ACCESS Program - Where We Work

The ACCESS Health Service Support Project (HSSP) is a four-year Associate Award from USAID to improve service delivery and the quality of basic health services in Afghanistan. In concert with the Ministry of Public Health (MOPH), HSSP provides support to nongovernmental organizations (NGOs) to improve the planning, management, implementation and monitoring of the delivery of a high-quality Basic Package of Health Services (BPHS)—the framework of primary and secondary health service delivery—in 13 provinces in Afghanistan. HSSP aims to:

Strengthen and develop systems that support service delivery quality.

Increase the number and performance of BPHS service providers, especially women in rural and underserved areas.

Improve the capacity and willingness of communities, families and individuals to make informed health decisions and support and sustain health-seeking behaviors.

Integrate gender awareness and practices into BPHS service delivery.

HSSP is working with the Afghan Public Health Institute (APHI) of the MOPH and local partners to expand implementation of the quality assurance (QA) process to initiate lasting change in the quality of sustainable health services and the performance of health care providers. In collaboration with the APHI, ACCESS developed a harmonized set of evidenced-based QA standards for 14 priorities of the BPHS. These standards were adapted for application in district hospitals, comprehensive health centers and basic health centers.

In response to performance gaps identified by the QA process and training needs assessments, HSSP conducts in-service trainings for BPHS health care providers in both clinical and non-clinical areas, such as infection prevention, family planning, and human resource management. To ensure that health providers can apply their skills and knowledge to practice, HSSP uses the QA standards post-training to measure individual and facility performance, and to further guide quality improvement.

Afghanistan faces a critical dearth of skilled female health providers. HSSP is supporting the MOPH to strengthen the midwifery pre-service education system to ensure a pool of competent midwives will practice where the need is greatest—in rural and underserved areas. HSSP has awarded 11 grants to NGOs to support community midwifery and midwifery education programs, and anticipates that 300 new community midwives will be trained by 2010. HSSP also provides technical support to the National Midwifery Education Accreditation Board, and is strengthening the technical capacity and leadership of the MOPH’s Information, Education and Communication department in Behavior Change Communication and Community Mobilization.

Under the ACCESS/Afghanistan program, ACCESS collaborated with the MOPH and partners to conduct a demonstration project to reduce the incidence of postpartum hemorrhage through counseling on birth preparedness and community-based distribution of misoprostol among women delivering at home with no skilled provider. Final results of the demonstration project showed that the intervention was safe, acceptable, feasible and programmatically effective. The MOPH and USAID have recommended expansion of the intervention to increase coverage. ACCESS is also helping to strengthen the capacity of the Afghan Midwives Association, a growing professional association that aims to strengthen the quality of health care in the country, particularly for women and their families.