FINAL PROGRAM REPORT

Project Title: Multi-sector emergency response for 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 , 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 , 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) 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. INTERSOS has recruited an experienced engineer in in the month of April, to

2 The question asked in the final KAP survey was more precise than the one asked in the initial KAP survey, and this could explain the reduction in the % of households storing water safely.

conduct the needs assessment of the HFs and to produce technical designs (BoQs) of the rehabilitation works. One of the supported HFs (Band-e-Temor in Maywand district) was excluded from the rehabilitation work because the building belongs to a private owner who rents it to the PPHD, and the latter reccomended INTERSOS not to proceed with rehabilitation as the HF could move to a different building. Following the launch of the competitive procurement process, the selected construction company has started the works in the month of July, under the supervision of the engineer and the project management team. The final report on the WASH rehabilitations is attached to the final narrative report. Activity 1.2: Hire and train 18 additional dedicated health staff – 9 midwifed and 9 nurses for RH and/or nutrition services at HF level (static) Despite some difficulties in the recruitment process (especially for Band-e-Temor, Health Facility located in the conflict area in Maywand), from January 2018 INTERSOS deployed the recruited staff (9 midwives and 9 nurses) to support the targeted HFs. Since then, the support to the HFs has been regular and with positive feedback from District Health Officers and the health facilities in charge. The following (refresher) trainings have been delivered to HF-based staff by INTERSOS in coordination with the PPHD: Midwives

Subject No. of days Month

January and HIMS and BCC 5 February

INTERSOS Code of Conduct, mission 1 March vision and strategy

New Born Care 5 April

Nutrition (IYFC and Breastfeeding) 4 May

Basic Package Health Services (BPHS) 5 June HIMS 4 July

First Aid 2 July Nurses Subject No. of days Month

Community mobilization, importance of breastfeeding, nutrition treatment (SAM January and and MAM), causes of malnutrition, 4 February assessment and management of acute malnutrition,

INTERSOS Code of Conduct, mission 1 March vision and strategy Nutrition 4 April

Basic Package Health Services (BPHS) 6 May

After INTERSOS intervention, the capacity of the HFs to provide reproductive health services by ensuring adequate dedicated staff, and also their (midwives) availability at night, has increased INTERSOS intervention has also boosted the demand for RH services thanks to the awareness work

of the CHWs and mobile teams, as well as the provision of baby kits to mothers delivering at the HF (1,166 kits throughout the implementation period). During the final evaluation of the project (attached to the final report), the participants to the FGDs (which focused on the effectiveness, relevance and appropriateness of the action), namely the District Health Officers and relevant staffs from the DoPH, identified the baby kits as a key element in incentivizing safe delivery at HF level among the most vulnerable groups. The only remaining gap / challenge is the provision of BEmONC services in all supported facilities. While INTERSOS had planned to recruit midwives already trained in BEmONC, such profiles proved not to be available (note that INTERSOS has planned to provide this training in the new program starting from October 2018). Moroever, most of the HFs do not have the minimum standard to have the BEmONC certification (i). not operating 24/7 (apart form the CHC on Zheray and Maywand and DH in Spin Boldak); (ii), lack of drugs and equipment for the BEmONC; (iii) appropriate physical structure (e.g.: heating and electricity 24/7). Activity 1.3 Compose/hire operate 3 mobile teams to support the outreach capacity of the HFs for provision of RH and nutrition services. The MHTs have been firstly deployed in the month of December 2017 in the districts of Spin Boldak and Zheray. Starting from January 2018, the three MHTs were fully operational. For the whole implementation period INTERSOS has covered drugs and medical supplies’ needs with its own funds, being BARAN (BPHS implementer) unable to provide such inputs because of their scarsity even for the static health facilities. As for the HFs supported staff, also the MHTs members have received both initial and refresher trainings by INTERSOS and DoPH.

Mobile Health Team No. of days Month

Community mobilization, reproductive health, nutrition treatment (SAM and MAM), causes of malnutrition, 5 January assessment and management of acute malnutrition, and importance of breastfeeding. INTERSOS Code of Conduct, mission 1 March vision and strategy

HIMS 2 March Nutrition 4 March

First Aid Training 2 April

Rational Use of Drugs 3 May

From December 2017 to September 2018 the MHTs have conducted 33,937 consultations (103% of the original target):

Total New >= 5 < 5 Consultations F M F M

33,937 17,738 7,930 3,903 4,366

This number can confirm the need of the population regarding general consultation services. Besides OPD consultations, the MHTs and INTERSOS team deployed in the HFs have also supported the RH services, with the following results:

MHTs from December 2017 to September 2018:

Type of services Achievement (number) Target (in %) Achievement (in %)

2 ANC 1,386 50% 46% PNC in 3 days 2,176 60% 72%

HFs from January to September 2018:

Type of services Achievement (number) Target (in %) Achievement (in %)

2 ANC 4,182 50% 31% PNC in 3 days 3,213 60% 24%

Assisted deliveries 4,150 50% 31%

The performance of the mobile teams is in line with the expected results, with the number of women attending at least 2 ANC visits being slightly below the target. This can be explained by the frequency of the presence of our teams in the targeted villages and the internal mobilisation of the population. However, when it comes to the HFs, the results fall highly behind expectations. The reason for such low achievement is 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. Finally, considering the request of the local health cluster and the PPHD, from April the Mobile Team have also included vaccinators. The management of cold chain, vaccines stock control and distribution to MHTs has been under the responsibility of the referral health facility. Activity 1.4: Identify and train new additional CHWs and CHSs (50% men and 50% women) In the month of March INTERSOS had engaged BARAN and the DoPH in the selection and recruitment of the CHWs and CHSs for the implementation of the health and nutrition awareness activities. 99 CHWs and 9 CHSs (validated by DoPH) had been then recruited and were offered training (see below). However, following the first round of monitoring of their activities, some CHWs and CHSs were found not be active and, after several warnings, they were excluded from INTERSOS list of volunteers. As of the end of the project, 80 CHWs and 7 CHSs (35 Female and 52 Male) were active in community mobilisation and awareness activities (87,8% of the original target). The trainings for the CHWs and CHSs have covered to following topics: Subject Month

Health Awareness Introduction April

Awareness on Safe Motherhood (ANC/PNC/ safe delivery) April BCC (Behaviour Change Communication) June

First Aid Training (For CHW Level) June

Nutrition screening July Infection Prevention and TB August

Activity 1.5: Community health awareness sessions by CHWs on different health related topics for different target groups Considering the delay in the creation of the volunteer network, INTERSOS decided to increase the weekly frequency of the awareness session in order to reach the target population. This change in the project implementation has allowed reaching and even exceeding the expected target for the Health and nutrition awareness sessions. The awareness sessions’ plan, designed by INTERSOS and the DoPH, was based on the training received by the CHWs (see activity 1.4 Health). In total the CHWs have reached the following beneficiaries since their activation:

Target Achieved District M F Spin Boldak 16534 14023 Maywand 5530 4643 Zheray 9923 12035 Total 31987 30701 Grand Total 62,688

SECTOR: NUTRITION

Sub-Sectors: Management of Severe Acute Malnutrition (SAM)

Objective: To improve access to nutrition services for conflict affected beneficiaries in Afghanistan

Beneficiaries Beneficiaries % targeted reached 45,666 30,367 66%

Activity 1.1: Identify and train new additional CHWs and CHSs (50% men and 50% women) The same CHWs and CHSs recruited and trained for the health awareness sessions have also been dedicated to the promotion of Nutrition messages, in particular for the promotion of IYCF practices among the population. After a training conducted in July on nutrition and MUAC methodology, the CHWs have been deployed into the field for the screening of nutrition status of U5 and PLWs. Out of the 39,600 screening initially estimated in the proposal, the CHWs have reached the 28.8% (11,432), with the following beneficiaries:

Referred District Target group Total Screened SAM MAM SAM MAM

Boys U5 731 25 33 25 3

Girls U5 723 31 48 31 16

PLWs 476 21 26 21 7

Maywand

Boys U5 1,570 148 201 148 201

Girls U5 1,476 132 193 132 193

Zheray PLWs 1,405 2 43 2 43

Boys U5 1,651 138 269 138 269

Girls U5 2,097 135 372 135 372

PLWs 1,303 70 90 70 90

Spin BoldakSpin Total 11,432 702 1,275 702 1,194

Activity 1.2: Community awareness sessions by CHWs on nutrition related topics for different target groups. The nutrition awareness sessions have been implemented together with the Health sessions. For more details, please see Health-activity 1.5 Regarding the CHWs awareness sessions on nutrition, INTERSOS team carried out a KAP survey3 in the month of September, which revealed that 83% of the interviewed sample had received IYCF awareness session.

After delivery, is there anyone who has provided awareness about Infant and Young Child Feeding?

17%

83%

YES NO

Among the 83% who declared having partiicpated into IYCF awareness sessions, the main message recalled are as follows:

Importance of breastfeeding 19% 29% 10% Start Breastfeeding within 1 hour of birth; 19% 23% Exclusive breastfeeding for 6 months;

3 For the KAP survey, INTERSOS applied a random samplying methodology. 420 people were interviewed on a target population of 72.466 individuals. More information on methodology is available within the final evaluation report.

Activity 1.3 Secure the OPD nutrition services at HF level by dedicated trained nutrition staff The nine (9) nurses recruited to support the OPD nutrition services at HF level, received a first initial training on nutrition in the month of January 2018, followed-up by a four-day training in April on screening, IYCF practices, malnutrition treatment and follow-up. Based on the monthly reports from these staff, they have supported and directly followed up the cases of SAM treatment in the HFs:

March April May June July August September

6-59 months M F M F M F M F M F M F M F children 218 180 271 234 187 364 140 151 267 299 96 249 84 79

Total 398 505 551 291 566 345 163 Gran Total 2,819

Activity 1.4: Compose/hire/operate 3 mobile teams to support the outreach capacity of the HFs for provision of RH and nutrition services During the implementation of the project, the MHTs (three up to August and six in September) have been offering nutrition services in order to enhance the outreach capacity of the Provincial Health system. Nevertheless, as already mentioned, INTERSOS was not able to provide treatment for malnutrition and or Vitamine A and deworming. As previously communicate to the donor, INTERSOS should have received from BARAN (BPHS implementer) RUTF (nutrition supplies) and drugs (for deworming and vitamin A) to use in its Outpatient Therapeutic Program (OTP). However, due to scarcity of the same, BARAN could not meet this commitment during all the year implementation. INTERSOS tried alternative ways to get RUTF, (i.e. talking directly with DoPH (to access UNICEF pipeline) but also these attempts failed). Considering this constraint, INTERSOS mobile teams have only offered screening services and referral to the closest health facilities (both using private cars and/or INTERSOS ambulance). In terms of screening and referral, the MHTs have reached the following target for U5:

December January February March April May June July August September

Number screened for malnutrition

M F M F M F M F M F M F M F M F M F M F

121 160 185 154 304 261 177 188 234 189 270 207 260 221 530 446 589 468 529 477

Total number of screening: 5970

Number reffered to HF for treatment

M F M F M F M F M F M F M F M F M F M F

64 21 10 11 20 11 17 17 13 8 24 17 30 28 46 56 63 74 31 32

Total number reffered to HF for treatment: 593

Among the cases screened, the MHTs have detected the following cases of MAM/SAM:

December January February March April May June July August September M F M F M F M F M F M F M F M F M F M F 1 2 6 8 15 9 12 13 7 6 15 10 14 16 28 35 41 44 24 19 Total N of MAM cases detected 325 M F M F M F M F M F M F M F M F M F M F 9 15 7 9 5 2 5 4 6 2 9 7 16 12 18 21 22 30 7 13 Total N of SAM cases detected: 219

SECTOR: PROTECTION

Sub-Sectors: Child Protection; Prevention and Response to Gender-based Violence; Psycho- social Support services

Objective: To enable protection-conducive environment to prevent and mitigate protection risks, as well as facilitate an effective response to protection violations for the most vulnerable conflict-affected individuals and communities in Afghanistan

Beneficiaries Beneficiaries % targeted reached 17,114 20,476 119%

Activity 1.1: Training in CP, GBV and PSS for different stakeholders, actors and volunteers During the months of March and April INTERSOS carried out a series of training on CP, GBV and PSS for different stakeholders targeting CoVs and community leaders. In total 120 people (28 female) attend the training among the CoVs and Community leaders, and 25 among the INTERSOS staff (20 protection team mebers). As per agenda, the main topics of the training were: CP (Early marriage, child labour, child education) GBV (Property right, domestic violence, deprivation of participation). All the training sessions have been developed based on INTERSOS COVs guideline for Protection in Afghanistan, i.e. an internal tool of the mission that approaches and explains protection issues through Afghan Islamic interpretation (where possible), to ensure a greater buy-in, making clear that protection principles are not contradicting with Islam but rather are in line with each other. INTERSOS has also conducted a five (5) day refresher training for the Protection Staff in the month of July (from the 4th to the 9th). The training, facilitated by INTERSOS Senior Protection Advisor, has focused on: (i) principle and definition of Protection, GBV and CP; (ii) identification of vulnerability criteria; (iii) Case management process and steps; (iv) creation and implementation of the referral system. Activity 1.2: Awareness sessions for community members on protection related issues (CP, GBV and PwSN) Following the training for the CoVs implemented in March and April, the community mobilization phase has started: the COVs have been engaged in multiple discussions with the local shura and leaders, so as to guarantee their buy-in and acceptance for the implementation of the awareness sessions. Protection issues remain, in fact, very sentisitive topics, especially in rural areas. Social stigma and fear of public blaming are among the elements that make discussions around protection (and case disclosure) complicated. Finally, implementation of awareness sessions could start in June, targeting different groups (i.e. IDPs, Un/Documented returnees, Host Community). The awareness sessions have been implemented on the basis of the IEC material and Protection awareness guidelines

developed by the Protection Unit. In order to compensate for the time spent in community / leaders’ mobilisation, and to ensure all topics could be discussed within the communities, INTERSOS team has decided, in coordination with the CoVs and the field team, to increase the number of protection awareness session, from 2 sessions per week to 6 sessions per week. This has allowed INTERSOS to reach the following beneficiaries (initial target was 8,000 people):

June July August Sept Type M F M F M F M F

Documented Returnees 0 0 38 93 40 72 424 843

Undocumented Returnees 53 2 86 15 199 91 286 532

IDPs 123 53 523 346 689 652 1,490 1,266

Host Community 259 92 475 300 1,069 802 1,692 2,395

Total 582 1,876 3,614 8,928

Grand Total 15,000

Activity 1.3: Individual case management services for individual protection cases (CP, GBV and PwSN) As per the awareness session, the implementation of the case management has proven to be one of the most challenging activities to put in place in Kandahar context. Besides the social stigma and cultural limitations, already mentioned, the delivery of comprehensive individual case management services was hampered by the fact that INTERSOS is the only actor in Kandahar province offering case management services to protection survivors, and there is a general lack of service providers to whom the organization could refer the cases for further external support. In addition to the lack of services, the stringent social and moral codes, imposed in particular to women and girls, make the population reluctant in sharing protection issue with third parties, and harder the identification of the cases by the INTERSOS team. Furthermore, at project planning phase, INTERSOS had considered the possibility to count on external referral of vulnerable cases in need of material assistance (cash or in kind). However, during the course of the project and despite the mapping and networking efforts, it became clear that majority of cases would not be served properly due to a lack of actors in the targeted districts offering material assistance. The impossibility of meeting material needs has also caused a reduction in the number of cases willing to be registered with INTERSOS, as psychosocial and psychological counselling are not yet appreciated at the same level as material assistance. For this reason, in order to meet beneficiaries’ needs, INTERSOS has proposed and been granted with the possibility to include the delivery of some wraparound services for the most vulnerable protection cases. These services have translated into the purchase and delivery of dignity kits and education kits. Both kits have been designed considering the local culture and habits, and the distribution plan has been carefully drafted in order to mitigate the risk of tension within the communities during the distribution and working on reducing the possibility of social shame for the beneficiaries, especially in relation to the distribution of the dignity kits. Out of the 262 kits distributed by INTERSOS, 120 were Dignity Kits for female survivors of GBV and 142 Education kits, for CP cases supported in the school enrolment. In total, the protection team has offered individual case management to the following protection cases:

Categories and gender

GBV CP PwSN

Male Female Boy Girl Male Female

March 12 16 11 10 21 19

April 19 28 13 12 6 2

May 5 6 6 7 21 8

June 0 4 3 5 21 2

July 2 8 25 8 5 12

August 9 45 44 18 56 36

September 34 152 141 70 141 138 Total 340 373 488

Grand Total 1,2014

A more in-depth analysis of the cases related to CP and GBV reveals the main otection concerns identified by the teams during the year:

Protection Type of protection concern identified Cathegory

Children Sexual and Child Child Recruitment Forced Physical Neglected Begging on Child Labor Physical Protection Marriage in Armed Marriage Violence Child streets Abuse Groups

N. of cases 37 151 4 22 10 96 3 21 identified

Type of protection concern identified

Gender Sexual and Deprivation Domestic Sexual Exchange Forced Physical Based Dowry Physical of Rights Violence Violence marriages Marriage Violence Violence Abuse (Property)

N. of cases 171 26 25 12 37 12 0 26 identified

Activity 1.4: Collective PSS activities organized for most vulnerable population groups at community level (CP, GBV and PwSN) Collective PSS sessions have also been a challenge, due to the difficulty of encouraging participation linked to the stigma attached to this, hence the impossibility to find appropriate safe spaces for collective discussion. After long coordination with the local communities, INTERSOS teams have been able to

4 Out of these, 257 are considered by INTERSOS as light case management, i.e. only PSS was needed.

identify safe spaces, ensuring confidentiality to the beneficiaries, within the target communities, and collective PSS sessions could be implemented. In particular, in Mirwais Mena and Loya Wala, the local clinics have accepted to offer to INTERSOS protection team a room to implement such activity, while in the rural districts INTERSOS has arranged a safe space within the community centers and/or the house of the local leader.

Collective PSS

Documented Undocumented Host Gender IDPs Total Returnees Returnees Community

Male 153 121 439 625 1,338

Female 221 120 296 661 1,298

Boys/Girls 364 181 415 534 1,494

Total 4,130

SECTOR: WASH

Sub-Sectors: Hygiene Promotion

Objective: Enhance community awareness in health-nutrition-WASH good practices for conflict- affected communities in Afghanistan.

Beneficiaries Beneficiaries % targeted reached 12,959 25,967 200%

Activity 1.1: Conduct WASH – HP sessions for different target groups Considering the high needs in terms of Hygiene promotion, and the combination of the hygiene session with health and nutrition and protection ones, this activity has reached and exceeded the initial target. In total, INTERSOS has deployed five (5) Hygiene Promotors throughout the whole project cycle, with additional 5 deployed in September.The table below shows the total achievement for HP sessions in the reporting period:

Category Male Female Girl Boy

Internally Displaced Persons (IDP) 2,572 3,245 1,441 1,220

Documented Returnees (DR) 208 452 291 167

Undocumented Returnees (UR) 719 1,055 678 625 Host Communities (HC) 3,860 4,654 2,590 2,190 Total 7359 9406 5,000 4,202 Grand Total 25,967

While conducting HP sessions, INTERSOS teams have come across very vulnerable populations who have no access to hygiene items because of extreme poverty and / or disregard for the importance of such items. In order to reinforce hygiene promotion messages, INTERSOS started to provide (following the amendement) hygiene kits to these vulnerable cases in order to: (i) promote hygiene behaviors within the family, such as hand washing at key times, washing of self and clothing; (ii) promote good practice around drinking water by enabling the HHs to storage safe drinking water at the household level. In total 500 kits have been distributed, following the criteria defined as: (i) anyone with a disability and/or special needs; (ii) Vulnerable group (i.e families with less income); (iii) Pregnant and lactating women; (iv) SAM cases identified. Furthermore, considering the presence of other NGOs working in WASH NFIs distribution in Kandahar city, and the much dire needs in the rural areas of the districts, amplified by the drought emergency, INTERSOS has opted to privilege the distribution of the kits through the MHTs working in Zheray, Maywand and Spin Boldak. In total INTERSOS WASH team has distributed 500 Hygiene Kits in the following locations:

TEAM NUMBER OF KITS

Zheray MHT 1 and 2 152

Spin Boldak MHT 1 and 2 120

Maywand MHT 1and 2 170

Loya Wala (Kandahar) Team 1 and 2 29

Mirwais Mena (Kandahar) Team 1 and 2 29

TOTAL 500

CHALLENGES AND SOLUTIONS

Challenges 1. The project was delayed due to the recruitment process. Kandahar province is a challenging environment and it was difficult to find expatriates staff to cover key management position. In addition, the security situation in project coverage districts is very volatile and national staff was not willing to go to the remote areas. These constraints have delayed the start of the activities. 2. Turnover in the project team (both expatriates and national staff) also hampered the project activities. Frequent volatile situation also limited the movements, which has impact to identify the CHWs, CHS, and COVs. 3. Lack of nutritional supplies from BARAN (BPHS implementer) for INTERSOS to run the OPD program 4. Delays in the activation of the community networks (both for health and protection) 5. Social barriers for the implementation of protection activities 6. Lack of service providers to activate referrals of protection cases

Solutions and recommendations 1. While still using the major source of job posting available in Afghanistan (i.e. ACBAR website) INTERSOS has increased the number of local posting (e.g. DoPH noticeboard) and the collaboration with local organization (e.g. BARAN), in order to find local skilled staff willing to work in the targeted

districts. 2. Despite the multiple attempts to obtain RUTF from various sources, INTERSOS could only implement screening and referrals of SAM and MAM cases 3. INTERSOS has increased the frequency of awareness sessions, so as to ensure messages could be delivered in the targeted communities within the given timeframe 4. Numerous discussions with local shura / leaders and investing in the COVs as liaisons with the local communities to create a favourable environment for protection awareness sessions 5. Despite the suggestion of local actors to start offering monetary incentives to the participants of protection awareness sessions (to motivate them), INTERSOS has decided to refuse this methodology. Instead of money transfer to the beneficiaires, INTERSOS has started to offer small refreshment (tea and biscuits) to the partecipant to the awareness session. 6. INTERSOS has boosted its own response / case management package with the inclusion of material assistance for the most vulnerable cases

Success stories https://www.intersos.org/ritorno-a-scuola-a-kandahar/ (Needs to be translated in English)