Afghanistan Sehatmandi Project

The Afghan health system has made considerable progress during the past decade thanks to strong government leadership, sound public health policies, innovative service delivery, careful program monitoring and evaluation, and development assistance. Data from household surveys (between 2003 and 2018) show significant declines in maternal and child mortality. Despite significant improvements in the coverage and quality of health services, as well as a drop in maternal, infant, and under-five mortality, Afghanistan health indicators are still worse than the average for low-income countries, indicating a need to further decrease barriers for women in accessing services. Afghanistan also has one of the highest levels of child malnutrition in the world. About 36.6 percent of children under five suffer from chronic malnutrition, and both women and children suffer from high levels of vitamin and mineral deficiencies. The Maternal Mortality Ratio (MMR) fell significantly from 1,600 per 100,000 live births in 2002 to 638 per 100,000 live births in 2017, according to estimates of the United Nations Inter-Agency Working Group for Estimation of Maternal Mortality.

The project co-financed with $140 million IDA grant and $35 million Global Financing Facility grant.

Sehatmandi Project comprises three components:

1. To improve service delivery, this component will finance performancebased contracts to deliver the Basic Package of Health Services and Essential Package of Hospital Services across the country.  
2. To strengthen the health system and its performance, this component will support a systematic organized approach to establish a performance management culture in the Ministry of Public Health (MoPH) and among stakeholders. 
3. To strengthen demand and community accountability for key health services, the third component will finance a range of activities, including communication campaigns aimed at raising overall awareness of health rights as well as specific health behaviors to support MoPH and service providers to be more responsive to community health needs

EXPECTED RESULTS:

1. Access measured by PENTA3 vaccination coverage among children ages between 12 and 23 months: Number of children 12–23 months old receiving the third dose of pentavalent vaccine, expressed as a percentage of the number of children 12–23 months old. 
2. Utilization measured by births attended by skilled health personnel: The number of births attended by skilled health personnel (doctors, nurses, or midwives), expressed as a percentage of the total number of births in the same period. 
3. Utilization measured by health facility visits per capita per year to BPHS/EPHS facilities: Number of clients/patients who visited BPHS/EPHS health facilities during the year, expressed as a proportion of estimated population in the same period. 
4. Quality of family planning services measured by contraceptive prevalence rate (modern methods): The proportion of women of reproductive age who are using (or whose partner is using) a modern contraceptive method at a given point in time. 
5. Quality of nutrition services measured by minimum dietary diversity: Proportion of children 6–23 months of age who receive foods from four or more food groups during the previous day. 
6. Quality of care measured by balanced scorecard (BPHS): Composite score out of 100 on indexes of quality of care as judged by a third party.