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Badghis Multi-Sector Rapid Assessment

Report

June 2018

Table of Contents

ASSESSMENT BACKGROUND...........................................................................................................4

ASSESSMENT METHODOLOGY........................................................................................................4

SUMMARY OF FINDINGS.......................................................................................................................7

FINDINGS.............................................................................................................................................................7

Agriculture production and livestock...................................................................................................11

Access to food, consumption and copying strategies...............................................................14

Household income sources, expenditures and priorities.........................................................16

Water, Sanitation and Hygiene................................................................................................................20

Health and Nutrition.......................................................................................................................................24

Education...............................................................................................................................................................32

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Glossary / AbbreviationsAfDHS Afghanistan Demographic and Health Survey

ALCS Afghanistan Living Conditions SurveyANC Antenatal CareARI Acute Respiratory InfectionBHC Basic Health Center

CDCs Community Development CouncilsCHC Comprehensive Health CenterCSO Central Statistics OrganizationDAIL Department of Agriculture, Irrigation and LivestockEFSA Emergency Food Security Assessment

FGD Focus Group DiscussionGAM Global Acute MalnutritionHEAT Household Emergency Assessment ToolHH HouseholdHRP Humanitarian Response Plan

ICP Integrated Food Security Phase ClassificationIDP Internally Displaced PeopleIMAM Integrated Management of Acute MalnutritionKII Key Informant Interview

MAM Moderate Acute MalnutritionMUNCH Maternal and under five nutrition and child healthSAM Severe Acute MalnutritionSHC Sub Health CenterWASH Water Sanitation and Hygiene

WFP World Food ProgramWVA World Vision Afghanistan

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Assessment Background

Badghis province is located in the Western region of Afghanistan. Badghis covers an area of 20,068 square km and is bordered with Turkmenistan to the north, Faryab to the east, Ghor to the southeast, and Herat to the south. Badghis has an estimated population of 512,582 people (249,515 female and 263,003 male) divided into 6 districts: Qala Naw, Muqur, Abkamary, Qadis, Jawand and Bala Murghab. The Badghis population is rural with 97% of inhabitants living in 1,182 villages and 3% of them (15,553) living in Qala Naw town which is the capital of the Province (CSO 2017-18).1

Agriculture is the main source of income for 59% of households. Livestock provides an income for 45% of rural households. 7% of households in the province earn some income from trade and services and another 5% of households earn income through non-farm related labor. Agriculture is heavily dependent on rain fed production and given that agricultural production is the main income source for households, the lack of rain fall and recurring drought in the past years makes the Badghis population highly prone to food insecurity, poverty and vulnerable to natural shocks (WFP, 2017)2.

The October 2017 Acute Food Insecurity Situation Overview from the Integrated Food Security Phase Classification (IPC) has classified Badghis as the only province in the country being in IPC emergency phase 4. According to the report, 60% of the population (308,358 people) is in a state of ‘crisis’ or ‘emergency’. The current drought conditions are likely to worsen over the coming year due to the following reasons: (1) Snow cover depth was lower over the previous winter, compared to the previous 4 years (FewsNet Early Warning report, 2017); (2) Average precipitation is below the normal seasonal average, i.e. drier (Winter season forecast, International Research Institute for Climate and Society, Earth Institute of Columbia University, 2017); and (3) Temperatures are above the seasonal average, i.e. warmer (Winter season forecast, International Research Institute for Climate and Society, Earth Institute of Columbia University, 2017).

The access to qualified health and nutrition services for children and reproductive age women is quite low in Badghis Province. According to the Afghanistan Demographic and Health Survey (AfDHS) 2015 Badghis Province is ranked amongst provinces with a high child mortality rate; infant mortality3 is 67 deaths per 1000 live births, under- five mortality4 is 77 deaths per 1000 live births. 73% of pregnant women have not received any Antenatal Care (ANC); 93% of births are delivered at home and only 5.9% of births are delivered in a health facility. 73.9% of women do not have a postnatal checkup from a qualified health worker and only 51.2% of children of age 12-23 months have received all basic vaccinations5 (AfDHS, 2015).

1 CSO statistics found at http://cso.gov.af/en/page/demography-and-socile-statistics/demograph-statistics/3897111

2 ‘Badghis Emergency Assessment Report’ Food Security Cluster and WFP’ 2017. Found at https://reliefweb.int/report/afghanistan/badghis-emergency-assessment-report-november-2017 3 The probability of dying between birth and the first birthday.4 The probability of dying between birth and the fifth birthday.5 BCG, measles, and three doses each of pentavalent and polio vaccine (excluding polio vaccine given at birth)

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The rate of global chronic malnutrition (stunting) in the Province is 49.7% (28% moderate, 21.8% severe), which is the highest level compared to other provinces in the Western Region. The rate of global underweight is 12.4% and the prevalence of diarrhea among children under 5 is 50% (WV MUNCH Project Evaluation, 2017).In the 2013-14 Afghanistan Living Conditions Survey (ALCS) Badghis is ranked among the provinces with the lowest adult literacy rate; 5% for females and 15% for men6. The net attendance ratio for primary school7 is 75.4%; 83.6% for boys and 67% for girls. The net attendance ratio for secondary school8 is 15.4%; 10.5% for girls and 20.2% for boys (AfDHS, 2015). Among female teachers in Badghis, only 20% are qualified. (Education for All 2015 National Review Report: Afghanistan).

Assessment Methodology

From 5 to 12 June 2018, WV Afghanistan (WVA) undertook a rapid needs assessment in 5 of the 6 districts of Badghis Province: Qala Naw, Abkamari, Moqur, Qadis and Jawand. The assessment primarily aimed at assessing the effect that drought has had on the food security, health and nutrition, and education status of the affected population in order to identify areas of concern.

The rapid needs assessment took place in 40 communities (villages) in five districts of Badghis Province. Due to security reasons at the time, it was not possible to conduct the assessment in Bala Murghab district, but that will be done in the near future. Eight communities in each district were randomly selected for the assessment (See the list in the table at the end of this section).

A mixed method approach was applied for the assessment, combining both quantitative and qualitative surveys for data collection. Primary and secondary information was collected at the provincial, district and community level. A team of 10 trained enumerators collected the data for the assessment.Quantitative survey:

a) Household (HH) interviews were conducted in the selected villages. Five households were randomly selected in each village totaling 200 household interviews overall. A quantitative questionnaire combining questions from the standard WASH, Food Security, Health and Education cluster assessment tools was used for HH surveys. The questions on the frequency of meals per day were not asked since the assessment was conducted during the Ramadan period.

b) MUAC measurements for children under 5 in the selected households and MUAC for pregnant lactating women were undertaken to determine the nutrition status of children and

6 Central Statistics Organization (2016), Afghanistan Living Conditions Survey 2013-14. National Risk and Vulnerability Assessment. Found at http://cso.gov.af/Content/files/ALCS/ALCS%20ENGLISH%20REPORT%202014.pdf7 The NAR for primary school is the percentage of the primary school age (7-12 years) population that is attending primary school.8 The Net attendance ratio is the percentage of the primary school age (13-18 years) population that is attending primary school.

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women. In the 40 villages, 346 children under 5 (54.8 % boys and 45.2% girls) were screened for their nutrition status and 342 pregnant lactating women. The methodology for the assessment was random sampling, the first level of random selection was selection of villages and number of households to be interviewed, and the second level of sampling was selection of households within the villages.

Qualitative surveys:a) Focus group discussions were held with Community Development Councils

(CDC) and community members to assess needs and concerns of the communities related to food security, WASH, health and nutrition, and education. A total of 14 FGDs were conducted with 173 members (102 male and 71 female).

b) Key informant interviews with school principals in 27 schools were conducted to assess the education situation.

Desk review: Secondary data of the Public Health department were reviewed to assess the capacity of health facilities in providing health and nutrition services in the five districts using the Integrated Management of Acute Malnutrition (IMAM) operational tool.

Site Observations: households, schools and water sources.

List of villages for the needs assessment

District Geographic Cluster VillageDaizangi

Naway Abkmary ZangarPahlawana

Abkamary Barnagry Gul_KhanaSir_Zarak

Barngary koocha KochaSir chashma Abkmary Qebchaq

Khoja pistaChesham dozadal Lagary Cheshma_Dozdak

Sangi AtashJafariSangi_AtashZertangi

Qahga kharistan KharistanMoqur Sanjitak Qarghach_Baloch

Firstan Qashlaq NowabbasiQahga kharistan TotakQrchagai Kemenji_OliaLangar Khak_Darwish

Ghaib_alidasht

Qalcharkh_UliaKariz Shorabak_Hajimuhammadshah

Qadis Shurab_SuflaQadis Center Haji_Mohammadali

Zad SalehaBaghak BaghakChaghab Cheshma_Sherin

KondilanSangab band kondilan

Qala Naw Serchashma kondilanChakab QudoqChakab ChakhabLaman Khosh Morgh

Tahtha_lamanJangalak

Takab AlamKhal Gosha

Jawand Mah jamlQala cha

Khoja sorkhayn Qaria kalanTagab Alam

Timani Khoja yakkdonZad hakim Zad hakim

Summary of Findings

Food Security and LivelihoodsThe assessment findings show a critical food security crisis as communities are experiencing reduced access to food due to drought affecting agricultural production and livestock, which are the main sources of livelihood in Badghis Province.

• Households (HH) estimated that the current cereal stock will last for 0.07 months or 2.1 days, whereas they estimated an average of 4 months cereal stock for the same time last year.

• 78% (156 out of 200) of HHs rated the food security situation “a lot worse” compared to the same time last year and 21% rated it as “worse” compared to the last year.

• 100% of HHs did not have enough food for the past week and the most frequent coping strategy was to rely on less preferred and less expensive foods – used 2 days in the past week; and reducing the portion of meals at mealtimes - used 1.5 days in the past week.

• All interviewed households claimed to have experienced shocks during the past six months, with the main shock being drought (77.5% of HHs). The other main shock was reduced income (70% of HHs).

• Decreasing expenditures, migration to look for jobs and increasing daily labor are the most important strategies used by households to cope with the food insecurity. An alarming finding

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to highlight is that approximately half (52.1%) of respondents in the households interviews cited early marriage of a daughter as a means to cope with food insecurity and lack of income to cover family expenses.

• There is a decrease in land cultivation due to the drought (8.1 jeribs of rain-fed land cultivated on average, versus 10 jeribs last year). Lack of irrigation and rainfall water shortage is reported as the most critical challenge for the cultivation process (61% of HHs) as well as lack of seeds (97.5% of HHs).

• Approximately half of the interviewed households own livestock and 68% had livestock deaths during the past six months as well as reduced livestock productivity (69% of HHs). Households report having an average of 7.4 sheep/goats this year versus 21.8 sheep/goats last year.

• More than half of the households (57%) reported no cash income for the past month and 99% reported a decrease of cash income compared to the past year.

Communities highlighted the urgent need for food commodities distribution, provision of fodder for the livestock, improving access to water through water systems improvement interventions, and health and nutrition services.

Water, Sanitation and Hygiene (WASH)

Assessment findings show that communities have been facing drinking water shortage issues as a result of the drought and are in need of improved water sources located in closer proximity in order to avoid negative coping mechanisms such as consumption of water from unsafe sources, school drop-out to collect water, early marriage of daughters, and migration.• Assessment results for key water, sanitation and hygiene indicators are

generally lower than the national averages. 15.5% of interviewed HH have access to improved water sources as compared to the national average of 65% according to the 2014 Afghanistan Living Conditions Survey (ALCS).

• The results are consistently poorer for Jawand District, where only WV has recently gained access. 100% of households in Jawand district, for example, are consuming water from unprotected sources.

• Furthermore, by not treating water (97.5% of households versus a national average of 90% according to the 2015 Afghanistan Demographic and Health Survey [ADHS]), household members are at risk of contracting waterborne diseases.

• Consumption of water from unprotected sources is considered by the communities to be a direct contributor to the high diarrhoea rates in children under 5 - 39% compared to the national average of 29% according to the 2015 ADHS.

• Water sources are also located far from the home, with 72% not meeting the key sphere standard of having a water source within 500 metres of the household.

• The majority of people collecting drinking water (mostly boys and men due to cultural restrictions on women), are spending more than 30 minutes collecting drinking water (66.5%), which is directly contributing to school absenteeism in 61% of households.

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• 88% of HHs reported to have on average a total of 5- 24 litres water storage, 8% of them have more than 25 litres water storage capacity and 4% have less than 5 litres water storage capacity

• With regard to hygiene, the low rate of access to soap (98.5%), coupled with reduced water access due to the drought is resulting in poor hygiene practices which is a key contributor to the high diarrhoea rate.

Health and NutritionMUAC results show that the nutrition situation is extremely critical and immediate food distribution and provision of life saving health and nutrition interventions is essential. The prevalence of malnutrition in children under 5 exceeds the WHO threshold for malnutrition (15%);• MUAC measurement results show a Global Acute Malnutrition (GAM) rate

of 32.8% (24.8 - 42.0 95% C.I.); Moderate Acute Malnutrition (MAM) rate of 15.9% (10.7 - 22.8 95% C.I.); and Severe Acute Malnutrition (SAM) of 16.9% (10.9 - 25.4 95% C.I.).

• SAM and MAM is extremely higher among girls than among boys (42.3% among girls compared to 25% among boys). The prevalence of oedema is 10.9%. Children 6 to 41 months have the highest level of SAM and MAM as compared to other age categories. The results show that 150 out of 342 women had a MUAC measurement of less than 23 cm, which means that 43.8% of women are malnourished.

• The assessment results show there is lack of access to nutrition services among communities and a low capacity of health facilities to provide IMAM services.

• 53% (20 out of 38) of health facilities are offering services for treatment of Severe Acute Malnutrition.

• None of the health facilities are offering nutrition services for Moderate Acute Malnutrition.

• In terms of supplies, all health facilities have MUAC tapes, 24 out of 38 health facilities have at least one SECA scale whereas 37% do not have a SECA scale.

• Only 28% (136 out of 488) of CHWs have received nutrition training since January of last year.

• The remoteness to the clinic to get qualified health services is a significant factor affecting access to services (97.5% of HHs). It takes on average 4.5 hours walking time to get to the nearest health facility. Other challenges include a lack of money for health treatments (78% of HHs) and lack of medicines in the health facility (reported by 56% of HHs).

• Pregnant women have a low level of access to antenatal and postnatal care. 51.9% of women of reproductive age have not visited a doctor/nurse or midwife at all during pregnancy. 81.9% of women have given birth at home and 65% were assisted by traditional birth attendants. Only 18.8 % have been assisted during delivery by skilled health staff.

• A low rate of basic immunizations among children aged 12 – 23 months is found in Badghis districts. 23.8% of caregivers reported that their child received Penta 3 and showed the card, and 24.4% reported the child has been vaccinated against measles and have cards.

• A high level of Acute Respiratory Infections (ARI) amongst children under 5 was reported by caregivers. 60% of women reported that their child under 5 had experienced an ARI episode in the past two weeks.

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• A high incidence of diarrhea (39% compared to national average of 29% [ADHS, 2105]) among under 5 children was found from the assessment household survey. Communities attribute the diarrhea incidence to the lack of safe drinking water, and poor hygiene and sanitation conditions and practices.

EducationAssessment results show low school attendance due to the drought as children have to collect water from far distances, work to support their families, and travel long distances from their communities to schools. The lack of household income creates an additional barrier as families are unable to afford children’s education expenses.• 46% (323 out of 704) of school age children in the surveyed villages are

currently attending school. Attendance is significantly lower for girls compared to boys - 37% for school age girls versus 54% for boys.

• The school attendance in Jawand district is alarmingly low as only 14% of school age boys and 3% of school age girls are attending school.

• 61.1% of HHs stated that children missed school days because they have to collect water.

• The main reasons explaining girls’ low school attendance are the social norms restricting girls to continue their education particularly secondary school, the unavailability of girls-only schools (most of the schools offer education for both girls and boys at the same time or different shifts), and lack of female teachers (particularly for secondary education when the girl students reach puberty age and families do not want their girls interacting with male teachers and administration staff).

• In 81% of the 27 schools surveyed there have been cases of children missing school days for an average of 7.4 days per month (school principals’ report) because of lack of water due to drought.

• In 37% of the surveyed schools there is lack of access to water because the water wells in the schools have dried and they also lack functional sanitation facilities (latrines).

Findings

Households and Communities Demographics

98% of the surveyed households (HH) reported to be permanent residents in the communities and only 1.5% reported to be Internally Displaced People (IDPs); 5% in Jawand District and 2.5% in Abkamary District.

The surveyed households have on average 12 people comprised of 4 adults (2 male and 2 female), 4 children of age 6-17 years old (2 male and 2 female), 4 children of age 0 to 5 (2 girls and 2 boys). In regards to shelter, 93% of

surveyed HHs live in a private house, 5.5% live in a room of a relative’s house (10% in Moqur) and 1.5% live in a tent/ plastic sheeting/ shelter.

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It is also important to note that there is a high rate of people living with disabilities in the communities (17.5% of households in Qadis, and 30% in Jawand District). The drought is therefore likely to exacerbate existing accessibility issues for these vulnerable groups. Refer to the table below and annexes for district level information on household demographics.HHs Residence status

Permanentresident Returnee IDP Total

District Abkamary Count 38 1 1 40% within District 95.0% 2.5% 2.5% 100.0%

Jawand Count 38 0 2 40% within District 95.0% 0.0% 5.0% 100.0%

Moqur Count 40 0 0 40% within District 100.0% 0.0% 0.0% 100.0%

Qadis Count 40 0 0 40% within District 100.0% 0.0% 0.0% 100.0%

QIN Count 40 0 0 40% within District 100.0% 0.0% 0.0% 100.0%

Total Count 196 1 3 200% 98.0% 0.5% 1.5% 100.0%

HHs who have people living with disabilitiesYes No Total

District Abkamary Count 6 34 40% within District 15.0% 85.0% 100.0%

Jawand Count 12 28 40% within District 30.0% 70.0% 100.0%

Moqur Count 6 34 40% within District 15.0% 85.0% 100.0%

Qadis Count 7 33 40% within District 17.5% 82.5% 100.0%

QIN Count 6 34 40% within District 15.0% 85.0% 100.0%

Total Count 37 163 200% within District 18.5% 81.5% 100.0%

Agriculture production and livestockCommunity discussions and household interviews indicate that the majority of households own or manage agricultural land, and rain-fed agriculture is predominant. 85% of HHs said they own or manage agricultural land and few of them have access to or own irrigated land. Focus group discussion (FGD) participants raised concerns about the significant negative impact that the drought has had on agricultural production this year.

“The cultivating lands are mostly rain fed and little amount of irrigated lands is available. But due to severe drought all our crops have been damaged and we will not have any products this year. The land in which we cultivated vegetables like potato and tomato have also has been damaged by the

recent flood” - FGD with CDCs male members in Tagab Alam in Jawand District.

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More specifically, 79.5% of interviewed households have estimated to have access to/own 12.8 jeribs (2.6 hectares) rain-fed land and 10% of the surveyed households have estimated to have access to/own 2.5 jeribs (0.5 hectares) irrigated land this year. The HH assessment surveys indicate a decrease in the land unit cultivation this year as compared to last year; respectively an average of 2.3 jeribs of irrigated land this year versus 3 jeribs cultivated last year and 8.1 jeribs rain fed land this year versus 10 jeribs cultivated last. Refer to the table below and annexes section for more detailed information for district level.

Do you or any of your household membersown or have access to agriculture land? Yes No TotalDistrict Abkamary Count 32 8 40

% 80.0% 20.0% 100.0%Jawand Count 38 2 40

% 95.0% 5.0% 100.0%Moqur Count 27 13 40

% 67.5% 32.5% 100.0%Qadis Count 31 9 40

% 77.5% 22.5% 100.0%QIN Count 35 5 40

% 87.5% 12.5% 100.0%Total Count 163 37 200

% 81.5% 18.5% 100.0%

HH survey respondents ranked the irrigation/rainfall water shortage as the first significant challenge faced for the cultivation process this year (61% of HHs), lack of seeds was ranked as the second most significant challenge (35.5% of HHs), and the third challenge cited was the lack of tools and fertilizers (20.5% of HHs). 97.5% of the respondents in the HH survey cited not having access at all to seeds for the plantation season and only 2.5% them said they have seeds, but still it is not sufficient.The lack of support and assistance for agriculture production was mentioned by the community members during the assessment surveys. Particularly in the remote areas in Jawand district the situation in regards to support is very critical given that no humanitarian organizations have been operating in the area. The only cases of support and assistance mentioned was the support given from the Department of Agriculture, Irrigation and Livestock (DAIL) to treat apple tree diseases in Arbab Sarwarvillage in Qadis District, and the assistance of World Vision in Zingar village in Abkamary district.49% of households reported to own livestock whereas the other 50.5% stated they do not. The number of livestock owned by households this year has

“We did not receive yet any type of assistance. As our village is far from the capital of the province we do not benefit from development projects and no organizations have interventions here” - FGD with CDC male members in Tagab Alam, Jawand District

decreased compared to the past year. Of those households who reported to have livestock, the average number of sheep/goats for this year is 7.4 compared to 21. 8 sheep/goats per household in the last year. The average number of cattle is 1.6 this year compared to 2 in the last year, and the average number of horses/mules or donkeys

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owned by household this year is 2 versus 2.9 in the past year. Only 30% of HHs reported to own on average 6.8 chickens.

68% of the HHs stated to have had livestock deaths during the last six months as a result of the drought, and similarly 69% of them reported to have experienced reduced livestock productivity during the same period. Lack of pasture was the most mentioned challenge faced for livestock during the past six months (77% of HHs), followed by lack of money (70.5% of HHs), and lack of water (69% of HHs). Unusual diseases in livestock were reported from 49% of the HHs and lack of market to sell the livestock by 47% HHs.In the FGDs community members also highlighted the critical situation regarding livestock loss because of the lack of water and pasture, and asked for assistance given that no governmental or humanitarian entities have provided any sort of livestock related assistance to them. Only in one case, in Zingar village in Abkamary District, did community members mention that DAIL has distributed food for livestock to 180 families.More detailed information on the livestock situation at the district level can be found in the tables below and annexes.

“Due to drought crisis, our livestock has been damaged and most of the animals have died because of no food and water. There is no posture because of no rain and our animals mostly died because of no water, fodder and disease” - FGD with womenin Sulaiman Khan Baghak, Qala Naw District.

Do you own any livestock/animals? Yes No TotalDistrict Abkamary Count 17 23 40

% 42.5% 57.5% 100.0%Jawand Count 28 12 40

% 70.0% 30.0% 100.0%Moqur Count 17 23 40

% 42.5% 57.5% 100.0%Qadis Count 17 23 40

% 42.5% 57.5% 100.0%QIN Count 20 20 40

% 50.0% 50.0% 100.0%Total Count 99 101 200

% 49.5% 50.5% 100.0%Have you experienced any livestockdeaths in the last six months due todrought? Yes No TotalDistrict Abkamary Count 22 18 40

% 55.0% 45.0% 100.0%Jawand Count 35 5 40

% 87.5% 12.5% 100.0%Moqur Count 29 11 40

% 72.5% 27.5% 100.0%Qadis Count 23 17 40

% 57.5% 42.5% 100.0%QIN Count 27 13 40

% 67.5% 32.5% 100.0%Total Count 136 64 200

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% 68.0% 32.0% 100.0%Has lack of pasture been a challenge forlivestock rearing in the past six months? Yes No TotalDistrict Abkamary Count 30 10 40

% 75.0% 25.0% 100.0%Jawand Count 35 5 40

% 87.5% 12.5% 100.0%Moqur Count 34 6 40

% 85.0% 15.0% 100.0%Qadis Count 24 16 40

% 60.0% 40.0% 100.0%QIN Count 31 9 40

% 77.5% 22.5% 100.0%Total Count 154 46 200

% 77.0% 23.0% 100.0%

Access to food, consumption and coping strategies

Household respondents estimated that this time last year they had an average of 4 months cereal stock, whereas for this year they estimated their current cereal stock will last for only 0.07 months or 2.1 days. In the focus group discussions, the major concerning theme for community members was the emergent crisis of reduced access to food and the consequences it will have for people if no one intervenes to assist them.

Household respondents were asked to select according to the order of importance three things they do to fill the food gap when harvested produce does not last until the next harvest season. Working for food and borrowing were the most ranked, as well as waiting for food aid.

“There are no positive changes this year, only negative change in regards to the access to food. It has decreased compared to the past year and it is highly likely that a human tragedy will occur if there is no immediate intervention by humanitarian organization and other entities” – FGD with CDC members in Tagab Alam, Jawand District.

Ranking of

responding

mechanisms

when the

harvest does

not last to the next

harvesting season

Perc 9.5

e 10 50

n 12 2112t

a 21.5g 37.5 36.5 29

4.5 4.5e

0.5 11124

5 9.54 4 2

Work for Borrow Borrow Wait for Sell assets Purchase Sell No actionfood from a food aid and buy from livestock

relative food savings and buy

First Second Third food

78% of households rated the food security situation “a lot worse” as compared to the same time last year and 21% rated it as “worse.” HH respondents claimed to have consumed cereals or tubers (such as bread, wheat, rice, maize, potatoes, sweet potatoes, etc.) on average every day in the past week, oil and fat 4 days in the past week, and pulses (such as beans, lentils, peas, etc.) only once in the past week. Other types of the foods such as meat products, dairy products, vegetables, fruits and sugars were scarcely reported as part of the food diet in the past week.

All interviewed HHs reported to not having enough food for the past week and the most frequent coping strategy was to rely on less preferred and less expensive food – used 2 days in the past week, and reducing the portion size of meals at mealtimes - used 1.5 days in the past week.

94% of HHs reported to have not had sufficient money to obtain food or to cover other expenditures in the past 6 months. The most cited coping strategies when having difficulties to obtain food and cover livelihood expenditures were decreasing expenditure on health and education, migration to look for jobs, increased daily labor and increasing the sale of natural resources. An alarming finding worthy to highlight is that about half (52.1%) of households cited early marriage of a daughter as a coping strategy when food is not secure and income is not able to cover other family expenses. Refer to table, charts below and annexes section for district level information in regards to food access and consumption.

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Main coping strategies used by HHs when facing difficulties to obtain food or to cover other family expenses

Districts Decreased Migrated toIncreased daily Increased

Early marriage

expenditures look for job labor (number collection of a daughteron health, of days and and sale ofeducation hours) natural

resourcesAbkamary 65.7% 68.6% 51.4% 74.3% 40%Jawand 69.2% 69.2% 64.1% 43.6% 56.4%Moqur 73.7 63.2% 65.8% 50% 55.3%Qadis 64.9% 62.2% 62.2% 59.5% 59.5%Qala Naw 82.1% 59% 51.3% 59% 48.7%Total 71.3% 64.4% 59% 56.9% 52.1%province

Frequency of coping strategies when HH food was not sufficient inthe past week

2.5

22

1.61 1.591.48

1.51.2

1

0.5

0rely on less preferred Borrow food, or rely Limit portion size at Restrict consumption Reduce number of

and less expensive on help from a friend mealtimes by adults in order for meals eaten in a dayfoods or relative small children to eat

Number of days used in the past week

Household income sources, expenditures and prioritiesThe assessment survey results show that the majority of the households rely heavily on rain fed agriculture and livestock for their livelihood and there is a significant lack of access to alternative income resources. The participants in the FGDs cited that the drought and low level of rainfall this past year has had a devastating effect upon their crops, therefore putting the families in a critical situation for food access currently and for the foreseeable future.

“The only income generation for the villagers are agriculture and animal husbandry which have been destroyed by this drought” - FGD with CDC members in Cheshma Dozdak Moqur District

90% (180 out of 200) of HH respondents ranked agriculture and livestock as the first source of cash income, followed by non-agricultural wage labor with 6.5%. 88.3% of respondents stated they do not have a second source of income and 94.5% of them stated not to have a third source of cash income.

85% of the HHs reported that the main source of their income comes from the production and sale of field crops, whereas another 3.5% cited shepherding wage labor as their primary source of cash income.57% of the surveyed HHs reported to have no cash income in the past 30 days. Of those 43% of HHs who reported having income, the income level was estimated to be an average of 2899 Afghanis (approx. 40 USD) in the past month.99% of the respondents stated that household income has decreased compared to last year. According to 98.5% of HH respondents the main reason identified for the decrease is the drought, followed by reduced opportunities to generate income (55% of HHs).

“Drought affected the community economy and people have lost their income sources. Some of the people have migrated and some of them don’t have access to bread to feed

In the HH interviews the respondents estimated an expenditure of 4024 Afghanis or approximately 56 USD in the last month, whereas the average expenditure of households on non- food items during the past 12 months was estimated to be 9422 Afghanis (131 USD).Households and community members reported a decrease in household expenditure for both food and non- food items compared to last year. More specifically, 96.5% of surveyed HHs reported a decrease of expenditure on food items and 94% of HHs reported a decrease of expenditures on non-food items.90.5% of interviewed HHs reported to have borrowed money or in-kind items to be able to provide for their livelihood in the past 12 months. The most important reasons ranked for borrowing money were the provision of food for family, followed by health expenses and the purchasing of agricultural inputs such as seeds, fertilizers and other tools.All households claimed to have experienced shocks during the past six months, with the main shock being drought (77.5% of HHs). The other main shock was reduced income (70% of HHs).Regarding HH priorities, 58% of the them ranked access to food as their first priority; the second ranked priority was improving access to quality drinking water (32% of HHs); and the third ranked was the improvement of health facilities and services in the area (29% of HHs). In the FGDs, food commodities distribution, provision of fodder for livestock and water interventions were identified as the top priority needs.

Please refer to following figures and the annexes section for more detailed information on HH income, expenditures, shocks and priority needs at the district level.

FGD with men in Zingar, Abkamary District

“We, the people of Cheshma dozdak village want World Vision and other donors to help us as soon as possible. Please provide food for us, make for us a water distribution network. Provide fodder for our livestock and help us for the nutrition of children” - FGD with women in Cheshma dozdak, Moqur District.

Page 17 of 34

What was your main first source of cash income in the last 12 months?

SmallAgriculture Non

business/

andAgriculture Skilled Salary Petty

livestockWage labor Labor work trade Total

DistrictAbkamary Count 36 3 1 0 0 40

% 90.0% 7.5% 2.5% 0.0% 0.0% 100.0%Jawand Count 40 0 0 0 0 40

% 100.0% 0.0% 0.0% 0.0% 0.0% 100.0%Moqur Count 35 3 1 0 1 40

% 87.5% 7.5% 2.5% 0.0% 2.5% 100.0%Qadis Count 35 4 1 0 0 40

% 87.5% 10.0% 2.5% 0.0% 0.0% 100.0%

QIN Count 34 3 2 1 0 40% 85.0% 7.5% 5.0% 2.5% 0.0% 100.0%

Total Count 180 13 5 1 1 200

% 90.0% 6.5% 2.5% 0.5% 0.5% 100.0%

What was your second source of cash income in the last 12 months?Assistancefrom

Small Govern-

Nonbusiness/

ment/UN/ No

Agriculture Skilled Salary Petty NGOs secondWage labor Labor work trade etc. source Total

DistrictAbkamary Count 4 4 0 1 6 22 37

% 10.8% 10.8% 0.0% 2.7% 16.2% 59.5% 100.0%Jawand Count 0 0 0 0 0 40 40

% 0.0% 0.0% 0.0% 0.0% 0.0% 100.0% 100.0%

Moqur Count 0 0 0 0 0 40 40% 0.0% 0.0% 0.0% 0.0% 0.0% 100.0% 100.0%

Qadis Count 3 0 0 0 1 36 40

% 7.5% 0.0% 0.0% 0.0% 2.5% 90.0% 100.0%QIN Count 3 0 1 0 0 36 40

% 7.5% 0.0% 2.5% 0.0% 0.0% 90.0% 100.0%Total Count 10 4 1 1 7 174 197

% 5.1% 2.0% 0.5% 0.5% 3.6% 88.3% 100.0%

What was your third source of cash income in the last 12 months?AssistancefromGovernment/ No third

Skilled Salary UN/NGOscash source

Labor work etc. Transport income Total

DistrictAbkamary Count 2 1 5 1 30 39

% 5.1% 2.6% 12.8% 2.6% 76.9% 100.0%Jawand Count 0 0 0 0 40 40

% 0.0% 0.0% 0.0% 0.0% 100.0% 100.0%Moqur Count 0 0 0 0 40 40

% 0.0% 0.0% 0.0% 0.0% 100.0% 100.0%Qadis Count 0 0 1 0 39 40

% 0.0% 0.0% 2.5% 0.0% 97.5% 100.0%QIN Count 0 0 1 0 39 40

% 0.0% 0.0% 2.5% 0.0% 97.5% 100.0%Total Count 2 1 7 1 188 199

% 1.0% 0.5% 3.5% 0.5% 94.5% 100.0%

Reasons for decrease in HH income120

100

80

60

40

20

0

100 10097.5 97.5 97.5 98.5

6560 55

47.542.5

17.512.5

1015

10105

7.55 5 2.5

55 5

8.5 82.5 0

Abkamary Jawand Moqur Qadis Qala Naw Total

Reduced opportunities for income Drought

Migration Conflict

More competion for jobs due to IDPs or returnees Illness or death of family member

“The refined drinking water well provided by WV has good quality for drinking and the people are very grateful for this innovation. People expect to have this type of intervention in other villages to solve their problems for drinking water, especially for the wellbeing of children” – FGD with community members in Zingar village, Abkamary District.

Water, Sanitation and Hygiene (WASH)WaterAssessment surveys indicate a critical situation regarding access to drinking water; in all communities people are facing water shortage and they accessing water from unprotected sources. The majority of observed HHs (84%) access water from unprotected sources (streams, rivers, unprotected springs, open hand dug wells and kariz) and access to drinking water is worsened significantly this year due to the severe drought. The main sources that people rely on are streams/rivers/ponds (53%) and open hand dug wells (29.5%).

“Due to the lack of rainfall and long drought, we were facing lack of the water in the spring. Well and underground water has decreased significantly; the river dried too”- FGD with CDC members in Cheshma Dozdak, Moqur District.

The average quantity of water used by an individual per day in the province is 5.6 litres. Only 15.5% of HHs consume water from protected sources (wells with concrete covers or hand pumps, boreholes with hand pumps, protected springs, piped water from a tap, or rainwater). The main protected sources are boreholes with hand pumps (5%) and piped water from a tap (5%). Of notable importance is the finding that 100% of households in Jawand District are consuming water from unprotected sources.

Overall, most of the community FGDs raised the issue of poor quality of drinking water and high salinity. Few examples of good safe drinkable water sources were mentioned, one of those came from community members in Zingar village where WV has recently constructed a solar powered reverse osmosis (RO) water treatment unit. 72% of the interviewed HHs have to travel a distance of more than 500 meters to their drinking water source and only 27.5% have a water source within 500 meters (SPHERE standard). 66.5% of HHs spend more than 30 minutes collecting drinking water. Only 3.5% (7/200) of households meet the Joint Monitoring Program (JMP) standard for “basic access” - an improved water source within a 30 minute round trip of the household.

It should be noted that the majority of communities selected for this assessment have not been targeted by WV WASH interventions in the past, which helps explain the low figure. 77.5% HHs have at least one narrow-necked or covered water container for exclusive drinking water use. 88% of HHs reported to have on average a total of 5- 24 litres water storage capacity, 8% of them have more than 25 litres water storage capacity and 4% have water storage capacity of less than 5 litres.

Adult males and boys were identified as the main HH members responsible for collecting drinking water (about 90% of HHs respondents cited them) and women and girls were less mentioned (less than half of HHs citing them). Community members mentioned during the FGDs that the long distance to drinking water sources is the responsibility of children for collecting water and it negatively affects their school attendance. 61.1% of HH survey respondents stated that children miss school because they have to collect water. In the FGDs, community members also raised concerns related to security and risks associated with water collection, particularly for children, given the long distance to the drinking water source. It seems that women and girls are less involved with water collection because of the security concerns and protective norms towards the movement of women and girls, thus men and boys are mostly involved with water collection.The assessment surveys indicate very poor practices in regards to the treatment of drinking water in the communities. 97.5% of interviewed households said they do not treat drinking water to make it safer to drink. Of those households who treat their drinking water, boiling and filtering by cloth were cited as the main treatment methods. People in the FGDs mentioned lack of awareness and knowledge for treating water and economic constraints as the main reasons why people do not treat water.SanitationWith regard to sanitation, 65.5% of HHs are using an improved latrine (composting / eco-san latrine) and 10.5% are using an unimproved latrine (simple pit/vault latrine with dirt floor). 24% of HHs do not have a latrine. Of the HHs that have a latrine, 66.5% reported the toilet to be functional.

HygieneAmong HHs surveyed 98.5% did not possess soap for hand washing and hygiene. 99.5% reported not having received hygiene kits within the past year. 52.5% of HHs have access to a bathing area at the household level and there are no communal bathing areas. For more detailed information on WASH at the district level, refer to the charts and tables below as well as the annexes section.

HHs accessing drinking water from a protected water sourceHand dug well Pipedwith concrete Borehole watercover or hand with hand from a

Protected Rain

pump pump tap spring water TotalDistrict

Abkamary Count 2 5 5 2 0 14

% 5.0% 12.5% 12.5% 5.0% 0.0% 35%Jawand Count 0 0 0 0 0 0

% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%Moqur Count 0 2 0 0 5 7

% 0.0% 5.0% 0.0% 0.0% 12.5% 17.5Qadis Count 1 1 0 0 0 2

% 2.5% 2.5% 0.0% 0.0% 0.0% 5%QIN Count 0 2 5 0 1 9

% 0.0% 5.0% 12.5% 0.0% 2.5% 22.5Total Count 3 10 10 2 6 31

% 1.5% 5.0% 5.0% 1.0% 3% 15.5%

Page 21 of 34

HHs accessing drinking water from an unprotected water source

Open handStream, river

dug well or pond Kariz Other TotalDistrict

Abkamary Count 10 16 0 0 26

% 25.0% 40.0% 0.0% 0.0% 65%Jawand Count 4 36 0 0 40

% 10.0% 90.0% 0.0% 0.0% 100%Moqur Count 7 26 0 0 33

% 17.5% 65.0% 0.0% 0% 82.5Qadis Count 28 7 3 0 38

% 70.0% 17.5% 7.5% 0.0% 95%QIN Count 10 21 0 1 32

% 25.0% 52.5% 0.0% 2.5% 77.5%Total Count 59 106 3 1 169

% 29.5% 53.0% 1.5% 0.5% 84.5%

HHs report on the distance between the HH and drinking water source

Water source more than 500 metres Water source less than 500 metres

100 92.590 82.5

8065

7270 62.5

57.560

5035 37.5

42.540

27.53017.5

20510

0Abkamary Jawand Moqur Qadis Qala Naw Total

Page 22 of 34

HH report on the time spent for water collection

TOTAL 33.566.5

QALA NAW 4555

QADIS 42.557.5

MOQUR 2575

JAWAND 1585

ABKAMARY 4060

0 10 20 30 40 50 60 70 80 90

Less than 30 minutes More than 30 minutes

What type of toilet facility is used in this HH?Simple pit/vault Compostingwith a dirt floor

eco-san latrine

(unimproved) (improved)No facility Total

District Abkamary Count 10 28 2 40% 25.0% 70.0% 5.0% 100.0%

Jawand Count 1 30 9 40% 2.5% 75.0% 22.5% 100.0%

Moqur Count 8 18 14 40% 20.0% 45.0% 35.0% 100.0%

Qadis Count 1 30 9 40% 2.5% 75.0% 22.5% 100.0%

QIN Count 1 25 14 40% 2.5% 62.5% 35.0% 100.0%

Total Count 21 131 48 200% 10.5% 65.5% 24.0% 100.0%

Analysis of WASH ResultsResults for key water, sanitation and hygiene indicators are generally lower than the national averages. According to the 2014 Afghanistan Living Conditions Survey (ALCS) for example, the national average for access to improved water systems is 65%, compared to 15.5% found in the assessment. Of the five districts above, the results are consistently poorer for Jawand District, where WV has only recently gained access. 100% of households in Jawand district, for example, are consuming water from unprotected sources. Furthermore, by not treating water (97.5% of households versus a national average of 90% according to the 2015 Afghanistan Demographic and Health Survey [ADHS]) household members are at risk of contracting waterborne diseases. This is considered by the communities to be a direct contributor to the high diarrhoea rates in children under 5 (39% compared

to national average of 29% according to the 2015 ADHS) (see Health and Nutrition section below for more details).Water sources are also located far from the home, with 72% not meeting the key sphere standard of having a water source within 500 metres of the household. The majority of people collecting drinking water (mostly boys and men due to cultural restrictions on women), are spending more than 30 minutes collecting drinking water, which is directly contributing to school absences in 61% of households. Average HH water storage capacity is low indicating a need for provision of safe water storage containers.Based on the above results, it is clear that communities in Badghis have been facing water shortage issues as a result of the drought and they are in need of improved water sources located in closer proximity to households in order to avoid negative coping mechanisms such as consumption of water from unsafe sources, school drop-out to collect water, early marriage of daughters, and migration.

It is also important to consider these results in relation to the high rate of people with disabilities in the communities (18.5% of interviewed households in Badghis, and 30% in Jawand District). The existing accessibility issues that these vulnerable groups are likely facing will be exacerbated by the drought; particularly for sourcing water which may now be located further away from their homes.

Health and NutritionChildren under 5 and women nutrition statusMUAC results show that nutrition situation is extremely critical and needs immediate food distribution and provision of life saving health and nutrition interventions to the affected locations. MUAC measurements results show a GAM rate of 32.8 % (24.8 - 42.0 95% C.I.); MAM rate of 15.9 % (10.7 - 22.8 95% C.I.) and SAM: 16.9 % (10.9 - 25.4 95% C.I.)SAM and MAM (GAM) is extremely high in girls comparing to the boys (42.3% in girls comparing to 25% among boys).The prevalence of oedema is 10.9 %. Children 6 to 41 months has the heights level of SAM and MAM comparing to other age categories.The results showed that 150 out of 342 women had MUAC measurement of less than 23 cm, which means that 43.8% (38.8 – 48.8 95% C.I.) of women are malnourished.

“Emergency help is needed for malnourished infants and women. Most people suffer from this. The health center is not able to give attention to malnourished children and women” - FGD with men in Arbab

Refer to tables below and annexes for more information on nutrition status for children under 5 and pregnant lactating women.

Page 24 of 34

Prevalence of acute malnutrition based on MUAC cut-off's (and/or oedema) and by sex

Description AllBoys

Girls

n = 372

n = 204

n = 168

Prevalence of global malnutrition(122) 32.8 %

(51) 25.0 %

(71) 42.3 %

(< 125 mm and/or oedema)(24.8 - 42.0 95%

(16.8 -35.5 95%

(30.7 -54.7 95%

C.I.) C.I.) C.I.)Prevalence of moderate malnutrition (59) 15.9 %

(25) 12.3 %

(34) 20.2 %

(< 125 mm and >= 115 mm, no(10.7 - 22.8 95% (7.2 - 20.1 95%

(12.3 -31.6 95%

oedema) C.I.) C.I.) C.I.)

Prevalence of severe malnutrition (63) 16.9 %(26) 12.7 %

(37) 22.0 %

(< 115 mm and/or oedema)(10.9 - 25.4 95% (7.0 - 22.0 95%

(14.5 -31.9 95%

C.I.) C.I.) C.I.)

Prevalence of acute malnutrition by age, based on MUAC cut off's and/or oedema

Description Severe wastingModerate wasting Normal

Oedema

(< 115 mm)(>= 115 mm and (> = 125 mm )<125 mm)

Age Total No. % No. % No. % No. %(mo) no.6-17 142 20 14.1 40 28.2 82 57.7 16 11.3

18-29 118 10 8.5 19 16.1 89 75.4 14 11.9

30-41 56 1 1.8 8 14.3 47 83.9 6 10.7

42-53 41 0 0.0 3 7.3 38 92.7 3 7.3

54-59 15 0 0.0 1 6.7 14 93.3 1 6.7

Total 372 31 8.3 71 19.1 270 72.6 40 10.8

Page 25 of 34

MUAC measurements results for children under five in district level

Ab Kamari MUAC results All Boys Girlsn = 90

n = 46

n = 44


(13) 28.3 %

(11) 25.0 %

(< 125 mm and/or oedema)(18.6 - 36.6 95%

(17.3 - 42.5 95%

(14.6 - 39.4 95%

C.I.) C.I.) C.I.)Prevalence of moderate malnutrition (5) 5.6 % (2) 4.3 % (3) 6.8 %(< 125 mm and >= 115 mm, no oedema) (2.4 -

12.4 95% (1.2 -

14.5 95% (2.3 - 18.2 95%

C.I.) C.I.) C.I.)

Prevalence of severe malnutrition(19) 21.1 %

(11) 23.9 % (8) 18.2 %

(< 115 mm and/or oedema)(14.0 -

30.6 95%

(13.9 -

37.9 95% (9.5 - 32.0 95%

C.I.) C.I.) C.I.)Moqur MUAC results All Boys Girls

n = 90

n = 48

n = 42


(14) 29.2 %

(17) 40.5 %


65.7 95%

(16.3 -

46.5 95% (8.2 - 83.9 95%

C.I.) C.I.) C.I.)Prevalence of moderate malnutrition

(15) 16.7 % (8) 16.7 % (7) 16.7 %

(< 125 mm and >= 115 mm, no oedema) (6.7 -

35.6 95% (9.6 -

27.4 95% (4.5 - 46.1 95%

C.I.) C.I.) C.I.)

Prevalence of severe malnutrition(16) 17.8 % (6) 12.5 %

(10) 23.8 %

(< 115 mm and/or oedema) (7.2 -37.

7 95% (7.2 -20.

7 95% (6.0 - 60.5 95%C.I.) C.I.) C.I.)

Qadis MUAC results All Boys Girlsn = 113

n = 59

n = 54


(18) 30.5 %

(14) 25.9 %


37.2 95%

(20.3 -

43.1 95%

(16.1 - 38.9 95%

C.I.) C.I.) C.I.)Prevalence of moderate malnutrition

(18) 15.9 % (9) 15.3 % (9) 16.7 %

(< 125 mm and >= 115 mm, no oedema)

(10.3 -

23.8 95% (8.2 -

26.5 95% (9.0 - 28.7 95%

C.I.) C.I.) C.I.)

Prevalence of severe malnutrition(14) 12.4 % (9) 15.3 % (5) 9.3 %

(< 115 mm and/or oedema) (7.5 -19.

7 95% (8.2 -26.

5 95% (4.0 - 19.9 95%C.I.) C.I.) C.I.)

Qala Naw MUAC results All Boys Girlsn = 41

n = 21

n = 20

Prevalence of global malnutrition(15) 36.6 % (5) 23.8 % (10) 50 %

(< 125 mm and/or oedema)(23.6 – 51.9 95%

(10.6 – 45.1 95%

(29.9 – 70.1 95%

C.I.) C.I.) C.I.)Prevalence of moderate malnutrition (6) 14.6 % (3) 14.3 % (3) 15 %(< 125 mm and >= 115 mm, no oedema)

(6.9 – 28.4 95% (5.0 – 34.6 95%

(5.2 – 36.0 95%

C.I.) C.I.) C.I.)Prevalence of severe malnutrition (9) 22.0% (2) 9.5 % (7) 35.0 %

(< 115 mm and/or oedema)(12.0 – 36.7 95% (2.7 – 28.9 95%

(18.1 – 56.7 95%

C.I.) C.I.) C.I.)

Page 26 of 34

Access to health servicesAll 200 households in 40 surveyed villages reported to have a walking distance of at least 30 minutes from the nearest health facility center. An average of 4.5 hours walking time to the nearest health facility was reported by the surveyed HHs. The remoteness of health facilities was the most cited health concern by communities in focus group discussions and household surveys. 97.5% of HH survey respondents cited remotenessamong the most serious health issues they are facing, followed by lack of money for health treatment (78% of HHs), and lack of medicines being available in the health facilities (56% of HHs).The assessment survey results show that pregnant women have a low level of access to health services and support from qualified health workers. 51.9% of women of reproductive age reported not to have visited a doctor, nurse or midwife at all during pregnancy. Only 2.5% have visited a health practitioner three times during the pregnancy.81.9% of women of reproductive age reported to have given birth at home, 18.8% of them gave birth in a public health facility (hospital or health facility). 65% of them were assisted during delivery by a traditional birth attendant, whereas only 18.8 % reported to have been assisted by a qualified health practitioner. 88% of female respondents said that no one checked on their health within the first 24 hours of delivery.96% of women reported to have breastfed their child under 5 years old and of those, 65.6% initiated breastfeeding with the first hour after delivery. 56.3% of women said their child under 5 has not received Penta 3 immunization. 23.8% reported the child has received Penta 3 and have a card, 7.5% said the child has received Penta 3 but did not have/show the card at the time of the survey, and the remaining 12.5% did not know. 57.5% of women respondents stated their child under 5 has not been vaccinated against measles, 24.4% reported the child has been vaccinated and has a card, 9.4% said the child has been vaccinated against measles but did not have/show the card at the time of the survey, and 8.8% did not know.A high level of Acute Respiratory Infection (ARI) amongst children under 5 was reported by caregivers, with 60% of women reporting that their child had an ARI episode within the past two weeks. A high incidence of diarrhea among under 5 children was found in the HH survey and 39% (187 out of 478) of children under 5 had experienced diarrhea in the past two weeks. Communities

attribute the diarrhea incidence to the lack of safe drinking water, and poor hygiene and sanitation conditions.

“The nearest medical clinic is far from here; it takes about 2 hours walking to reach the clinic located in the district center”- FGD with community members in

“There is an increase in diseases such as diarrhea, vomiting and nose-bleeding in this community. The main reason for these types of diseases is lack of safe drinking

water”- FGD with community members in Arbab Sarwar village, Qadis District.

For more detailed information about women and children’s health status and health-related issues at the district level, refer to the tables and charts below as well as the annexes section.

Page 27 of 34

Main health concerns reported by HHs

Districts RemoteLack of money for

Lack of medicines Lack of health

facilityhealth treatment in the health workers in the

facility facilityAbkamary 95% 62.5% 55% 30%Jawand 100% 77.5% 72.5% 72.5%Moqur 95% 77.5% 55% 40%Qadis 100% 72.5% 50% 37.5%Qala Naw 97.5% 100% 47.5% 35%Total 97.5% 78% 56% 43%province

Where did you give birth to the youngest child?Health Facility

Hospital (BHC, CHC) Home TotalDistrict Abkamary Count 3 4 33 40

% within District 7.5% 10.0% 82.5% 100.0%Moqur Count 5 1 34 40

% within District 12.5% 2.5% 85.0% 100.0%Qadis Count 1 3 36 40

% within District 2.5% 7.5% 90.0% 100.0%QIN Count 5 7 28 40

% within District 12.5% 17.5% 70.0% 100.0%Total Count 14 15 131 160

% 8.8% 9.4 81.9% 100%

Has your child had ARI in the past two weeks?Yes No Total

District Abkamary Count 20 20 40% within District 50.0% 50.0% 100.0%

Moqur Count 23 17 40% within District 57.5% 42.5% 100.0%

Qadis Count 26 14 40% within District 65.0% 35.0% 100.0%

QIN Count 26 14 40% within District 65.0% 35.0% 100.0%

Total Count 95 65 160% 59.4% 40.6% 100.0%

Prevalence of diarrhea for under 5 years old children

70 64.56050

36.5 40.2 3940 31.5 30.13020100

Abkamary Jawand Moqur Qadis Qala Naw Total

Has your child been vaccinated against Measles?

Yes ( has a Yes (doesn’t Don’tcard) have a card ) No Know Total

District Abkamary Count 21 1 13 5 40% within District 52.5% 2.5% 32.5% 12.5% 100.0%

Moqur Count 4 2 26 8 40% within District 10.0% 5.0% 65.0% 20.0% 100.0%

Qadis Count 6 6 27 1 40% within District 15.0% 15.0% 67.5% 2.5% 100.0%

QIN Count 8 6 26 0 40% within District 20.0% 15.0% 65.0% 0.0% 100.0%

Total Count 39 15 92 14 160% 24.4% 9.4% 57.5% 8.8% 100.0%

Has your child received Penta 3?

Yes ( has a Yes (doesn’t

card) have a card ) NoDon’t Know Total

District Abkamary Count 14 1 16 9 40% within District 35.0% 2.5% 40.0% 22.5% 100.0%

Moqur Count 7 2 28 3 40% within District 17.5% 5.0% 70.0% 7.5% 100.0%

Qadis Count 8 3 24 5 40% within District 20.0% 7.5% 60.0% 12.5% 100.0%

QIN Count 9 6 22 3 40% within District 22.5% 15.0% 55.0% 7.5% 100.0%

Total Count 38 12 90 20 160% 23.8% 7.5% 56.3% 12.5% 100.0%

IMAM services in health facilitiesThe document review of the records of Health Facilities (HFs) was undertaken to assess the current capacities of 38 facilities for provision of nutrition services in the five districts.

Page 29 of 34

The available data and the feedback of communities during FGDs indicate lack of and/or poor nutrition services and low capacity of health facilities to provide IMAM services. Also the long distance to the district center health facilities makes it difficult to access services. With some exceptions of vaccinator teams going out (about half of the villages reported this), there are no mobile health teams providing nutrition services in the communities.

“Only a vaccination team has come to this village.” - FGD with CDC members Baghak village, Qala Naw District

“We can't get proper access as we have no facilities offering nutrition services.” - FGDwith CDC members in Zingar village, Abkmary district

53% (20 out of 38) of health facilities have an outpatient department (OPD) for nutrition services for SAM, none of the health facilities has an OPD to offer nutrition services for MAM, and only the provincial Hospital in Qala Naw has an Inpatient Department (IPD) offering services for SAM. There are fewer health facilities in Qala Naw, Jawand and Moqur for SAM services than in the other districts (for more information see the tables at the end of this section).None of health staff in 38 health facilities have received Standard Operating Procedure (SoP) for nutrition training since January of last year and there is the need to train a total of 135 available health staff (22 doctors, 62 nurses, 18 Community Health Supervisors and 33 midwives). In terms of supplies, all health facilities have MUAC tapes, 24 out of 38 health facilities have at least one SECA scale, whereas 37% do not have a SECA scale.With regards to community outreach services for health and nutrition, only 47% of the health facilities have active health posts. The total number of active health posts is 244, and 488 (244 female and 244 male) Community Health Workers (CHWs) are in place to provide health services at the community level. Only 28% (136 out of 488) of CHWs have received nutrition training since January of last year. Of the active health posts, 201 out of 244 of them are implementing Community Based Nutrition Package (CBNP) activities. None of the Jawand district health posts are doing CBNP activities.All 38 health facilities reported to have had Vit. A and deworming coverage in the districts during the last National Immunization Day (NID) campaign. NGO staff and external monitors can go to health facilities for monitoring of services in all 38 health facilities. None of the health facilities are using the standard IMAM reporting tools, but all of them have submitted some form of a monthly report in the past three months.See the table below and annexes section for more detailed information about health facilities and IMAM services at the district level.

Health facilities and IMAM servicesAbkamary Moqur Jawand Qadis Qala Naw Total %

number

Number and 2 Basic 4 BHCs 2 BHC 6 BHC1 Provincial 1 HP

type of HFs Health2 SHC 4 SHC 4 SHC

Hospital (HP)

16 BHCCenters2 BHC(BHCs) 1 CHC 1 CHC 18 SHC

3 SHC5 Sub Health 3 CHCCenters 6 HFs

total(SHC) 6 HFs total

7 HFs total 11 HFs 38 HFs

1 totalComprehensive HealthCenter(CHC)8 HFs inTotal

Number of HFs 5 out of 8 3 out of 6 3 out of 77 out of 11 2 out of 6

20 out of 53%

with OPD SAM 63% 50% 43% 64% 40% 38

Number of HFs 0 0 0 0 0 0 0with OPD MAM

Number of HFs 0 0 0 0 1 1 3%with IPD SAM# of available 23 16 16 32 48 135 100%health staff who

2 doctors 6 nurses 2 doctors 2 doctors 16 doctors22 doctorsneed SoP

training 9 nurses 4 CHS 7 nurses 12 nurses 28 nurses 62 nurses4 CHS 6 midwives 2 CHS 7 CHS 1 CHS 18 CHS8 midwives 5 midwives

11 midwives 3 midwives

33 midwives

# of active49 in 4 out of

45 in 4 out of

93 in 7 out of

43 in 2 out

14 in 1 out of 488 in 18

47% of

health posts and 8 HFs 6 HFs 11 HFs of 7 HFs 6 HFs

HFs out of

HFs have

CHWs 49 female and

45 female and

93 female and

43 female

14 female and

38 activehealth

49 CHWs 45 male 93 maleand 43 male 14 male

244 female postsmale CHWs CHWs CHWs CHWs and 244male CHWs

# of CHWs20 out of 98

32 out of 90 0 56 out of

28 out of 28

136 out of 28%

received 186 488nutrition training

# of HPs49 out of 49

45 out of 45 0 out of 93

93 out of 93

14 HPs out of

201 out of 83%

implementing 14 244 HPsCommunityBased NutritionPackageactivitiesStandard IMAM No No No No No Noreporting tools

Page 31 of 34

EducationAssessments found that the school attendance is currently low; 46% (323 out of 704) of school age children in the surveyed villages are currently attending school. As per HH survey findings 54% (202 out of 374) of school age boys are attending school whereas only 37% (121 out of 330) of school age girls are currently attending school. The school attendance in Jawand district is alarmingly low as only 14% of boys and 3% of girls in surveyed households are reported to attend school. After Jawand, Moqur district has the lowest attendance rate followed by Qala-I-Naw and Abkamari respectively.

“One of the major challenges that affects children’s school attendance is that they are busy with fetching water for their families from long distances and grazing the livestock." - FGD with CDC members in Cheshma Dozdak village, Moqur district.

“Children also work to support their families as families cannot manage economically as thereis lack of food.” -Jawand District

In the HH survey and FDGs, the reasons cited for children not going in school were the drought (56% of respondents), long distance (55% of respondents), working to support family (52% of respondents), fetching water from far distances (46.5%) and lack of water in school (45%).For girls’ low school attendance additional reasons were cited in the FGDs:

“There is not a school building for girls, there are no female teachers and that is why less girls attend school. Girls commonly drop out after 7th grade because of these conditions and the cultural customs in the community.” - FGD with CDC members in Zingar village, Abkamary District.

a) The social norms restricting girls from continuing their education, particularly secondary school;b) The unavailability of female-only schools (most of the schools offer education for both girls and boys at the same time or in different shifts);c) Lack of female teachers, particularly for secondary education when the girl students reach puberty age and families do not want their girls interacting with male teachers and administration staff.

As it was noted in the first section, it is rather concerning that about half (52.1%) of households cited early marriage of the daughter as a coping strategy because of food insecurity and reduced income means families are not able to expenses.27 schools were also assessed during this assessment in 4 districts of Badghis (Moqur, Qala Naw, Abkamari and Qadis) in order to find out about school needs and the effects of the drought on children’s education. According to the Key Informant Interviews (KIIs) with school staff there has been a decrease in

FGD with men in Tagab Alam,

children’s access to school, with 48% of school principals reported cases of the absence of children in the school. The main reasons cited for the absence were the drought and also the displacement of some families from the area. In 81% of the schools surveyed there have been cases of children missing school days for an average of 7.4 days per month.

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The lack of water due to drought and non-functional sanitation (latrine) facilities is also negatively affecting student participation. In 37% of the surveyed schools there is lack of access to water because the water wells have dried and there is a lack of functional toilet and sanitation facilities.The school principals also identified the lack of drinking water as one of the most common reasons why children are not attending school (85% of respondents). Children having to work to contribute to earn income for the family (81% of respondents) and parents not being able to afford to keep them at school (59%) were also cited as reasons why children are not attending school.More detailed information about children’s education at the district level can be found in the charts below and annexes section.HHs report on proportion of boys and girls currently attending schools

80 76

70 67

62

6055 54

50 47

40 4240 37

30

20 14

10

0Abkamary Jawand Moqur Proportion of

age school girls going to school

Qadis Qala Naw Total Proportion of age

school boys going to school

HHs report on the reasons children do not attend school

45

Total 46.5 52.5 55.556. 5

Qala Naw 47.55052.5

45 47.5

Qadis52.5 57. 5

57.567.567.5

4555

Moqur 57.555

55

35 53Jawand 55

67.567.5

30

Abkamary 30 42.5

42.545

0 10 20 30 40 50 60 70 80

Lack of water in school Have to fetch water Have to work Long distance Drought

Page 34 of 34

· web viewworld vision afghanistan page 3 of 34 author diana ceci created date 08/12/2018...

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