project the remaining fund 1.2 MUS$ shifted to C-IMCI • Closure report will be compiled as part of overall HSS report ( APHI to provide completion report)

10. Activity.2.1. Implementing IEC campaign for immunization & other MCH messages • A Central stock for IEC materials constructed • 7 workshop of IEC/BCC for telecommunication companies, NGOs, MoPH staff, and the staff of hospitals • IEC materials for public awareness printed • 44 TV health messages produced and broadcasted • 36 Radio health messages produced and broadcasted • 20 episode Radio Drama in Dari /Pashto produced and broadcasted

11. Activity.2.1. Cont……………. • Health and Islam National Conference conducted • Monitoring visit conducted from the health facilities (existence of IEC materials ) • Establishment of National Data Base for distribution of IEC materials • KAP Survey of Increased Demand for health service utilization conducted • Communication strategy based on the finding of KAP survey has been developed and translated in 1390 MOPH action plan. • 1,590,942 IEC materials (Posters & Brochures) distributed to health facilities

12. Activity.2.2/3. Pilot the effectiveness of consumer incentive and demand-side financing/CHWS incentive • 4 provinces and 16 districts were selected based on a set of criteria (Wardak, Badakhshan, Kapisa & Faryab) • The implementer NGO with the technical support from MOPH developed the end of project survey tool, the survey sampling methodology and training manual developed. • The end line survey completed by the implementers, and the project ended by end of June 2011, waiting to receive the final report. • The final report will be presented to MOPH leadership and other partners and will be published soon after approval.

13. Activity 3.1. Up grading the physical & technology of the M&E department at the central and provincial levels • 25 out of 34 provinces were provided with rented vehicles for strengthening monitoring functions. • Regular monitoring visits from BPHS, EPHS and other Health relevant Projects of MoPH conducted . in total 29 out of 34 (85%) of the provinces, were monitored once a year while 11 provinces (32%) monitored twice and 8 provinces monitored three times. • M&E team assisted the third party (JHU/IIHMR) in conducting of BSC and 5 HSS indicators covered in the BSC 1)Contact/person 2) DPT3 coverage 3) Provider knowledge 4) Intuitional deliveries 5) CHWs Activity (Referral) which is showing significant progress • 27 MOPH staff successfully completed the one year M&E capacity building course, which was contracted out through an open competition and covered 6 modules ( Report writing, Biostatistics, Health System Research, Applied epidemiology, health survey and HMIS) .

14. Activity 3.1. Cont………………. • Standards, monitoring checklists and guidelines developed for HSS related health projects (C-IMCI, DSF, DPHOs, In-Service training, QPHMS. • Monitoring checklists for private sector developed • GIS different material tools developed for different departments of MoPH • NMC revised and training conducted • New NMC database developed

15. Activity 3.3.Exapnd program for capacity building MOPH managers at the central and provincial levels • The first round of QPHMC ended by April 2010 / covered 24 provinces. • In total 1287 ( 759 PHOs, 328 MOPH central staff, and 200 DHOs) of which 1215 males and 72 females were trained on the following five training modules : Policy and Strategy; Supervision, Monitoring and Evaluation, Financial Management; Planning and Budgeting; English and Computer • The second round of QPHMC started on May 1st 2011 and will be ended by April 2012, covering 34 provinces. • 5 training modules is planning to be taught Basic Leadership, Basic Management, Disaster Management, Report Writing and Proposal Writing an

16. Activity 3.4.Developing a communication & internal advocacy program • Public Relation Strategy finalized and published in MoPH website. • Media database including media emails and contact numbers has been created and developed. • PR tools; such as newsletters, press releases and news released in Dari, Pashto and English languages. • MoPH website has been created and designed in three separate pages (Dari, Pashto and English languages). • More than 420 Journalists introduced for preparation of the reports and stories from the local hospitals and reflection of progress and challenges of health sector through media.

17. Activity 3.5. Launching an initial cadre of District Health Officers DPHO Side Selection Districts : • To launch a cadre of DPHOs who in each district will: • Help coordinate inter-sectoral responses to disease outbreaks and other emergencies • Play an important role in coordinating immunisation coverage • Support and monitor the work of the front line health care providers implementing the BPHS The districts were selected based on 5 criteria including security, HMIS based performance measures (Vaccine coverage) remoteness, population density & MCH services. Rolled out in two phases: 1 – 50 districts (2008) 2 – additional 102 (2009) Currently all existing DPHOs are part of the government tashkil

18. “The DPHOs are an important addition to the health services in their district” Interviews with stakeholders show positive towards the DPHOs and their roles. Important finding of the evaluation A representative of the government A bridge between the district and the province. A problem-solver Able to find gaps in service provision and work with the stakeholders and resolve problems at the local level. A coordinator Due to their attendance at health meetings and non-health sector meetings they are able to have a good relationship with all the key people in the district. A monitor Their presence ensures the health facilities and NGOs perform better and also reassures the community that the NGOs are performing well.

19. Status of outcome indicators GAVI HSS support

20. Status of output indicators GAVI HSS support

21. Impression of June GAVI IRC: “IRC commends the country for the impressive progress it has made over the few years. Given the difficult terrain, their history and current security issues, it is truly an inspiring case. The commitment from the government; the co-financing plans; use of CSOs for service provision; the country’s ability to plan and act on HSS activities is a best case example and should be used by GAVI to encourage other countries to emulate their example. Equally worth mentioning is the role of HSCC and the oversight it provides for all HSS activities”

22. CSO Type A implementation • CSO representatives selected. • Data base developed. • Study conducted. • Reports disseminated • Ensuring proper coordination among CSOs still remains a challenge

23. CSO Type B There were two groups of projects funded from CSO type B: • Four community midwifery schools achieved progress in teaching their relevant curriculum in four insecure provinces of Kunar, Ghazni, Zabul and Nimroz. • In total 91 students from four schools completed their taught program at the end of 2010 and students started their practical work in hospitals and BPHS health facilities (HFs).

24. CSO Type B cont……… • The two pilot models of partnerships with private health service providers (PPHSP) completed in two insecure and underserved provinces of Uruzgan and Farah Provinces by 12th August 2011. • 55 private health service providers were providing immunisation and basic reproductive and child health services in return for incentives. • The private health service providers are trained for providing immunisation and basic reproductive and child health services. • The mid and end of project evaluation have been completed and presented to CGHN .

25. Challenges: Even with these impressive gains, it is only a start—much remains to be done: • Infant, child and maternal mortality remain high • Health is an essential element for improving the country’s security • Many communities continue to have inadequate access to health services • Quality of health services must be improved • Further health gains require sustained support from our partners for the long-term

26. Thank You