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Description of Main Accomplishments, Overall Performance and Impact Of FINAL PROGRAM REPORT Project Title: Multi-sector emergency response for Kandahar province for the conflict affected population (IDPs, returnees, vulnerable (host) communities) Agreement Reference Number: AID-OFDA-G-17-00224 Reporting Period: 14th August 2017 to 30th September 2018 Description of main accomplishments, overall performance and impact of the project: HEALTH AND NUTRITION ACCOMPLISHMENTS: After the recruitment process and negotiation with the local DoPH (Department of Public Health) for the allocation of the target villages, INTERSOS health and nutrition teams have deployed in the field starting from December 2017. The first two teams deployed have been Zheray and Spin Boldak, followed by Maywand in January 2018. Since then the teams been regularly deployed both in the target HFs and in the areas covered by the mobile clinics in the districts of Zheray, Maywand and Spin Boldak. During the last month (September) the MHTs have been doubled in number with the purpose of covering the increased needs in the districts caused by the drought. INTERSOS has covered drugs and medical supplies’ needs with its own funds during the whole implementation period of the project; this was due to the fact that BARAN, local BPHS implementer, could not meet its commitment to provide drugs and supplies due to scarcity of the same. Capacity building of the medical teams, both MHT and HF-based, has been provided during the full implementation period – more details are presented in the concerned section. In terms of nutrition, INTERSOS MHTs have provided screening and referral services, while the running of the OTP services was hampered by the lack of RUTF and the impossibility of the BPHS implementer to meet its commitment of providing outreach teams with such supplies (see further explanation in the amendment request). Outreach activities have been complemented, as planned, by the work of the CHWs network, whole role has been strengthened by increasing the number of so called “activations” – see more details in the relevant section. Lastly INTERSOS supported the targeted HFs with the needed WASH rehabilitations, which have been successfully completed in the month of September. PROTECTION: As planned, protection activities have been integrated into the work of the mobile teams, composed of both medical/paramedical and protection staffs. While this strategy has shown its effectiveness in ensuring access to remote areas also with sensitive activities like protection awareness and case management (INTERSOS is still the only actor providing CM services in Kandahar), protection work remains one of the main challenges in the context of Kandahar, especially in terms of GBV (as raised also during the thematic FGDs - see further explanation in the final evaluation report), due to some rooted social norms and the stigma associated with being victim of protection violations, which make case disclosure difficult. WASH: Througout the implementation period INTERSOS has deployed hygiene promoters within its mobile teams, coupling hygiene promotion with other Behaviour Change Communication (BCC) activities on health and nutrition. During the last months of implementation (following the amendment), INTERSOS teams have been able to complement the HP awareness sessions with the distribution of hygiene kits for the most vulnerable households. OVERALL PERFORMANCE: The table below shows the total number of beneficiaries reached per sector and overall by the project. The overachievement in the sectors health, protection and WASH is mostly linked to the high numbers of people reached through the awareness raising activities carried out by the CHWs and the COVs. For the nutrition sector the lower achievement is due to the reduced number of screenings, as this activity started late in the project lifetime. Overall the project reached 83,529 people, i.e. 116% of the target. Sector Targeted Reached % Health 39,066 52,872 135% Nutrition 45,666 30,367 66% Protection 17,144 20,476 119% Water, Sanitation and Hygiene 12,950 25,967 200% TOTAL (without double counting 72,241 83,529 116% between sectors) In terms of specific sub-sector indicators, the table below compares targets (original and revised in June), baseline values and final results. Overall results are positive, except for the sub-sectors of Reproductive Health and Management of SAM. In the first case (RH), the under-achievement is linked to the georgraphic dispersion of the population in the targeted districts, the long distances between villages of the official catchment area and the health facilities; such distances discourage women to attend the HFs for RH care services. In the second case (SAM), the underachievement is due to the impossibility for INTERSOS to get RUTF (nutrition supplies) and drugs (for deworming and vitamin A) to use in its Outpatient Therapeutic Program (OTP) from BARAN (BPHS implementer), hence the impossibility to provide treatment for malnutrition. Overall the project has contributed to improve the knowledge hence the service demand by the population on one side, and to increase the availability of services, both in terms of health and nutrition, and protection (the latter being inexistent before INTERSOS intervention). Revised Baseline Endline Sub-sector Indicators Target Target findings Results Number of health care Health facilities supported Systems and and/or rehabilitated by 9 9 0 9 clinic support type (e.g., primary, secondary, tertiary) Number of health care providers trained by type (e.g., doctor, nurse, community 27 27 n/a 45 health worker, midwife, and traditional birth attendant), by sex Number and percentage of health facilities 9 9 9 9 submitting weekly 100% 100% 100% 100% surveillance reports Number of consultations, by sex 33,000 33,000 N/A 33,937 and age Number and percentage of pregnant women who Reproductive 2,300 2,300 have attended at least 34,4% 34% health 50% 50% two comprehensive antenatal clinics Number and percentage of women and 1,386 1,386 newborns that received N/A 32% 60% 60% postnatal care within three days after delivery Number and percentage of pregnant women in 1,155 101% their third trimester who 0 N/A 50% (baby kit) received a clean delivery kit Number and percentage of pregnant women who deliver assisted by a skilled (not traditional) 924 924 68% 1 31% birth attendant by type 40% 40% (e.g., midwife, doctor, nurse) and location (e.g., facility or home) Number of cases of 50 15 29 0 sexual violence treated 5% 5% 58% Community Number of CHWs Health trained and supported Education/Beh (total and per 10,000 99 99 n/a 87 avior Change population within project area), by sex Number and percentage of CHWs specifically n/a n/a n/a n/a engaged in public health surveillance Number and percentage of community members 14,859 14,859 utilizing target health 47% 83% 75% 75% education message practices Number of health care Management of providers and Severe Acute volunteers trained in the 126 126 n/a 126 Malnutrition prevention and (SAM) management of SAM, by sex and age Number of sites established/rehabilitated 9 9 0 9 for inpatient and outpatient care 1 This is believed to be an inflated number (due to the way the question was asked), as it is much higher than the data available in the health sector (and reflected in reality of HF deliveries) Number of people 702 treated for SAM, by sex 1,485 0 0 (referred and age cases) 5% 5% referred referred Rates of admission, 90% 90% default, death, cure, cured cured N/A. See relapse, nonresponse- 0 Narrative and 3.75% 3.75% transfer, and length of ART report. default default stay 1.25% 1.25% died died Number of people trained in child Child protection, 144 144 n/a 145 Protection disaggregated data by sex Number of children benefitting from CP individual case 2,000 300 0 373 management services, disaggregated data by sex Prevention and Number of individuals Response to benefitting from GBV 1,000 300 0 340 Gender-based services, by sex Violence (GBV) Number of people trained in GBV 144 144 n/a 145 prevention and response, by sex Psycho-social Number of people Support trained in psychosocial 144 144 n/a 145 services (PSS) support, by sex Number of people provided with PSS services (individual PSS 9,000 5,200 0 5,331 and collective PSS), by sex Referral maps established for PSS and 12 12 0 5 protection services (CP, GBV & PwSN) Number of people receiving direct Hygiene Hygiene Promotion (excluding 12,950 12,950 n/a 25,967 promotion mass media campaigns and without double counting) Number of households with soap and water at N/A N/A 56% 58% a hand washing location Number of households who store their drinking N/A N/A 86% 77% 2 water safely in clean containers SECTOR: HEALTH Sub-Sectors: Health Systems and clinic support, Reproductive health, Community Health Education/Behavior Change Objective: To improve access to health services for conflict affected communities in Afghanistan, with specific focus on reproductive health. Beneficiaries Beneficiaries % Targeted reached 39,066 52,872 135% Activity 1.1: 9 existing HFs are supported with structural rehabilitation The table below shows the 9 HFs supported by the project: Sr. No. Name of the facility Type of the facility District 1 Loy Kareaz Basic Health Centre (BHC) Spinboldak 2 Nawy Kaly Basic Health Centre + (BHC+) 3 District Hospital District Hospital 4 Rabbat Basic Health Centre (BHC) 5 CHC Comprehensive Health Centre (CHC) Maiwand 6 Band – E _ Taimoor 7 House Madad Basic Health Centre (BHC) Zheray 8 Zheray B.H.C 9 Senzeray B.H.C Comprehensive Health Centre (CHC) Eight out of nine Health facilities have been supported with structural rehabilitation under the project, while all 9 HFs have been supported with additional staffs to guarantee RH and nutrition services.
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