NATIONAL REPRODUCTIVE HEALTH STRATEGY ISLAMIC REPUBLIC OF AFGHANISTAN MINISTRY OF PUBLIC HEALTH PREPARED BY Reproductive Health Task Force Ministry of Public Health NATIONAL REPRODUCTIVE HEALTH STRATEGY ISLAMIC REPUBLIC OF AFGHANISTAN MINISTRY OF PUBLIC HEALTH PREPARED BY Reproductive Health Task Force Ministry of Public Health Printed on ............ Kabul, Afghanistan National Reproductive Health Strategy (2012 2016) FOREWORD The Ministry of Public Health of the Islamic Republic of Afghanistan places reducing maternal and neonatal deaths and improving the quality of reproductive health among its top priorities. Afghan families deserve the highest possible standards of reproductive health. With this Strategy, the Ministry demonstrates its continued commitment to achieving its goal of making quality reproductive health services available to all families in Afghanistan. Four components of the Strategy are considered to be of the highest priority: Maternal and Neonatal Health, Birth Spacing/Family Planning, breast and cervical cancer and Sexually Transmitted Infections. Several other areas are included with a view to developing a strategic plan and taking initial steps to implement it during the next five years with the understanding that full implementation is a long-range goal. These areas are Infertility and Obstetric Fistula. Numerous issues were also identified that affect more than one component of the Strategy and sometimes all components. These are treated separately in the document. They are Reproductive Health in Emergency Situations, Gender, Nutrition, Mental Health, Information Education Communication/Behaviour Change Communication (IEC/BCC), Quality Assurance, Reproductive Health Research and Reproductive Health and the Private Sector. The role of the Reproductive Health Directorate is accurately defined in this National Strategy as one of stewardship. The principal activity of the Directorate, therefore, is not primarily one of providing services, but one of motivating, advocating, guiding, linking, standard setting, monitoring and collaborating with its partners. The Ministry considers this to be the most effective, efficient and least costly way for Afghanistan to achieve its reproductive health goals. This revised policy and Strategy will guide the MoPH in developing an implementation plan and annual work plans to address the reproductive needs of the country. It will also guide the RH Directorate, the Ministry as a whole, related ministries, donors, implementing agencies, the private sector and other partners to identify means of financing and implementing its priority areas. I would like to thank the Reproductive Health Directorate for the energy it put into the development of this revised Policy and Strategy. Working with the Directorate have also been many vital partners in reproductive health, without whose support and technical expertise this strategy would not have been able to take its final form. I am confident that the MoPH and its many partners will coordinate their efforts in implementing this Policy and strategy; they will succeed in developing a strong reproductive health partnership from which all Afghan families will benefit. Sincerely, Suraya Dalil, ( MD , MPH ) Minister of Public Health Kabul, Afghanistan National Reproductive Health Strategy (2012 2016) ACKNOWLEDGEMENTS The Reproductive Health Strategy 2012 2016 was prepared by the Reproductive Health Task Force in close collaboration with the Reproductive Health Directorate of the Ministry of Public Health. The work was a collaborative effort, with 12 working groups deliberating on a regular basis over a period of more than three months to identify key elements of the Strategy. These working groups covered the areas of Maternal and Neonatal Health, Birth Spacing/Family Planning, Sexually Transmitted Infections, Infertility, Obstetric Fistula, Breast and Cervical Cancer, RH in Emergencies, Gender, Nutrition, Information Education Communication/Behaviour Change Communication, RH Research, and RH and the Private Sector. In addition, workshops were held in January, June and December 2010. The names of the principal contributors to the revised Strategy are listed in Annex 4. The Reproductive Health Directorate and the Reproductive Health Task Force would like to extend their sincere thanks to H.E. Dr. Nadera Hayat Burhani, previous Deputy Minister for Health Care Services Provision, and Dr. Ahmad Jan Naiem, Policy and Planning Deputy minister, MoPH, for their continued support and guidance throughout the strategy development process. The Reproductive Health Directorate is grateful for the input provided by participants in the National Consultative Meeting on the revision of the Reproductive Health Strategy held on 20 and 21 October 2010. Their recommendations have been incorporated into the present document. Finally, the Reproductive Health Directorate and the Reproductive Health Task Force express their appreciation for the support provided by the Consultative Group on Health and Nutrition, the Technical Advisory Group and the Executive Board. Dr. Sadia Fayaq Ayubi Reproductive Health Directorate Ministry of Public Health Page ii National Reproductive Health Strategy (2012 2016) TABLE OF CONTENTS FOREWORD __________________________________________________________________________________ i ACKNOWLEDGEMENTS________________________________________________________________________ ii LIST OF ABBREVIATIONS/ACRONYMS ___________________________________________________________ v BACKGROUND _______________________________________________________________________________ 1 Guiding Principles __________________________________________________________________________ 1 Core Values_____________________________________________________________________________ 2 Operational Principles ______________________________________________________________________ 2 Achievements and Successes_________________________________________________________________ 3 Problems and Constraints ___________________________________________________________________ 3 Government Policy Statements _______________________________________________________________ 4 Targets to Be Achieved ______________________________________________________________________ 5 Strategic Goals ____________________________________________________________________________ 7 Strategic Objectives (based on RH segment of HNS goals) _________________________________________ 8 STRATEGIC COMPONENTS _____________________________________________________________________ 9 Component 1: Maternal and Neonatal Health __________________________________________________ 9 Strategic Approach 1.1: Increase women s access to and utilization of antenatal care, skilled care, emergency obstetric and neonatal care (EmONC) and postpartum care ________________________ 9 Strategic Approach 1.2: Improve the quality of MNH services, including EmONC __________________ 11 Strategic Approach 1.3: Improve monitoring and evaluation of MNH services and use of data _______ 15 Strategic Approach 1.4: Other Initiatives ___________________________________________________ 15 Component 2: Birth Spacing/Family Planning (BS/FP)___________________________________________ 16 Strategic Approach 2.1: Strengthen the capacity to provide of a full range of FP methods __________ 17 Strategic Approach 2.2: Improve provision of BS/FP services at all levels Strategic Approach 2.3: Expand approaches for community-based FP ___________________________ 18 Strategic Approach 2.4: Increase information, education and communication (IEC) and behaviour change communication (BCC) for wider use of BS/FP _______________________________________ 19 Strategic Approach 2.5: Strengthen monitoring and evaluation of BS/FP activities _________________ 20 Strategic Approach 2.6: Strengthen BS/FP services through the private sector ____________________ 20 Component 3: Sexually Transmitted Infections and HIV/AIDS ____________________________________ 21 Strategic Approach 3.1: Improve the quality of STI clinical services _____________________________ 21 Strategic Approach 3.2: Build health workers capacity in STI management ______________________ 21 Strategic Approach 3.3: Increase public awareness of STIs ____________________________________ 21 Component 4: Strategic Approaches to Breast and Cervical Cancer _______________________________ 21 4.1: Breast Cancer _____________________________________________________________________ 22 4.2: Cervical Cancer ____________________________________________________________________ 22 4.3: General Approach to Breast and Cervical Cancer _________________________________________ 23 Component 5: Strategic Approaches Related to Other Issues ____________________________________ 23 5.1: Obstetric Fistula ___________________________________________________________________ 23 5.2: Infertility _________________________________________________________________________ 24 Page iii National Reproductive Health Strategy (2012 2016) Component 6: Cross-Cutting Issues __________________________________________________________ 24 6.1: RH in Emergency Situations __________________________________________________________ 24 6.2: Gender Issues _____________________________________________________________________ 25 6.3: Nutrition _________________________________________________________________________ 25 6.4: Maternal Mental and Reproductive Health _____________________________________________ 26 6.5: IEC/BCC __________________________________________________________________________