Ghor province with 635,302 population and 83,333 households is located in the western Afghanistan. The province covers an area of 38,666 square km. More than 92% of the province has mountainous or semi mountainous terrain, while a small part of the area is made up of flat land (5%). The province is divided into 9 districts namely, Taiwara, Dolaina, Saghar, Lal-wa-Sarjangal, Passaband, Sherak, Tolak, Dowlatyar and Charsadda. Agricultural and animal husbandry are the primary occupations of inhabitants. Ghor province security is significantly affected by the neighbor provinces especially from the southern part. The Ministry of Public Health (MoPH) has expanded access to primary health care services for 80% of the Afghan population, prioritizing maternal and child health, through implementation of Basic Package of Health Services (BPHS). However, large sections of the rural population in Ghor province still have limited access to essential healthcare services. Factors that contribute to this lack of access is the mountainous topography of Ghor province, communities that are scattered and live in small pockets (in part due to the geography) and the absence of basic infrastructure such as roads and bridges. During winter season road to most of the districts are blocked which makes travel to and inside the province difficult. These factors also impede physical utilization of existing stationary health facilities as evidenced by the health management and information system (HMIS) of MoPH nationally. According to the assessment of ACTD team, approximately 17% of populations live in excess of more than 10kilometers from the nearest health facility. Of the 2,172 villages in Ghor, only 19 have access to health centers and another 32 are served by private dispensaries (with questionable quality of services), people seeking medical attention must travel more than 10kms to get it. ACTD has been awarded to implement BPHS in Ghor province from December 2011 to July 2013 and will provide quality primary health care services. However, large segments of the population still do not have access to health care. The proposed lifesaving one year project will contribute to improving quality of lives of 108,000 Afghan populations living in underserved and unprivileged communities of Ghor province, and address some of the greatest challenges and emergency health care needs. Women in these scattered and unserved villages are unable to travel and seek health care services. This is mostly due to lack of transportation means, inability to make a decision to seek health care services even during the pregnancy (husband and mother in laws limits women particularly young married women to travel long distance and seek health care services), lack of information and awareness and other attributing factors such as load of home works, child care and traditional believes. All these factors are contributing to high maternal mortality, low utilization of health care services and low immunization coverage among women and children. As a matter of fact, most of these women who lives in scattered and un-served villages have not visited the city unless they were too sick or were in emergency needs, thus sometimes it was too late for them to reach health facilities due to late arrival and or due to late decision to seek health care services. The target populations live in isolated villages and small-scattered unregistered settlements which do not qualify to BPHS standards and its level of health facilities. Opening additional health facilities through BPHS is not considered cost-effective. Therefore, provision of emergency lifesaving health care services through establishing 4 mobile health team will cover their primary health needs particularly women of reproductive age and children under five years old, with the hope for more standardized and regular services by MoPH in future.

Each mobile team will establish service delivery points (SDPs) which will be visited by MHTs at least once a month. The villages where SDPs are established will be identified based on predefined criteria of the MoPH. However, list of SDPs will be finalized in collaboration and consultation with PPHCC and communities based on the accessibility of population to the SDP by cluster villages, and willingness of the village population for provision of space and support for the MHT. A yearly plan of operation for each MHT will be prepared and shared with PPHCC for approval and the communities for their information. It is envisaged that each team will work 22 days a month, which is roughly 264 working days per year. Taking average travel times as a guide, it is estimated that each service delivery session in a particular SDP will have an average 3 working days duration including travel time. These services will be offered to everyone in the area, but more emphasis will be placed on those with greatest need e.g. women and children. Summary of services provided by MHTs are listed below: • Provide immunization to women and children; • Provide outpatient consultations and treatment through MHT visits; • Provide antenatal consultations to pregnant ladies; • Provide family planning services to CBA; • Provide referral services to complex and complicated deliveries and diseases; • Establishing community based emergency preparedness and response mechanisms; • Establishment of emergency response committees at service delivery points; • Detection of disease outbreaks and early response; • Raising community awareness on health related issues and disasters; • Provide health education during the health services sessions particularly for women; • Birth preparedness planning for safe deliveries of pregnant ladies;

• 70% of Women and children in the catchment area (beyond zone c of fixed health facility catchment area) have greater access to basic and primary healthcare services • Around 90% of the communities allow their women and children to get health services due to the close-to-door nature of mobile health services • The served communities of all of the 51 un-served villages have responsive disaster preparedness and response mechanisms • Awareness on importance of primary healthcare services among people enhanced (to acceptable level) in more than 70% of families. • Mortality and morbidity rates among women and children decreased by 5% at the end of the project • Immunization coverage among under-five children and women in the catchment area population increased by 50%

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