Component 1

Component 1: Sustaining and improving BPHS and EPHS services (estimated total cost of US$307 million): This component will support the implementation of the BPHS and EPHS through performance-based partnership agreements (PPAs), i.e. contracts between MOPH and NGOs which will deliver health services as defined in these packages. It will also support the government’s efforts in delivering the BPHS and EPHS through contracting in management services in designated provinces, and the implementation of an urban version of the BPHS in Kabul city and possibly to other cities. It will include support to improve access to and quality of BPHS/EPHS services, as well as training of additional community midwives and community nurses. In addition, financing will be made available for contracted services specifically for marginalized populations such as prisoners and nomads. HIV/AIDS prevention services will be contracted out for targeted population sub-groups who are at an elevated risk for HIV-infection, if funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria is insufficient.

The RBF scheme, piloted under the current SHARP project, will be mainstreamed. This will involve the completion of ongoing pilot in 14 provinces as well as an in-depth impact evaluation to inform future direction and mainstreaming of the RBF in Afghanistan under SEHAT. This will help to further refine the performance-based contracts with NGOs. The RBF scheme has been under implementation for the past 24 months. Preliminary results are promising and show increasing coverage of key maternal and child health services, besides higher equity of service utilization and quality of services. Furthermore, the implementation arrangements for the scheme will be mainstreamed so that it is embedded in the arrangements for BPHS and EPHS implementation. As such, the contract management, monitoring and supervision of the scheme by MOPH will be within those of BPHS/EPHS. The impact evaluation under SEHAT will supplement the impact evaluation of a more limited scope to be completed under SHARP to measure the results of the RBF implementation in the selected provinces. The impact evaluations will be financed by the HRITF.