Afghanistan: Primary Health Care Partnership for the Poor (formerly Piloting Health Care Partnership)

The overall objectives of the Projects were to: (i) reduce Infant Mortality Rate (IMR) by 30%, the prevalence of common infectious diseases and malnutrition in children, the maternal mortality ratio, and the birth rate in the targeted communities over a period of 3 years; (ii) demonstrate the potential of partnership of the Ministry of Health (MOH), and NGOs, and communities in developing sustainable community-based health service delivery system, targeting 10 high priority districts, which lacked services, for a possible replication of the system nationwide ((later reduced to 9 districts: 5 in Badakhdhan Province and 4 in Gohr District).

The specific objective of the Project are to (i) make interventions through health centers and with the use of CHWs; (ii) provide quality health services at less cost by training health staff of MOH and CHWs, supplying equipment , and developing a drug supply system; (iii) improve water supply and sanitation through the provision and repair of water pumps and latrines, including schools; (v) promote healthy life styles and timely referral through health, nutrition , and birth spacing education, by increasing access to radio education programs for women and by training local leaders, CHWs, and health staff; (vi) strengthen local leadership in community development activities for health, with linkages to other sectors such as education and agriculture, and (vii) build the capacity of MOH, NGO, and communities in a sustainable partnership.

The Project consisted of five components: (i) support to local community organization and NGOs ($693,000); (ii) support to local health centers construction and rehabilitation ($670,000); (iii) training and capacity development of CHWs ($542,000); (iv) essential drug supply ($471,000); and (v) project management ($220,000).

1. Reduce poverty by improving health, nutrition, and reproductive health status of the rural poor.

2. Demonstrate the potential of Ministry of Health (MOH)-nongovernment organization (NGO) partnership to develop quality community-based health care for the poor in 10 undeserved districts.

1. Improvement of health services in 10 districts.

2. Community Health Worker (CHW) program for women and children.

3. Drug supply system.

4. Capacity building in public-private partnership.

1. Community Management.

2. Health centers.

3. CHW services

4. Drug supply system

5. MOH capable of contracting and managing NGOs.

The Project's design, objectives, components, implementation arrangements and schedule were appropriate and relevant in view of the fast evolving context of Afghanistan, with the limited government capacity and NGOs' strong presence at the community level.

All stakeholders actively participated in the Project's activities from the planning stage and then throughout the entire project implementation period. MOH and the Ministry of Finance made good communications for project implementation on a regular basis. Many collaborating international and local NGOs also demonstrated their strong interest in the Project, and provided their advice and supports to the Project, which had to be implemented despite a substantial difficulty in terms of geography, climatic condition, capacity of governments, security, and cultural aspects.

Communities, the most important stakeholders, were fully involved in the Project at each stage of project implementation. They always extended their contribution to the Project, in terms of provision of labor and donation of land for clinic buildings, ensuring security of clinic staff, and introducing volunteers who became CHWs. Women Committees were also organized and they regularly held meetings for decision making on the health-related matters in their communities. The local authorities of MOH were also cooperative and they fully participated in project implementation. The Project also received technical support from local health authorities of the Government of Tajikistan. (For example, female health workers had to be brought and recruited from Tajikistan.) Furthermore, the Project received technical support of UNICEF, WHO and other international development agencies in Afghanistan.