#1• = x * * * 1 MCH Handbook initiative as a tool for COC and UHC in Afghanistan Mother and Child Health Handbook BY: Dr. Mohammad Salim Bahadury#2Outline Country profile MCH Handbook initiative in Afghanistan MCH HB Contents Implementation modality Capacity building How did MCH HB enhance coordination between distributing points at health facility? Continuum of care by implementing MCH HB Universal health coverage through MCH HB Lesson learn Success story Costing Challenges Next steps#3Country Profile . Total Population 30,000,000 AFGHANISTAN Growth Rate 2.6% Life Expectancy 62 (Men), 64 (Female) 661/100000 LB Turkmenistan Uzbekistan Tojikiston Feycabat JOWZAN Shobergher Sharif KONDUZ Tolga Kenduz BADAK A BALKH TAKHAR Moymonen Etre Pl FARYAR Kinme SAMANGAN BAGHLAN SARI PUL PANJOLER BIZD NURISTAN ВАРАНІЯ " MMR . Under Five MR 55/1000 Chachchars SA VIAN Clark Chahud-1-Foci Bamiyang PARVAN HEPISO KABUL LASHMAN KUVAR avtom o CHIDAR HFRAT VALAK LOWGAR NANGAKHAR IMR 45/1000 ا الله DAY KUNDI KHOST PARTIA C GHAZM NMR 22/1000 BRUZGAN Sheran lar n FARAH PARTIKA Faraho ZABOL CPR 23% O Pakistan Lachkar Bahu Ju " ⚫ TER Deliveries by 5.3 An QUANCALAR NIMRUZ HELNAND 51% SBA www.mapsopensource.com ndin Chine#4MCH HB Initiative in Afghanistan Contextualized and field tested by technical committee (2015) Evaluated by third party Concept brought by a team from Indonesia in 2015 Pilot designed based on lesson learn of other countries, and implemented in two districts by Support of JICA from Aug 2017- Jul 2018 National scale up started fro 2019 by issuing a decree by MOPH#5MCH HB Initiative in Afghanistan (Cont....) Maternal Health (pregnancy, delivery, post natal) Child Health (from birth to 2 years) Health messages + illustrations Health records - ANC, Delivery, PNC - FP - TT Card Health messages + illustrations Health records - Vaccination card - Growth monitoring Meters Health 1. Antenatal Case Child Health A. (2) قات مقبل ولمین مالی لملك كما علقت وقد عادة 14 • 333 533 Zinsp#6Provincial coordinator Implementation modality & Phase wise Scale up Project manageme nt team - Implementing NGOs - PPHO team • · First phase (2019): • Three provinces (Kabul, Nangarhar and Bamyan) Second phase (2020): Eight more provinces will be added (Daikundi, Kandahar, Balkh, Hirat, Badakhshan, Parwan, Kpisa and Panjshir) Third phase (2021): • National wide (23 remaining provinces will be added)#7Capacity building Training micro plan developed: ToT training for Technical teams of PPHD & Implementer NGOs. • Initial training for HCPs (Midwife, Vaccinator & Nutrition counselor). • ToT training for Community health supervisor (CHSS). • Orientation workshop for community health workers(CHWs).#8Distribution 378434 MCH-HB Distribution by each distribution point 751831 1148601 2295554 by N.C. % of distribution RICH HB distribution 1 Of by each dsitribution point 2838 7837 6013 % of distribution by Vaccinators 33% Distribution by Redistribution DistNbution by Radicstralbation by VacoDisttbution by Redistribution by Matal Distribution % of distribution by MW 50% Retention rate 99,3% Re distribution 0,7%#9How did MCH HB enhance coordination between distributing points at health facility? Interdepartmental coordination Regular referral Tracking of missed services by each department Minimize miss- opportunities Coordination between distributing points MCH section Immunization section Nutrition section#10معافيت اطفال حرارت رشد Continuum of care by implementing MCH HB MCH HB tracks services during pregnancy, child birth and after birth ● ● Antenatal care Care during delivery • Post natal care . • Vaccination Nutrition services As window of opportunity during first 1,000 days of life All#11Universal Health Coverage through MCH Handbook • Distributing MCH HB through public health facilities Adopting community based interventions like family health action groups Distribution of MCH HB through private sector(Next step) Health facilities -Counseling - ANC, Delivery, PNC, FP - Vaccination -IMNCI -Growth Monitoring and Promotion Household: -Retention - Valid source of health information at family level - Birth certification -Immunization Health post: - Home visits - Health education - Community growth promotion - Referral#12Monitoring • • Accelerated monitoring plan developed. Joint monitoring with PPHDs and NGO.#13Review Workshops Review workshop conducted for Phase 1-2 of Provinces at provincial level. ور کتاب مرور شش ماهه تطبیق پروژه وم مشهودیت کرده کتاب دیوا کتاب رهنمای صحت مادر و قفل الم باللی ایران باكر وكتاب JICA Semi-annual Review Workch on Implementation PCH Harbo Kandabar jud 200#14Promotion of MCH HB • Facebook page and viber group created. • MoPH decree sent to all PPHDS and implementing NGOs. • MCH HB article published in the BMC Public Health Journal. • An article on MCH HB presented in the FMIC 9th international conference. • MCH HB presented in the health assembly. . MCH HB Dashboard created in DHIS 2 to monitor the distribution of MCH HB at national and subnational levels. وطن MCH Handbook GANCAR MICH Handbook НАЗИЯ#15ویکتاب آموزشی کتابی Lesson learn Involvement of professional associations such as midwifery association is necessary for successful implementation of MCH HB. More focus on training of healthcare providers will minimize the confusion during distribution of MCH HB. Involvement of community will promote utilization of MCH HB specially male involvement in maternal and child health. Coordination at central, provincial and community levels. A#16Success story A mother having MCH HB in their hand at corridor of the Health facility and waiting for getting health service from MCH section. When the monitor asked who is this book belong to? she responded "its belong to me". The monitor asked her do you know the content of this book, and have you ever learned anything about health of mother and child from this book? she said: yes, since I am studied primary school and I learned from written messages as well as pictures of the book, for example before during my previous pregnancy period I don't know regarding care of pregnant women and jumped form stair to the ground and unfortunately I do miss abortion and when I got the handbook and read it specially regarding take care of pregnancy period for the pregnant women I follow the mentioned important message, now fortunately I have a healthy infant.#17Costing Total Contribution (USD) Total Programmable Amount (USD) Total Fund Utilization to end of Feb,2021 (USD) (Actual expenditure + Commitments as of the reporting date; excluding 8% Recovery Cost) Fund Utilization Rate (%) (Based on the above Utilization) 8,031,623 7,436,688 5,424,457 73%#18Challenges • • AGES, prohibited MCH-HB distribution in some provinces (Farah, Noristan & Kunduz). Security challenge for conduction of ToT for provincial technical teams at zonal level. Geographical and climate issues. • Corona virus pandemic.#19Next step(Integration of MCH HB in the health system &Involvement of Private sector) • Cost of printing and supply of MCH HB will be included in the contracts of implementing NGOs after end of 2021. • MCH HB indicators are under process to be included in HMIS • Coordination with private sector related MoPH directorate as well as private sector association at central and provincial level. • Conduction of MCH-HB orientation workshop for Private HFs staff in 2022. • Technical support for implementing NGOs during year 2022.#20THANK YOU