RMNCH Trust Fund Project

Background:
In Late 2013 an announcement was made during the UN General Assembly from the WB Group, UNICEF, USAID and the Government of Norway for a collective total of USD $1.15 billion of new funding for three years to accelerate progress toward the MDGs 4 and 5, and to ensure essential services and medicines reach women and children who need them in countries with the highest burdens of maternal and child mortality. 42 countries were eligible including Afghanistan, of those 36 countries were belong to Africa.
The Country Engagement process is led by the Ministry of Public Health with the support of UNICEF, WHO and UNFPA along with other in-country partners. The Reproductive Health Directorate was key coordinating body for the proposal development and implementation of the RMNCH TRUST fund activities. A detailed proposal submitted to the RMNCH Trust Fund Secretariat and Coordination Team, the proposal was approved under the reference of SC130722 on mid July 2016 and actual implementation of the project started on Aug 2016. Total ceiling of the project was US$ 7,747,555 (programmable US$ 6,621,842), the project was came to end on Dec 31, 2016 with fully utilized allocated amount of the project.

Project area:

Whole country with particular focus on the high burden districts and the low performing areas of the country.

Objectives:

  • Strengthen the quality of community and facility based RMNCH services
  • Improve availability of essential RMNCH supplies, equipment and drugs
  • Strengthen and expand the referral system
  • Enhance M&E system for improved MNCH service delivery 

Project modality:

The project was led by MoPH-Reproductive Health Directorate with close coordination and collaboration of other technical departments (CAHD, CBHC, PLD and GCMU). The project followed the off-budget pattern, and all financial issues channelled through three UN agencies (UNICEF, UNFPA and WHO). In order to track the project progresses the project coordination committee established and had regular monthly meetings.

Achievements:

Trainingtrust2

  • Around 2,400 service providers trained on BEmONC, CEmONC, Basic and Advanced Newborn Care, Family Planning and Obstetric Fistula
  • 11,000 CHWs trained on family planning counseling and contraceptive technology
  • 500 members of CDC, Health Shura, and other community influencers oriented on community based newborn care
  • Around 500 religious leader, 189 high school teachers, 95 journalist and civil society members oriented Family Planning and discouraging harmful practices

 

Ambulances, Medical equipment, Supplies and Pharmaceuticals 

  • 40 ambulances procured and distributed for strengthening of referral system.
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  • Equipment for blood bank of 21 PHs/RHs provided and distributed for improvement of CEmONC services.
  • Supplies and commodities for all 34 blood bank of PHs/RHs provided and distributed.  
  • Essential drugs and equipment for 47 Family Health Houses procured.
  • 2600 Salter scale procured and distributed for improvement of essential newborn care services.
  • Contraceptives for MOPH supported HFs procured and distributed.
  • Chlorhexidine for cord care procured and distributed.

 

Expansion of services

  • Newborn care corner established at 130 CHCs
  • Newborn stabilization unit established in 20 provinces
  • Obstetric Fistula ward of Malalai Hospital renovated, equipped and supplied
  • Obstetric fistula repair and Pelvic Floor Disorder services expanded at sub-national level 

Success Story:

1. Significant improvement in Newborn care services in Hirat Regional Hospital after building capacity of healthcare providers

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2. Afghan religious leaders spread the word on family planning “Now I understand the value of contraceptives”

Name: Mohammad Ibrahim Barakzai13
Province: Baghlan
“I do promote family planning during my Friday preaches. And I know about birth spacing. Just last week I was talking about maternal health. But what I didn’t know was how a woman gets pregnant. Today I learned about the menstrual cycle; which days is a woman fertile and which days she is not.

We talk about different issues in our madrassa, also about family planning. Now I can understand the females who come to me with questions much better. Also I can better advise them on the use of modern contraceptives. I’m happy that I can provide this information to my people.”

 

Lessons learned:

  • The first ever off budget project led by a MoPH-Technical Department
  • Direct involvement of MoPH technical departments increase the efficiency of projects
  • Strong coordination among MoPH and fund channeling agencies led to fully utilized amount of the project

 

Challenges:

During the implementation of the project there were some challenges, which highlighted as follow:  

  • Different approaches by fund channeling agencies
  • Delay of shipments of the project in the ports
  • Limited managerial staff at MoPH level
  • Low quality of performance of some outsourced activities
  • Insecurity which led to limited monitoring activities

 

Suggestions:

  • To reduce operational and administrative cost, the same similar project can be directly implemented by MoPH technical departments with some adjustments/flexibility in the modality of the project i.e.
    1. Increase number of project management and technical staff at MOPH level
    2. Give more authority to the MoPH technical department.
    3. Avoid subcontract modality with third parties

 

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