Leadership and Governance

Problem Analysis:

Over two decades of war has devastated the country’s infrastructure, including in the area of education, health care, and roads. Afghanistan’s Human Development Index is one of the lowest in the world, comparable only to a few poor landlocked or war-torn countries of sub-Saharan Africa. Life expectancy at birth is 45 years, 20 years lower than any other Asian country.

Afghanistan displays one of the highest ratios of maternal mortality in the world – estimated at 1600 deaths per 100,000 live births. In some parts of the country, nearly 7% of mothers die during childbirth, the highest MMR ever recorded! Fewer than 15% of births are attended by medically trained personnel; 10% by traditional midwife; 75% births attended to by family members. Antenatal care coverage is also low with a little more than one-in-three women able to access such services.

Acute gender disparity in Afghan society is apparent. Afghanistan has the lowest female literacy rate in the world, with boys twice as likely to complete primary school as girls. In addition, violence against women is pervasive, a silent epidemic due to the low status of women, and compounded by long standing conflict.

Early marriage in the country is widespread with nearly 16% of Afghan girls married before the age of 15 and 52% before the age of 18. There is poor awareness in the general population on issues relating to RH including family planning, with a contraceptive prevalence rate of 10%. The country also has a high total fertility rate of 6.8.

Afghanistan is also a country with high-risk of HIV/AIDS, though the current prevalence is low. As the country is the worlds leading producer of opium and a rapidly growing producer of heroin as well, intravenous drug use is increasing, with an estimated 40% users sharing needles.

Strategic Direction:

AFGA will work to increase access to quality reproductive health information, education and services by reducing socio-cultural barriers to access.

Goal:

All people, particularly the poor, marginalized and underserved are able to exercise their rights and have access to quality reproductive health information, education and services.

Objectives:

Objective 1:

To reduce socio-cultural barriers inhibiting access to reproductive health information, education and services.

Objective 2:

To increase coverage by 50% to quality reproductive health services in Kabul and to extend these services to 2 other provinces.

Activities:

Activities for objective 1:

Conduct research on FBV and socio-cultural barriers to accessing reproductive health right-related information and services.
Develop and disseminate BCC materials on Reproductive Health and Family Based Violence (FBV).
Orient staff members and volunteers on reproductive health rights and services and family based violence issues.
Sensitize key stakeholders such as government officials, religious leaders, civil society groups, media and community gatekeepers, on reproductive health rights and services and FBV-related issues.
Establish strategic partnerships to improve access to reproductive right-related services.
Review national policies related to access to reproductive health rights and services.

Activities for objective 2:

Set up 5 new clinics and strengthen existing facilities to increase access to comprehensive reproductive health services.
Conduct baseline on access to reproductive health, including mapping of partners, KAP study of service providers and deprivation ranking.
Establish resource centre on reproductive health and related issues.
Develop training module and screening protocol on Family Based Violence.
Conduct capacity building programmes on attitudinal reconstruction on gender and rights for staff members and volunteers.
Train service providers on provision of quality reproductive health services, including emergency contraception.
Capacity building on counseling skills for counselors, service providers and family welfare promoters.
Develop referral system for continuity of care.
Establish a panel of experts on access-related issues
Development of AFGA policy position paper on Access to Reproductive Health entitlements and services.
Standardization of infrastructure/facilities at clinics.
Adopt IPPF quality standards.
Strengthen competency of service providers through training.

Outcomes :

Baseline and end-line information on access to reproductive health services.
Increased number of clinics providing quality reproductive health services.
Increased number of clients receiving quality services irrespective of age, sex and marital status.
Standardization of facilities and services.
Competent service providers.
Strategic partnerships established.
Reduced socio-cultural barriers for access to reproductive health services.

Indicators:

Indicators for objective 1:

Report on socio-cultural barriers to reproductive health services.
Number of sensitization trainings conducted for government officials, religious leaders and influential people on importance of reproductive health-related issues.
BCC material on reproductive health and FBV issues developed and distributed.
Number of newspapers and radio programmes disseminating sensitization messages on importance of reproductive health and FBV issues.
Number of MoUs signed between AFGA and strategic partners.

Indicators for objective 2:

Baseline and end-line study reports on access to reproductive health services.
Number of AFGA Family Welfare Centers /clinics established.
Findings of periodic quality assessment of clinics.
Percentage of clients expressing their satisfaction while receiving services from the clinics by age, sex and marital status.
Types of training conducted and number of service providers trained in each.
Types of systems established for quality assurance including supervision.
Number of MoUs signed with government agencies and other NGOs working on reproductive health and family based violence issue.