Country Team Action Plan

(AFGHANISTAN)

Tracks 1 & 2

2

2007-Present /PPH

1. Expansion of Prevention of Post-Partum Hemorrhage at Home Births

• The pilot using misoprostol took place between March 2006 and Sept 2007

• The expansion plan for PPH project post-Bangkok 2007 began in December 2007

Tracks 1 & 2

3

2007-Present/ PPH

Expansion plan developed in 5 phases:

Phase 1: Planning and preparation Phase 2: Early implementation Phase 3: Implementation in round 1 sites Phase 4: Implementation in round 2 sites Phase 5: Review phase

Tracks 1 & 2

4

2007-Present/PPH

Ongoing process: • PPH protocol

developed, finalized, and RFPs issued

• Training document reviewed, revised and ready for printing

• Provincial change agent selected and recruited

Tracks 1 & 2

5

2007-Present2-Zinc introduction: – Introduction of Zinc for the management of

diarrhea presented to MoPH – Working group formed– Developed national strategic plan for control

of DD– Developed plan of action for improved

diarrheal case management + (introduction of Zinc and low osmolarity ORS )

– Conducted consensus workshop

Tracks 1 & 2

6

2007-Present / cont

• Zinc included as part of Basic Package of Health Services, new Child Health Strategy, IMCI and C-IMCI

• Zinc supplementation implemented in 20 provinces out of 34

• 14 provinces will be added by the end of 2010

Tracks 1 & 2

7

2007-Present

2- Kangaroo Mother Care:– Technical Working Group established – Developed community-based maternal

and newborn care package – Field testing carried out– A ToT will be conducted in March – Will scale-up to all 13 USAID-supported

provinces and selected districts [other provinces funded by WB and EU]

Tracks 1 & 2

8

Current Situation for Birth Spacing

Male involvement:• Males are involved but not

systematically• No standard guidelines for male

involvement • In several provinces of Afghanistan,

UNFPA has conducted a training program for male involvement

Tracks 1 & 2

9

Current Situation for Birth Spacing

Religious leader involvement:• FP in the Light of Islam booklet is under

review at MoRA and approved by MoPH.• A conference on “Health in Islam” held

and reference manual and guidelines from Egypt regarding health and Islam have been translated and distributed

• A number of health facility Shura have religious leaders as members

Tracks 1 & 2

10

Where do we want to be?GOALS

• Afghanistan has improved access to and utilization of birth spacing methods for women of reproductive age through increased awareness and support of religious leaders and men

• The Best Practice which has been Chosen for Scaling up :

Involving men and religious leaders in birth spacing services in Afghanistan

Tracks 1 & 2

11

Where do we want to be? GOALSComponents of chosen best practice:• Developing and issuing a Fatwa• National Plan of Action• Training program for (RLs, health providers,

managers…)• Ensure membership of RLs in community

health Shura• Having male counselors (at health facilities) for

BS

Tracks 1 & 2

12

Where do we want to be? GOALS

Components of chosen best practice:2• Establish an Inter-Ministerial

Committee• Develop a comprehensive M&E plan• Arrange study tours for religious

leaders and other people for increased networking

Track 2 13

What is the evidence to support this best

practice?• Fatwa (issued in other Islamic countries)• IEC/BCC materials (messages developed

and used in other countries )• Experience of Health Shura (health staff

and community leaders and RLs)• Experiences in other countries such as

Egypt, Yemen, Iran, Indonesia, and Pakistan

Track 2 14

What are the modifications needed to improve the

intervention’s scalability?Modify:• To make more credible: the project

should be modified based on experiences in other countries, such as Yemen

• Action: further evidence needed for the Afghan context—modify advocacy and communication materials, involve RLs in development of plan

Track 2 15

Modify:

Compatible:Make the plan compatible with Afghan

valuesIncorporating Afghan values and

cultural practices will make the scale-up easier

Training package, IEC/BCC materials need to be adapted to fit the Afghan context

Track 2 16

Testable:

• Male and RL involvement in Birth Spacing (BS) is already happening as part of the National Health Strategy and National Reproductive Health Strategy

• We can review the results so far as a kind of test of our approach

Track 2 17

Who will be involved in scaling-up?

User organizations:• MoPH: RH/FP, CBHC, and Health Promotion

Departments• MoRA: Health Shura and and other

stakeholders• Afghan Resource team:

MoPH: FP/RH, HP, CBHC, AFGA, BASICS, HSSP, Tech-Serve, UNFPA, WHO, UNICEF, COMPRI-A. MoRA, and MSI

Track 2 18

What policy, regulatory, budgetary, or other

institutional steps are needed?

• Create National Action Plan, Guidelines, Learning Package

• See action plan

Track 2 19

Where, when and how will the best practice be expanded?

• Phased approach starting in the 8 “regional” provinces

• Phase I will be completed by June 2011

• Innovations will be disseminated through the National Health Coordination Workshop and the Annual Health Retreat

• See action plan for other details

Track 2 20

What will be the costs of expansion and how will

needed resources be mobilized? • Costs include: Training, Technical

Assistance, IEC materials, Study Tour, Communication materials, Media spots, Workshops, Logistics including transportation, M&E, etc.

• Government, USAID and UNFPA support will be mobilized for the scale-up effort

Track 2 21

How will the process, outcomes and impacts be

monitored? How will results be fed into decision-making?

• M&E Plan will be established as part of the National Action Plan

• Details and indicators will be determined as part of this process

• Outcomes will be integrated into the national HMIS

Tracks 1 & 2

22

What are our action steps?Action

StepResponsible Person

Timeline

Establish steering committee for the project MoPH: CBHC Dept. Tech-Serve, HSSP May 2010Promote innovation within Inter Ministerial Committee Reconvening Bangkok Team May 2010Establish task force at Ministry of Religious Affairs MoRA MoPH- Health Promotion May 2010Establish MOU and share TOR between MOPH and MORA

DG of Policy Planning, MoPH June 2010

Gather information on evidence MoPH- Health Promotion Tech-Serve June 2010Hold consensus building workshop to develop fatwa

MoPH-CBHC and Health Promotion, Planning and Policy and RH & MoRA August 2010

Develop Fatwa MoRA/and Shura Ulama MoPH- Health Promotion August 2010

Tracks 1 & 2

23

What are our action steps?

Action Step

Responsible Person

Timeline

Hold national conference to announce fatwa

MoPH- Health Promotion and CBHC/MoRA Tech-Serve September 2010

Ensure Membership of Religious Leaders at community health Shura MoPH- CBHC & MoRA September 2010

National plan of action (MoPH and MoRA) including M&E and communication plans Steering Committee Tech-Serve October 2010

Engage community leaders to encourage men to be involved in birth spacing Steering Committee Tech-Serve October 2010

Tracks 1 & 2

24

What are our action steps?

Action Step

Responsible Person

Timeline

Create Guidelines

Steering Committee/Technical Working Group Tech-Serve and HSSP November 2010

Develop units on Islamic values in all line ministries

MoPH-Health Promotion & MoRA Compri-A, AFGA November 2010

Create media spots and other materials using popular male figures

MoPH-Health Promotion & MoRA Compri-A November 2010

Hold national, provincial and community level meetings with shura ulama Steering Committee Stakeholders December 2010

Tracks 1 & 2

25

What are our action steps?

Action Step

Responsible Person

Timeline

Build capacity of mullas including study tour

MoPH- CBHC and Health Promotion & MoRA Tech-Serve June 2011

Create IEC/BCC materials (messages )

MoPH-Health Promotion & MoRA USAID November 2011

Create training program (HSSP,UNFPA) MoPH- APHI/Training USAID, UNFPA November 2011

Train and deploy male birth spacing counselors at health facilities

Implementing NGOs and MoPH- RH UNFPA, USAID January 2012