Country Team Action Plan (AFGHANISTAN)

Tracks 1 & 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 & 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 & 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 & Present 2-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 & 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 provinces will be added by the end of 2010

Tracks 1 & 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? GOALS Components 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 values Incorporating 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, HSSPMay 2010 Promote innovation within Inter Ministerial Committee Reconvening Bangkok TeamMay 2010 Establish task force at Ministry of Religious Affairs MoRAMoPH- Health PromotionMay 2010 Establish MOU and share TOR between MOPH and MORA DG of Policy Planning, MoPHJune 2010 Gather information on evidence MoPH- Health PromotionTech-ServeJune 2010 Hold consensus building workshop to develop fatwa MoPH-CBHC and Health Promotion, Planning and Policy and RH & MoRAAugust 2010 Develop Fatwa MoRA/and Shura UlamaMoPH- Health PromotionAugust 2010

Tracks 1 & 2 23 What are our action steps? Action StepResponsible Person Timeline Hold national conference to announce fatwa MoPH- Health Promotion and CBHC/MoRATech-ServeSeptember 2010 Ensure Membership of Religious Leaders at community health Shura MoPH- CBHC & MoRASeptember 2010 National plan of action (MoPH and MoRA) including M&E and communication plans Steering CommitteeTech-ServeOctober 2010 Engage community leaders to encourage men to be involved in birth spacing Steering CommitteeTech-ServeOctober 2010

Tracks 1 & 2 24 What are our action steps? Action StepResponsible Person Timeline Create Guidelines Steering Committee/Technical Working GroupTech-Serve and HSSPNovember 2010 Develop units on Islamic values in all line ministries MoPH-Health Promotion & MoRACompri-A, AFGANovember 2010 Create media spots and other materials using popular male figures MoPH-Health Promotion & MoRACompri-ANovember 2010 Hold national, provincial and community level meetings with shura ulama Steering CommitteeStakeholdersDecember 2010

Tracks 1 & 2 25 What are our action steps? Action StepResponsible Person Timeline Build capacity of mullas including study tour MoPH- CBHC and Health Promotion & MoRATech-ServeJune 2011 Create IEC/BCC materials (messages ) MoPH-Health Promotion & MoRAUSAIDNovember 2011 Create training program (HSSP,UNFPA) MoPH- APHI/TrainingUSAID, UNFPANovember 2011 Train and deploy male birth spacing counselors at health facilities Implementing NGOs and MoPH- RHUNFPA, USAIDJanuary 2012