ADVOCACY

Problem Analysis:

o  The health system of Afghanistan is recovering from a collapse in the recent decades of conflict. Many of the country’s main health outcome indicators – although improving – remain at the very bottom of the international rankings. The poor general health conditions in Afghanistan are directly related to many factors such as nutrition, access to safe drinking water and adequate sanitation. Yet one of the main causes for these poor health outcomes not being overcome is the inadequate availability, access and quality of health care services.

o  The proportion of women using at least one method of modern family planning in Afghanistan is relatively low: only 15 percent of currently married women. However, there were significant differences between women across different provinces. Urban areas were more likely to use modern family planning methods than those from rural areas (28 percent versus 13 percent). The overall proportion of women delivering with a skilled birth attendant is very low in Afghanistan at 24 percent. More than a third of women (37 percent) delivered in the presence of relative or a friend. Use of traditional birth attendants is also common (33 percent). There are significant differences across provinces and among the nomadic, rural and urban populations.

o  Afghanistan faces the challenges of a very young and rapidly growing population. Among other things, these challenges emerge in high and increasing demand for education, health services and basic infrastructure, as well as in growing numbers of youth entering the labor market. AFGA as one of active national NGO would like to contribute in addressing above mentioned problems in the issue of Reproductive health and rights through its planned advocacy project.

o  The current school health curriculum does not have any topics regarding RH and inclusion of the RH topics will increase the knowledge and awareness of students and will be prepared for responsible motherhood and fatherhood period. This will contribute to improve family planning services and women and family health in the community.

 

Strategic Direction:

AFGA intends to promote Reproductive Health and Rights, including for young people through involving policy makers, media and influential people in the community.

Goal:

To increase programmatic and financial commitment of the Afghan Government towards for reproductive health and rights initiatives in Afghanistan. (though financial commitment has been mentioned as a goal however none of the advocacy objectives currently deal with increase in financial resources for RHR programmes)

Specific Objectives:

1.   To ensure availability of Emergency contraceptive in health service delivery points at the national level by end of 2013.

2.   To ensure approval of school curricula which covers essential RH topics and its inclusion in teacher training program by the end of year 2015, and allocates financial resources for its implementation.

3.   To ensure integration of HIV and AIDS into Reproductive health department of provincial and regional hospitals through provision of VCT (Voluntary Counseling and Testing) and PMTCT (Prevention of Mother to Child Transmission) services by the end of 2014.

Expected Advocacy Results:

1.   By the end of year 2013, Ministry of public Health of Afghanistan, approve the inclusion of Emergency contraceptive in Afghanistan National Essential Drug list through National Essential Medicine Committee and allocates sufficient fund for its procurement and distribution to all health centers at the national level.

2.   By the end of year 2015, National Education Curricula Revision Committee of the Ministry of Education of Afghanistan, in collaboration with Afghan civil society organizations includes a health subject into secondary and high school curricula as a compulsory subject (grade 9-12); which covers issues on Reproductive health such as growth and development, anatomy and physiology of Reproductive health system, pregnancy, STI, family planning and gender mainstreaming .The Ministry allocates sufficient fund for its implementation including (printing of books, training of school teachers and inclusion of subject in teacher training curricula) at all government school at national level.

3.   By the end of 2014, Ministry of public Health of Afghanistan, in collaboration with National AIDS Control Program implementers and other health related NGOs ensure integration of HIV  and AIDS into Reproductive health department of provincial and regional hospitals through provision of VCT( Voluntary Counseling and Testing) and PMTCT (Prevention of Mother To Child Transmission ) services. The Ministry will allocate sufficient fund for implementation of this strategy.

 

Priority intervention for Advocacy Expected Result 1:

o  Collect regional evidence on efficacy of emergency contraceptive utilization for improvement maternal health and distribute it to potential allies.

o  Orientation of potential allies (member of National Reproductive Health Task force) on AFGA emergency contraceptive manual. The task force is comprised of national and international organizations who are working in the field of Reproductive health in Afghanistan. The meeting is chaired by Director of Reproductive Health of Ministry of Public Health. This meeting takes place regularly for coordination of RH activities among stakeholders and to review and refer any RH related policy change to higher level at the Ministry. There is no sufficient information and update knowledge of EC among stakeholders and this manual will increase their awareness and justify the reason for its inclusion of this item in Essential Medicine list.

o  Active participation at national meeting on revision of Essential Medicine list to emphasize importance of emergency contraceptive.

o  Lobby with policy makers through formal and informal meeting with members of National medicine Board and to gain their support for inclusion of Emergency contraceptive into essential medicine list of Afghanistan. The formal meeting will held during regular essential medicine board meeting on quarterly basis and informal will be meeting the members in other occasions.

Priority intervention for Advocacy Expected Result 2:

o  Active participation at school curricula revision committee at Ministry of Education monthly. The committee already exists in the Ministry of Education which comprises of relevant government department and NGOs working in health and education fields. The committee is responsible to consider any change in the existing school curricula. AFGA is member of the committee.

o  Gather school health related available materials and adapt to Afghanistan situation.

o  Prepare and finalize school health guideline for student and teachers. The guideline will have information of health issues including RH which will be used by students, while teacher guideline will includes detail information on topics and teaching methodologies that is required for this. Assigned member of the committee included AFGA will be involved in preparation of the guideline.

o  Printing of school curricula to pilot in selected schools.

o  Lobby with policy makers through formal and informal meeting with member of school curricula revision board and to gain their support for inclusion of health topics into the school curricula. The formal meeting will held during regular curriculum revision board meeting on quarterly basis and informal will be meeting the members in other occasions.

Priority intervention for Advocacy Expected Result 3:

o  Establishment of a committee to take forward the issue at national level. The committee will comprise AFGA, NACP, RH department of MOPH and related UN, national and international NGO.

o  Preparation and finalization of mainstreaming checklist for integration of HIV and AIDS into Reproductive health services.

 

Indicators for Advocacy Expected Result 1:

Quantitative indicators (process)

o  Number of National Medicine Board meeting discussed inclusion of Emergency contraceptive as main agenda.

Qualitative indicators (Result)

o  Government revised essential medicine list with inclusion of Emergency contraceptive.

Qualitative Indicators

o  Support speech by policy makers and potential allies on advocacy issue.

Indicators for Advocacy Expected Result 2:

Quantitative indicators (process)

o  Number of curricula revision committee meeting with AFGA participation.

Quantitative indicators (Result)

o  Number of Final student and teacher guideline on school health get printed has been used.

Qualitative indicators

o  Approval of revised school health guideline by Ministry of Education to approved revised school health guideline.

Indicators for Advocacy Expected Result 3:

Quantitative indicators (Process)

o  Clear action plan for implementation of integration.

Quantitative indicators (result)

o  Number of clients received integrated services.

Qualitative indicators

o  An approved action plan of NACP for integration of HIV into RH.

ADOLESCENTS

Problem Analysis:

Lack of access and awareness of young people to information and services regarding reproductive health.  [57% of the population below 18 years of age.]

Low literacy rate among young people. [34% are literate of this only 18% are women.]

High incidence of young people using drugs.

Poor participation of youth in policy making and implementation.

High rate of early marriage [16% of the Afghan girls are married before the age of 15, and 52% before their eighteenth birthday.]

Societal and religious resistance to providing adolescents with Reproductive Health information and services.

Lack of proper communication between adolescents, parents and other related people e.g., teachers, doctors and others in the community to discuss Adolescent Reproductive health issues in a youth friendly environment.

Youth friendly services are not part of national health care system and services providers at health system are not trained in youth friendly services and do not have required skills to provide such services.

Limited number of youth information and youth friendly services at national level.

In sufficient collaboration and coordination among government, non-government and youth networks /associations on youth program at national level.

Strategic Direction:

Empower Adolescents by increasing their awareness and capacity to access reproductive health services.

Goal:

All adolescents and youth are aware of reproductive health and rights and have access to information and services on RHR.

Objectives:

To strengthen commitment and support of community gatekeepers and policy makers for RHR initiatives for adolescents and young people.

To increase the knowledge and access of adolescents and young people to reproductive health services, education and information including Youth friendly services.

Priority Interventions for Objective 1:

Strengthen strategic partnerships with government, non-government organisations and youth volunteers association to increase support and commitment for Youth policy implementation at nation level.

o  Publish and distribute IEC/BCC materials on Reproductive and general health for adolescents and young people to promote healthy lifestyles regarding reproductive health and prevention of risky behaviors.

Disseminate messages on Adolescent Reproductive health issues through, community based awareness raising activities, local newspapers and Radio/ TV programs.

Encourage youth participation in the planning, implementation and evaluation of programs.

Improve dialogue with community and religious leaders, parents and teachers on Adolescent Reproductive Health issues for the creation of an enabling environment.

Strengthen and expand Parent-teacher network for life-skill education in schools and youth friendly services.

Active participation in the Adolescent policy discussion and policy development process at national level.

Development of AFGA Adolescent policy and strategy with active participation of youths in line with national priorities and ensure its implementation and follow up.

Finalize Child protection policy, training of staff and volunteers on the policy and ensure its proper implementation and Monitoring.

Priority Interventions for Objective 2:

Provision of quality youth friendly services through current AFGA services delivery points and expand its coverage to other provinces.

Strengthen AFGA current youth peer education program in Kabul, Mazar, Herat and Jalalabad cities through continuous supporting supervision and on the job training.

Establish strategic partnerships with government, non-government organisations and youth volunteers association to increase Adolescent Health education and information coverage at nation level.

Work closely with Child and Adolescent Health Directorate of Ministry of Public Health to integrate youth friendly services into Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS).

o Work closely with Health Directorate of Ministry of Education to include Reproductive health information and education for high school student.

o Training of service providers of national health care system on youth friendly services using approved youth friendly services curriculum and resource materials.

o Work closely with youth association and other civil society working on youth issues and to encourage them to include adolescent health initiatives in their program for school and out of school youths and improve referral system for youths.

o Take part at national initiatives to conduct need based assessment and other kind of relevant studies to collect reliable data on youth problem and issues that can support evidence based decision making.

o Training of AFGA staff and volunteers on youth friendly services.

o Involve AFGA youth network members and other volunteers in planning, implementation and monitoring of youth friendly service centres and youth peer education program.

o  Build capacity of AFGA youth volunteers and youth network members on Adolescent Reproductive health and general health and development issues.

Develop and publish culturally appropriate resource materials in local language on Adolescent Reproductive health and general health and development issues.

Provide opportunities for young people to attend relevant workshops and events at national, regional and international level.

Outcomes:

1.   Increased policy level commitment and support for implementation of youth policy and programs at national level.

2.   Increase parent, teachers, religious leaders and general public awareness on importance of Adolescent Reproductive health issues.

3.   Enabling environment for youth people to access Adolescent health related information, education and services.

4.   Improved coordination and collaboration among relevant agencies on prioritization and implementation of youth program at national level.

5.   Increased access of youth to quality youth friendly services and youth information and education through AFGA existing centres.

6.   Increased access of youths to youth friendly services integrated into national health care system.

   Indicators for objective 1:

1.   Number of strategic partnerships established with relevant agencies for implementation and collaboration of Adolescent Health program.

2.   Number of IEC/BCC materials on Adolescent Reproductive health and general health issues distributed to target audiences.

3.   Number of parent, teacher and religious leaders with active participation in the dialogue and awareness rising sessions on Adolescent health issues.

4.   Number of youth members involved in the planning, implementation and evaluation of programs.

5.   Number of staff and volunteer trained on AFGA youth policy and child protection policy.

Indicators for objective 2:

1.   Number of youth receives youth friendly services and information through AFGA centres.

2.   Number of AFGA staff and volunteers trained on youth friendly services.

3.   Number of service providers from national health care system trained on youth friendly services.

4.   Number of updated resource material on adolescent health issues available at local languages.

5.   Number of youth attending national, regional and international training and capacity building meeting and events.

HIV & AIDS

  

Problem Analysis:

  • Afghanistan is among the countries of Central Asia and South Asia of low prevalence and a concentrated epidemic that are confronted with growing risk of HIV/AIDS, mainly due to the high incidence of injecting drug use that partially intersects with sex work. Latest UNAIDS data indicate that the epidemic presently remains under 0.5 percent among the general population, yet has the potential to grow quickly from a small base of injecting drug users (IDUs) to their sexual partners and thus to heterosexual men and women unless effective, vigorous, and sustained action is taken early.
  • Most recently available data indicated 636 HIV-positive cases reported in 2009, and the number of deaths due to AIDS was estimated under 10 cases.
  • Afghanistan faces a variety of political, security, economic, social and human development challenges among which the HIV and AIDS epidemic poses an emerging threat.
  • Afghanistan is a country of low prevalence with prevalence of under 0.5 percent among general population, it exhibits a wide spectrum of risks and vulnerability factors of various segments of the population that call for immediate action. These factors include certain economic, social, demographic and behavioral determinants that if not addressed effectively may fuel the spread of the HIV epidemic.
  • Underlying factors such as poor HIV knowledge and limited access to reproductive education, low literacy level (85 percent), and high stigma and discrimination of people living with HIV (PLHIV), as well the key populations (KPs), including – injecting drug users (IDUs), female sex workers (FSWs), men who have sex with men (MSM), and prisoners, are most apparent.
  • Involvement of the PLHIV in the national AIDS response in Afghanistan is presently non-existent, and interventions to strengthen this area have been limited. Similarly, nutritional and socio-economic support programs for PLHIV and their families such as children affected by the HIV/AIDS (CHABHA) are not available and nor are psycho-social and continuum of care interventions in place. As of 2010, there has been minimal development of support groups on PLHIV other than by MDM (Médecins du Monde) and other NGOs for a limited number of IDUs living with HIV. The existence of stigma and discrimination associated with HIV is one of the main challenges for the HIV response as whole.
  • In addition to drug production and trafficking and presence of a large number of IDUs and other drug dependant populations, including women and children, poor blood safety and unsafe surgical practices, limited basic physical and health care, high prevalence of TB, STIs, Malaria, Hepatitis A, B, and C, a number of social determinants or amplifiers to HIV have been recently noted.
  • Existing low economic status of women, high illiteracy level among women and girls, gender and age discrimination, including gender segregation and consequent seclusion and low mobility of women, violence against women, labor and sexual exploitation of girls and children, and human trafficking are serious challenges.
  • About 2 million widows, 2 million orphans, almost 2 million disabled, over 4 million returnees and 500,000 IDPs reside in Afghanistan, while almost 4 million Afghan refugees still live in Pakistan and Iran. As a result, drug dependency, including injecting drug use has become a coping strategy for the physical and physiological trauma faced by a large number of Afghans.
  • In Afghanistan, besides KPs, populations particularly susceptible to HIV include (i) long-distance truck drivers, (ii) refugees, returnees and internally displaced populations (IDPs), (iii) uniformed services (police and military), (iv) migrant workers; and (v) youth and street children. However, no systematic data is presently available on HIV prevalence or behavioral data for most of these populations.
  • Establishment of 2nd Generation Surveillance in Afghanistan and completion of the first ever comprehensive Integrated Bio-Behavioral Surveillance (IBBS, 2009) among KPs and vulnerable populations, including IDUs, FSWs, prisoners, and long-distance truck drivers. The results of the survey indicated (a) injecting drug use is increasingly the major source of new HIV infections, with highest rates reported in Western Afghanistan; (b) HIV prevalence is also high among prisoners (mostly IDUs); (c) HIV prevalence is at zero percent among FSWs and road transport workers, suggesting limited sexual transmission in Afghanistan to date, but with (d) high rates of STIs, blood borne viruses and risk behavior in the surveyed groups.
  • In spite of the progress made, the sustainability and effectiveness of the HIV response is undermined by a number of serious challenges that include political instability and insecurity, poverty and unemployment, mass outmigration, deterioration of basic health and education services, as well as gender imbalances, high illiteracy, and stigma associated with HIV and AIDS and discrimination of PLHIV.

Strategic Direction:

AFGA intends to create an enabling environment to reduce vulnerability to HIV/AIDS through increased public awareness on HIV/AIDS and provision of integrated HIV and RH services.

Goal:

To maintain low incidence of HIV infection in Afghanistan.

Objectives:

Objective 1:

To reduce socio-cultural barriers that makes people vulnerable to HIV and STI infections.

Objective 2:

To increase access to interventions for the prevention and treatment of HIV/STI infection through integrated, gender-sensitive RH programmes.

Priority Interventions for Objective 1:

Strengthen strategic partnerships with government and non-government organisations to support multi-sectoral approach to HIV preventive initiatives and interventions; and to enhance supportive environment, policy and legal framework.

Active participation in HIV/AIDS Coordination Committee of Afghanistan (HACCA) and other national coordination mechanism.

Take active part in national response and initiative to address HIV and AIDS related stigma and discrimination.

Communicate HIV messages and increasing awareness and commitment to HIV among key stakeholders, including religious leaders, communities, mass media, and service providers through different BCC intervention, campaigns and sensitization training.

Include specific messages into awareness campaigns addressing social stigma towards PLHIV and those at risk as an effort to create an enabling environment for HIV prevention and support.

Training of AFGA staff and volunteers on HIV and AIDS related stigma and discrimination.

Integration of prevention services into AFGA centers and youth peer education program.

o Expand awareness raising initiatives targeting most at risk and vulnerable population in major cities e.g. Kabul, Mazar, Herat and Jalalabad.

o Sensitize PLHIV and their families on their rights, and build capacity through support groups and networks to protect their rights.

o Advocacy efforts for integration of HIV into RH through Global Fund and working closely with Country Coordination Mechanism and active engagement of civil society organizations.

Priority Interventions for Objective 2:

Provision of quality integrated HIV and RH integrated services through AFGA centres in four major cities e.g. Kabul, Mazar, Herat and Jalalabad.

Build capacity of AFGA staff on integrating HIV and RH, focussed prevention among vulnerable population, VCT, STI management and PPTCT.

Provision of VCT services following standard protocols and guidelines in AFGA centers.

Provision of VCT services to female prisoners in Kabul female prison.

Improve quality of services through using updated national guideline for HIV and AIDS.

o Provide technical support to finalize and make available guidelines on clinical management, treatment, care and support for PLHIV to relevant health services.

o Strength the referral system between AFGA centers and ART center.

o Provision of PPTCT services through AFGA centers in four major cities e.g. Kabul, Mazar, Herat and Jalalabad.

Outcomes:

1.   Improved coordination and collaboration with different agencies working on HIV/AIDS at the national level.

2.   Increased public awareness on HIV/AIDS/STI prevention and stigma reduction.

3.   Increased commitment for HIV/AIDS programs at national level.

4.   Increased access to quality integrated HIV and RH services through AFGA centres in four major cities of Afghanistan.

5.   Improved knowledge and awareness on HIV among youths, most at risk and vulnerable population.

Indicators:

Indicator for objective 1:

Number of strategic partnerships established with relevant agencies for HIV and AIDS program at national level.

Number of awareness raising events conducted on reduction of HIV and AIDS stigma and discrimination.

Number of BCC interventions for most at risk and vulnerable population.

Number of advocacy meetings held for integration of HIV into RH.

Number of AFGA staff and volunteers trained on HIV and AIDS related stigma and discrimination.

o  Number of advocacy programmes conducted with different stakeholders.

Indicator for objective 2:

Number of clients receives integrated RH and HIV services through AFGA centres.

Number of clients referred to ART services.

Number of HIV and AIDS related guidelines and manual updated and made available.

Number of female prisoners receives VCT services.

Number of women received PPTCT services through AFGA centres.

Number of service providers trained on HIV and RH integration.

Number of people receiving VCT services and who know their test results

ABORTION

Problem Analysis:

Abortion in Afghanistan is only permitted on medical indication to save the life of women, otherwise it’s not legal. This process involves certification by three medical professionals and the approval of the Public Health Ministry.

Unsafe abortion is one of the factors contributing to MMR in the country, which at 1600/ 100,000 live births) is one of the highest in the world. Despite reliable available data, the rate of unsafe abortions in the country is estimated to be very high, with most abortions performed in unhygienic conditions and by unskilled providers.

Low awareness among the general population on the impact of unsafe abortion, poor quality of post-abortion care services especially in rural areas and the absence of skilled and knowledgeable service providers are key problems leading to high MMR in the country.

Strategic Direction:

Increase awareness on the health and social justice impact of unsafe abortion through national advocacy, community mobilisation and quality post-abortion care service provision.

Goal:

Improve maternal health among target population through prevention of unsafe abortion.

Objectives:

Objective 1:

Reduce barriers that prevent women to access to quality post abortion care services in the target population.

Objective 2:                                     

Increase access of women to quality post abortion care services in AFGA target provinces.

Priority Interventions for Objective 1:

o  Maintain database of abortion related information and use the data for awareness raising and sensitization of policy makers.

o  Develop target specific IEC/BCC tools to increase awareness on the impact of unsafe    abortion, and train staff in the use of these tools.

o  Conduct orientation workshop to media staff and other key stakeholders to increase awareness on the health and social justice impact of unsafe abortion.

o  Active participation at national level policy and advocacy meeting to increase access of women to post abortion care services.

Priority Interventions for Objective 2:

o  Provide post abortion care including post abortion counseling and provision of post abortion contraception through AFGA centers (Family Welfare center and Youth friendly services center) in four major cities e.g. Kabul, Mazar, Herat and Jalalabad.

o  Conduct gender and abortion related issues training to health staff from government and NGOs.

o  Develop referral protocols in collaboration with MoPH (Maternity Hospitals), for effective referral of abortion related complications and their subsequent follow up.

o  Develop standards of care for abortion related services and develop guidelines and protocols for effective implementation.

o  Conduct training to service providers on Post abortion care components

o  Document and share experience and models of best practice in abortion related programs.

Outcomes:

1.   Reduction in the incidence of unsafe abortion in the target provinces.

2.   Increased access of women to quality post-abortion care services including referrals for complications.

3.   Increased awareness of the general population, especially women about the consequences of unsafe abortion leading to a reduction in the need for abortion.

4.   Increased partnership and collaboration with MoPH and other key stakeholders for provision of quality post abortion care services.

5.   Improved capacity of service providers on post abortion care components.

Indicators:

Indicators for objective 1:

Number of sensitization meeting held with policy makers at national level.

Number of culturally sensitive IEC/BCC materials developed and distributed to target audiences.

Number of national level with active participation of AFGA representative.

Number of strategic partnership established to increase access to post abortion care services.

 

Indicators for objective 2:

Number of client receives quality post abortion care services including referral through AFGA centres.

Number of staff attend abortion related training program.

Number of update guideline and resource materials developed.

ACCESS

Problem Analysis:

o  Life expectancy at birth (LEB) is 47 years for Afghan men and 45 years for women, slightly more than half that of the wealthiest countries of the world. The country suffers greatly from very high levels of Infant Mortality Rate (IMR) at 129/1000 live births, Under 5 Mortality Rate (U5MR) at 191/1000 live births and the Maternal Mortality Ratio (MMR) is estimated at 1600 for every 100,000 live births, the highest in the world except Sierra Leone.

There is acute gender disparity – Afghanistan has the lowest female literacy rate in the world, with boys twice as likely to complete primary school as girls. Violence against women is pervasive due to low status of women and long standing conflict.

Total fertility rate is 6.6 (2008) and contraceptive prevalence rate (CPR) is 22.8% (2007). The national household survey conducted by the Ministry of Public Health (MoPH) in 2006 reported that 33% of currently married women demonstrated knowledge of at least one modern method of contraception.

Basic package of Heath Services which is main mechanism for provision of Reproductive and general health services in the country only reach to 65% of the population.

Strategic Direction:

AFGA will work to increase access to quality Health care services including Reproductive Health information, education and services especially to poor, marginalized and underserved population of Afghanistan.

Goal:

All people, particularly poor, marginalized and underserved are able to access quality health services including Reproductive health information, education and services in AFGA target areas.

Objectives:

Objective 1:

To reduce socio-cultural barriers inhibiting access to quality health services including Reproductive information, education and services in AFGA target areas.

Objective 2:

To increase access of families to quality health services including Reproductive health information, education and services in AFGA target areas.

Priority Interventions for Objective 1:

o  Strengthen and expand strategic partnership with relevant government and non-governmental organizations to address socio-cultural barriers to Reproductive health information, education and services.

o  Active participation at national level policy dialogue to improve access to quality health and Reproductive health services.

o  Meaningful involvement of male into Reproductive health program through awareness raising and training.

o  Awareness rising on general health and reproductive health using culturally appropriate IEC /BCC materials and tools.

o  Work closely with Ministry of Haj and Islamic affairs, media and other agencies to increase awareness on importance of family planning and reproductive health services for wellbeing of families.

o  Finalize AFGA male involvement into Reproductive health and prepare and follow up implementation action plan.

Priority Interventions for Objective 2:

o  Provide quality reproductive health services to clients through Family welfare Center and youth friendly services in four major cities e.g. Kabul, Mazar, Herat and Jalalabad.

o  Provide quality Basic Health and Reproductive health services through two mobile Health clinics in rural areas of Kabul city.

o  Implementation of Quality Assurance System (Conduct self assessment of SDPs and develop SDP action plan, conduct self assessment, develop management action plan and AFGA overall action plan and budget).

o  Provision of integrated services for survivors of Family Based violence including screening, counseling and referral using standard guideline and screening tools.

o  Increase awareness on importance of family planning thorough peer education program.

o  Establish strategic partnership with relevant organizations for integration of Reproductive health into country emergency response plan and disaster preparedness program.

o  Organizing MISP training to service providers with relevant agencies at national level.

o  Capacity building of service providers on comprehensive family planning including emergency contraception.

o  Increase access of youth to reproductive health information, education and services thorough integration of youth friendly services into existing AFGA centers.

o  Ensure Reproductive health commodity security and effective coordination with key organizations at national level.

o  Update relevant training guidelines and resource materials.

o  Conduct Gender mainstreaming training for AFGA and other related agency service providers and program staff.

o  Scale up existing community based program for improvement of access to quality reproductive health services.

o  Strengthen and expand strategic partnership for the delivery of RH services including referrals at national level.

Outcomes

1.   Improved strategic partnership to increase access to quality health and reproductive health services.

2.   Increased political commitment and support for Reproductive health program at national level.

3.   Increased access to quality health and reproductive health services in the target areas.

4.   Improved general awareness on reproductive health information.

Indicators:

Indicators for objective 1:

o  Number of strategic partnership establish with relevant agencies.

o  Number of policy dialogue and meeting with active participation of AFGA representative.

o  Number of culturally appropriate IEC/BCC materials developed and distributed.

o  Number of trainings conducted for key stakeholders on RH-related issues

o  Support speeches by religious leader for family planning.

o  Media coverage to broadcast messages and information on Family planning and reproductive health.

Indicators for objective 2:

Number of clients receives quality integrated Reproductive health services thorough AFGA centres.

Percentage of satisfied clients during client exit interview.

Number of clients receives general health services thorough AFGA mobile health clinics.

Number of Family Based violence survivors receives integrated services thorough AFGA centres.

Number of update guideline and resource materials available.

Quality Assurance action plan with clear follow up plan.

Number of staff trained on different Reproductive and general health issues.

 

Governance & Accreditation

Background and Situation Analysis:

Spirit of volunteerism is not so strong in the country and there is need for increasing number of volunteer and diversification of volunteer base within AFGA.

Effective involvement of governing board member in strategic planning, policy setting and effective governance need strengthening within AFGA. In addition, AFGA need compliance with governance standards through accreditation review and implementation of the Code of Good Governance.

Build professional capacity of volunteers for advocacy on Reproductive health, planning and implementation of RH programs to the poor, marginalized and socially excluded people in underserved area is a priority for AFGA.

Development of AFGA as a democratic, transparent and accountable national Health (particularly Reproductive Health) organization through good management and governance is crucial for financial sustainability of AFGA.

AFGA Strategic direction

AFGA intends to have an effective, efficient and transparent governance structures and procedures, and a strong volunteer base.

AFGA Goal

Increase competency of voluntary leadership and governance to increase public, political and financial support for Reproductive health and right.

AFGA Objectives

1.   To increase effectiveness, active participation and diversity of AFGA volunteer base.

2.  To develop professional culture among volunteers at all levels of governance for effective advocacy, resource mobilization and image building of the Association at national , Regional and international level.

Priority Interventions for Objective 1:

o  Increase governing body member knowledge and awareness on governing principles and code of conduct.

o  Maintain proper data base of volunteer information and its updates on regular basis.

o  Ensure Active involvement of governing body members in strategic planning, policy setting, oversight, advocacy and resource mobilization efforts of the association.

o  Ensure continued participation of youths in governing board and foster their meaningful participation.

o  Organize induction program for new volunteers and ensure their proper interaction with other experienced volunteers.

Priority Interventions for Objective 2:

o  Develop AFGA governing body manual that contains the essential documents; update it regularly and distribute it to the members.

o  Organize executive committee and General Assembly meetings in compliance to AFGA constitution.

o  Introduce AFGA volunteers to Regional and international events organized by IPPF and other related organization.

o  Organize regular meeting of AFGA youth network and provide need based capacity building program for its members.

o  Ensure participation of governing board member in resource mobilization and advocacy efforts of the Association.

Outcomes:

1.     Improved leadership and governance in AFGA.

2.     Increased capacity of governing body and volunteers on effective governance and code of conduct.

3.     Increased spirit of volunteerism among AFGA staff and volunteers

4.     Good image of AFGA at the national and Regional level.

5.     Increased number of volunteers with diverse base and competency.

6.     Increased participation of volunteers in policy making process and governance.

7.     Increased participation of youth volunteers in governing board.

Indicators for objective 1:

o  Number of volunteers attended need based training program.

o  Numbers of new volunteers get AFGA membership.

o  Number of induction program organized for new volunteers.

o  Number of board meeting with active participation of youths.

Indicators for objective 2:

o  Number of volunteers attended regional and international events organized by IPPF/SARO and other organization.

o  Number of executive committee meeting held.

o  Number of volunteers attend general assembly meeting.

o  Number of senior volunteer attends AFGA advocacy events.

Recource Mobilization

Background and Situation Analysis:

o  AFGA as one of IPPF Member association have traditionally depended to a very large extent (more than 90%) on IPPF to raise resources. As a result over the last years AFGA have become more of program implementers with little or no focus on resource mobilization.

o  It is a fact that  many of IPPF donor ,Governments and Foundations facing difficult conditions  due to the need to finance public expenditure during the economic crisis and falling global stock markets. It is also clear that other International NGOs are facing difficulties as a result of the on-going economic crisis. They will, therefore, be competing even more aggressively for funds, increasing the risk of declines in the unrestricted funding IPPF receive. The new evolving funding architecture calls for a new and expanded role of member Association nationally in the area of Advocacy and Resource Mobilization.

o  AFGA is still recognized as Family planning organization and not implementing Basic Package Service (BPHS) and Expanded Hospital Package Services (EPHS) which is two main national strategy and system for service delivery in the country. Therefore, AFGA is not able to attract resources from major health sector donors (USAID, World Bank and European Commission) which are mainly fund BPHS and EPHS program at national level.

o  According to the national constitution, all basic health service delivery is free of charge and makes it difficult for AFGA to generate income from its services. In addition, high human resource cost due to increasing living cost making the organization unattractive to donors.

o  Ample funding opportunities are available especially for health sectors in Afghanistan, AFGA in addition to streamline its program with national health system (BPHS and EPHS), need to improve its capability in the areas of like absorption capacity, program delivery capacity, and program delivery efficiency to become attractive to donors.

o  In light of current economic climate there is a greater need for AFGA to demonstrate the effectiveness and efficiency of their operations whether this in service provision or providing advocacy. AFGA is operating in an increasingly competitive environment, by being able to demonstrate how we are delivering greater efficiency will assist in securing future funding. In such circumstances, it is vital for AFGA to build relationship with international donor providing funding to health program in Afghanistan such as USAID, World Bank and European Union.

AFGA Strategic direction

Develop AFGA as a sustainable and financially sound organization to meet the increasing