1.
The
views
expressed
in
this
document
are
not
necessarily
the
views
of
UNFPA
Evaluation
of
UNFPA's
2nd
Country
Programme
in
Afghanistan
2006
–
2009
JUNE
–
AUGUST
2010
FINAL
EVALUATION
REPORT
Authored
by
Altai
Consulting

2. Altai
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2
nd
Country
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Contents
Contents
.................................................................................................................................................
2
List
of
Acronyms
.....................................................................................................................................
5
Acknowledgements
................................................................................................................................
8
1
Executive
Summary
........................................................................................................................
9
2
Introduction
..................................................................................................................................
14
2.1
Purpose
of
the
Evaluation
.......................................................................................................
14
2.2
Methodology
and
Tools
..........................................................................................................
15
2.3
Limitations
and
Constraints
.....................................................................................................
16
3
Strategic
Overview
.......................................................................................................................
18
3.1
Context
(2006)
.........................................................................................................................
18
3.2
Activities
..................................................................................................................................
19
3.3
Positioning
...............................................................................................................................
21
3.4
Ownership
and
Sustainability
..................................................................................................
23
3.5
Alignment
................................................................................................................................
24
3.6
Coordination
............................................................................................................................
28
3.7
Technical
Assistance
................................................................................................................
30
4
Organisational
Overview
..............................................................................................................
32
4.1
Too
much
with
too
little?
A
quick
financial
overview
.............................................................
32
4.2
Country
Office
Human
Resources
Management
.....................................................................
32
4.3
Geographical
targeting
............................................................................................................
34
4.4
Provincial
Offices
.....................................................................................................................
35
4.5
Support
Role
of
the
Regional
Office
........................................................................................
35
4.6
Partnership
with
Non-­‐Governmental
Organisations
...............................................................
36
4.7
External
Communication
and
Visibility
...................................................................................
36
5
Reproductive
Health,
Reproductive
Health
Commodity
Security
and
Family
Planning
...............
38
5.1
Objectives
and
Activities
.........................................................................................................
38
5.2
Relevance
................................................................................................................................
40
5.3
Effectiveness
...........................................................................................................................
42
5.4
Positioning
...............................................................................................................................
48
5.5
Ownership
and
Sustainability
..................................................................................................
49
5.6
Impact
.....................................................................................................................................
50

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2
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Country
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6
Mobile
Health
Units
.....................................................................................................................
54
6.1
Objectives
and
Activities
.........................................................................................................
54
6.2
Relevance
................................................................................................................................
54
6.3
Effectiveness
...........................................................................................................................
55
6.4
Positioning
...............................................................................................................................
59
6.5
Ownership
and
Sustainability
..................................................................................................
60
6.6
Impact
.....................................................................................................................................
61
7
Population
and
Housing
Census
...................................................................................................
65
7.1
Objective
and
Activities
...........................................................................................................
65
7.2
Relevance
................................................................................................................................
65
7.3
Effectiveness
...........................................................................................................................
67
7.4
Positioning
...............................................................................................................................
69
7.5
Ownership
and
Sustainability
..................................................................................................
71
7.6
Impact
.....................................................................................................................................
71
8
Religious
Leaders
..........................................................................................................................
73
8.1
Objectives
and
Activities
.........................................................................................................
73
8.2
Relevance
................................................................................................................................
73
8.3
Effectiveness
...........................................................................................................................
75
8.4
Positioning
...............................................................................................................................
76
8.5
Ownership
and
Sustainability
..................................................................................................
77
8.6
Impact
.....................................................................................................................................
78
9
Humanitarian
Assistance
..............................................................................................................
79
9.1
Objectives
and
Activities
.........................................................................................................
79
9.2
Relevance
................................................................................................................................
79
9.3
Positioning
...............................................................................................................................
80
10
Youth
Information
Centres
(YICs)
............................................................................................
82
10.1
Objectives
and
Activities
.....................................................................................................
82
10.2
Relevance
............................................................................................................................
82
10.3
Effectiveness
.......................................................................................................................
82
10.4
Positioning
..........................................................................................................................
83
10.5
Ownership
and
Sustainability
.............................................................................................
84
11
Gender
based
violence
(GBV)
..................................................................................................
86
11.1
Objectives
and
Activities
.....................................................................................................
86
11.2
Positioning
..........................................................................................................................
86

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11.3
Efficiency
.............................................................................................................................
87
11.4
Effectiveness
.......................................................................................................................
87
11.5
Ownership
...........................................................................................................................
88
12
Recommendations
..................................................................................................................
89
12.1
Strategic
Level
Recommendations
......................................................................................
89
12.2
Operational
Level
Recommendations
.................................................................................
91
12.3
The
Implementation
and
Thematic
Levels
..........................................................................
92
Appendix
A
–
Key
Informant
Interviews
...............................................................................................
95
Appendix
B
–
Baseline
Indicators
.........................................................................................................
98
Appendix
C
–
HR
Shortfall
..................................................................................................................
101
Appendix
D
–
Survey
Locations
..........................................................................................................
102
Appendix
E
–
Community
Based
Survey:
Are
Religious
Leaders
the
Best
Gate
Keepers?
..................
104

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Afghanistan
2
nd
Country
Programme
Evaluation
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List
of
Acronyms
AADA
Agency
for
Assistance
and
Development
of
Afghanistan
AIRHC
Afghanistan
Independent
Human
Rights
Commission
ANC
Antenatal
Care
ANDMA
Afghanistan
National
Disaster
Management
Agency
ANDS
Afghanistan
National
Development
Strategy
ANSP
Afghanistan
National
Statistics
Plan
ASRH
Adolescent
Sexual
and
Reproductive
Health
AWP
Annual
Work
Plan
BHC
Basic
Health
Centre
BPHS
Basic
Package
for
Health
Services
BSB
Bi-­‐annual
Support
Budget
CB
Capacity
Building
CBO
Community
Based
Organisation
CDC
US
Centers
for
Disease
Control
and
Prevention
CHC
Comprehensive
Health
Centre
CME
Community
Midwifery
Education
CMW
Community
Midwife
CO
Country
Office
CP2
Second
Country
Programme
CP3
Third
Country
Programme
CPAP
Country
Programme
Action
Plan
CPR
Contraceptive
Prevalence
Rate
CSO
Central
Statistics
Organization
CST
Country
Support
Team
DAC
Development
Assistance
Committee
DFID
UK
Department
for
International
Development
DH
District
Hospital
DMoYA
Deputy
Ministry
of
Youth
Affairs
Dy
Deputy
EA
Enumeration
Area
EC
European
Commission
EMIS
Education
Management
Information
System
EMOC
Emergency
Obstetric
Care
EPHS
Essential
Package
of
Hospital
Services
FGD
Focus
Group
Discussion
FHH
Family
Health
House
FP
Family
Planning
GBV
Gender-­‐Based
Violence
GIRoA
Government
of
the
Islamic
Republic
of
Afghanistan
GTZ
Deutsche
Gesellschaft
für
Technische
Zusammenarbeit
HMIS
Health
Management
Information
System
HP
Health
Post

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2
nd
Country
Programme
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HR
Human
Resources
HSSP
Health
Services
Support
Program
I-­‐ANDS
Interim
Afghanistan
National
Development
Strategy
ICAB
International
Census
Advisory
Board
IP
Implementing
Partner
IUD
Intra
uterine
device
JICA
Japan
International
Cooperation
Agency
KII
Key
Informant
Interview
MDG
Millennium
Development
Goals
MHU
Mobile
Health
Unit
MICS
Multi
Indicator
Cluster
Survey
MISP
Minimum
Initial
Service
Package
MMR
Maternal
Mortality
Rate
MoE
Ministry
of
Education
MoF
Ministry
of
Finance
MoHRA
Ministry
of
Hajj
and
Religious
Affairs
MoI
Ministry
of
Interior
MoPH
Ministry
of
Public
Health
MoU
Memorandum
of
Understanding
MoWA
Ministry
of
Women's
Affairs
MRRD
Ministry
of
Rural
Rehabilitation
and
Development
MTR
Mid-­‐Term
Review
NDF
National
Development
Framework
NDMP
National
Disaster
Management
Plan
NGO
Non-­‐governmental
Organisation
NPO
National
Programme
Officer
NRVA
National
Risk
and
Vulnerability
Assessment
NYJP
National
Youth
Joint
Programme
OECD
Organisation
for
Economic
Cooperation
and
Development
PDS
Population
Development
Strategies
PHD
Provincial
Health
Director
PNC
Postnatal
Care
PRSP
Poverty
Reduction
Strategy
Paper
PTSD
Post
Traumatic
Stress
Disorder
RH
Reproductive
Health
RHCS
Reproductive
Health
Commodity
Security
SBA
Skilled
Birth
Attendant
SC
Sub-­‐Centre
SPS
Standardising
Pharmaceutical
Systems
TA
Technical
Assistance
UNAMA
United
Nations
Assistance
Mission
to
Afghanistan
UNCT
UN
Country
Team
UNDAF
United
Nations
Development
Assistance
Framework
UNDP
United
Nations
Development
Programme
UNESCO
United
Nations
Educational,
Scientific
and
Cultural

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nd
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Organization
UNFPA
United
Nations
Population
Fund
UNHABITAT
United
Nations
Human
Settlements
Programme
UNICEF
United
Nations
Children's
Fund
UNIFEM
United
Nations
Development
Fund
for
Women
UNODC
United
Nations
Office
on
Drugs
and
Crime
USAID
United
States
Agency
for
International
Development
VAW
Violence
Against
Women
WHO
World
Health
Organisation
YIC
Youth
Information
Centre

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nd
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Acknowledgements
This
evaluation
was
prepared
by
Altai
Consulting1
at
the
request
of
the
UNFPA
Afghanistan
Country
Office.
The
work
has
been
undertaken
under
the
overall
guidance
of
Arie
Hoekman,
UNFPA
Afghanistan
Representative,
with
consistent
support
and
guidance
provided
by
Seth
Broekman,
Monitoring
and
Evaluation
Specialist.
The
UNFPA
Country
Office
provided
documentation
and
was
available
throughout
the
evaluation
to
provide
information,
facilitate
meetings
and
provide
logistical
support.
The
research
has
been
carried
out
on
the
basis
of
a
multi-­‐stakeholder
consultation.
Altai
would
like
to
acknowledge
appreciation
to
all
those
who
spared
their
time
to
participate
in
interviews
and
focus
group
discussions
in
Kabul,
the
provinces
and
other
UNFPA
offices,
as
well
as
a
special
thanks
to
the
implementing
partners
who
facilitated
the
field
trips.
The
list
of
people
from
the
organisations
that
were
interviewed
can
be
found
in
Appendix
A.
This
list
does
not
include
all
the
community
members,
religious
leaders,
local
leaders
and
local
health
workers
that
were
interviewed.
1
Main
authors:
Sarah-­‐Jean
Cunningham,
Francoise
Jacob

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nd
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1 Executive
Summary
a) Introduction
The
United
Nations
Population
Fund
(UNFPA)
second
country
programme
(CP2)
in
Afghanistan
was
implemented
from
2006-­‐2009
with
a
budget
of
USD
39
million.2
CP2
focused
on
three
vital
areas
of
work:
reproductive
health
(RH),
gender
equality
(GE)
and
population
and
development
strategies
(PDS).
This
evaluation
was
commissioned
to
provide
the
Country
Office
(CO)
with
the
data
and
information
required
to
make
evidence-­‐based
decisions
about
the
design
and
implementation
of
its
third
country
programme
(CP3),
by
reviewing
past
activities
and
identifying
the
lessons
learned.
The
evaluation
assessed
the
programme
against
the
five
OECD/DAC
criteria:
relevance,
efficiency,
effectiveness,
impact
and
ownership/sustainability,
using
a
multi-­‐layered
approach
looking
at
the
strategic
and
organisational
levels
in
Kabul
and
at
the
implementation
level
in
UNFPA
provinces.
Over
80
Key
Informant
Interviews
(KIIs)
and
20
Focus
Group
Discussions
(FGDs)
were
conducted
plus
450
interviewed
for
the
survey,
taken
place
between
23
May
and
3
August
2010
in
Kabul,
Bamiyan,
Badakhshan,
Faryab
and
Jalalabad.
b) Context
The
maternal
mortality
rate
(MMR)
in
Afghanistan
is
the
second
highest
in
the
world
(1,600
per
100,000
live
births).3
This
critical
situation
is
caused
by
lack
of
access
to
RH
health
services
and
information
with
a
deficient
number
of
skilled
birth
attendants
(SBA)
and
a
large
proportion
of
the
population
living
in
scattered,
hard-­‐to-­‐reach
communities.
Meanwhile,
women
continue
to
face
pervasive
human
rights
violations,
including
gender-­‐based
violence
(GBV),
and
are
disempowered
with
limited
access
to
public
life,
education,
healthcare
or
employment
opportunities.
Discrimination
is
more
acute
in
rural
areas.
A
full
household
and
population
Census
has
never
been
conducted
and
socio-­‐demographic
data
are
desperately
needed
at
all
levels
of
society
for
the
GIRoA,
donors
and
other
development
actors
to
build
consensus
and
form
effective
policy.4
c) Strategic
Overview
Relevance
and
Alignment
In
2006,
UNFPA’s
three
core
mandates
were
amongst
the
top
socio-­‐
economic
challenges
that
Afghanistan
needed
to
address.
Not
one
of
the
most
visible
agencies
on
the
ground,
UNFPA
nonetheless
had
a
key
role
to
play
in
the
reconstruction
process
of
the
country.
UNFPA
is
the
only
UN
agency
mandated
to
work
on
PDS
issues;
however
the
spheres
of
RH
and
2
The
Executive
Board
initially
approved
$52
million
for
2006-­‐2008;
$11
million
from
regular
resources
and
$41
million
from
other
sources.
The
CP2
was
extended
by
one
year
to
harmonize
programme
cycles.
The
actual
budget
available
for
2006-­‐2009
was
$39
million
of
which
$33.9
million
was
spent.
3
Afghanistan
Maternal
Mortality
Study,
Center
for
Disease
Control
and
Prevention,
2002
4
First
Population
Census
was
undertaken
in
1979
but
was
not
complete.
Only
67
percent
of
the
total
enumeration
areas
were
covered.

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Gender
are
occupied
by
a
large
number
of
development
players,
many
of
which
have
more
resources
and
therefore
a
bigger
footprint
in
Afghanistan.
Efficiency
A
total
of
USD
33.9
million
was
spent
during
CP2,
and
considering
all
activities,
with
the
number
of
geographic
locations
and
partnerships,
and
the
related
human
resource
requirement,
the
possibility
of
spreading
resources
very
thinly
became
a
definite
risk.
UNFPA
often
opted
for
short-­‐
term
consultancies
versus
a
more
established
technical
presence
with
government
counterparts,
at
the
expense
of
both
credibility
and
relationship
building,
leading
to
a
less
efficient
use
of
the
budget.
CP2
ambitiously
targeted
multiple
outcomes
of
the
UN
Development
Assistance
Framework
(UNDAF)
and
the
Afghanistan
National
Development
Strategy
(ANDS).
Consequently,
the
CO
team
was
engaged
in
numerous
partnerships
and
coordination
mechanisms
that
required
a
range
of
strategic
approaches,
implementation
modalities,
human
and
financial
resources,
all
of
which
were
neither
consistently
available
nor
developed
during
the
four-­‐year
period.
This
proved
to
be
quite
taxing
on
the
organisation.
Effectiveness
UNFPA
has
had
a
mixed
success;
the
majority
of
planned
projects
have
to
a
certain
extent
been
implemented,
but
the
sheer
number
of
these
activities
meant
that
UNFPA
was
not
able
to
effectively
monitor
the
quality
of
implementation,
contributing
to
the
inability
to
reach
planned
programme
objectives
at
the
outcome
level
and
sometimes
also
at
the
output
level.
Ownership/Sustainability
UNFPA’s
sustainable
approach
to
supporting
CSO
is
a
good
example
of
how
effective
long-­‐term,
committed
capacity
building
activities
can
build
institutional
muscle
with
long-­‐lasting
effects
and
pave
the
way
for
a
sustainable
future
collaboration.
The
impact
may
have
been
stronger,
had
this
intervention
been
more
strategic.
On
the
other
hand,
the
support
to
MoWA
and
MoPH
has
been
less
enduring,
focusing
on
short-­‐term
projects
and
products,
and
not
allowing
for
the
fostering
of
a
strong
partnership
or
the
transfer
of
valuable
knowledge
and
skills.
At
the
service
delivery
level,
there
have
been
occasions
where
UNFPA
has
not
had
a
clearly
communicated
handover
plan
leading
to
the
sudden
removal
of
services
within
a
community.
Organisational
The
strategy
developed
under
CP2
required
a
range
of
technical
and
management
skills,
which
were
only
partly
available
during
the
implementation
phase.
With
a
relatively
high
staff
turn-­‐over,
including
at
the
most
senior
levels
of
its
organigram,
and
extensive
use
of
external
short-­‐
term
consultants,
the
CO
could
build
only
limited
institutional
memory,
and
could
not
ground
its
partnership
with
government
counterparts
with
solid
long-­‐term
relationships.
This,
in
turn,
had
an
impact
on
the
coherence
of
succeeding
annual
work
plans
within
the
main
CP2
framework,
and,
in
some
cases,
on
the
understanding
of
shifting
dynamics
within
the
three
areas
of
intervention.
Strategic
areas
for
improvement
UNFPA
needs
to
prioritise
the
objectives
and
outcomes
for
the
next
programming
phase
and
refocus
the
activities
in
a
simplified
framework.
Interventions
should
be
evidenced-­‐based,
i.e.
after
the
conduct
of
a
needs
assessment
or
situational
analysis,
and
ensuring
alignment
with
government
strategies
and
sustainability
of
impact.
UNFPA
should
focus
its
overall
approach
to
technical
assistance;
take
a
long-­‐term
perspective
to
capacity
building
and
look
at
a
more
integrated
approach
with
institutional,
organisational
and
individual
capacity
building
plans
for
a
reduced
number
of
institutions
at
the
national,
provincial
and
field
levels.

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Operationally,
UNFPA
must
improve
the
learning
from
implementation
by
enhancing
the
quality
of
monitoring
and
evaluation.
UNFPA
must
continue
to
improve
and
rationalise
its
systems,
improve
filing,
document
important
decision-­‐making
processes
and
spend
more
time
closer
to
project
implementation
i.e.
with
the
counterpart
at
the
ministry
and
in
the
field,
monitoring
projects.
d) Reproductive
Health
UNFPA
had
significant
achievements
in
its
RH
work
at:
(i)
Capacity
building
at
central
level,
supporting
the
development
of
important
national
strategies
in
the
field
of
RH
including
the
2006-­‐
2009
RH
Strategy
and
a
leading
role
in
the
development
of
the
National
Human
Resources
Development
Plan
for
RH;
(ii)
Capacity
building
at
sub-­‐national
level,
through
supporting
community
midwifery
education
and
increasing
the
family
planning
knowledge
and
skills
of
in-­‐
service
health
providers;
and
(iii)
the
service
delivery
level,
through
funding
MHUs
and
EMOC
and
supporting
fistula
service
delivery
sites.
UNFPA
has
been
overshadowed
by
other
larger
players
in
the
RH
field.
To
have
an
increased
impact,
firstly,
UNFPA
needs
to
refocus
its
attention
on
its
niche
fields:
(1)
immediately
evaluate
the
scale
of
fistula
in
Afghanistan
through
a
prevalence
study
and
design
a
focused
programme
accordingly;
and
(2)
increase
the
support
to
family
planning.
Secondly,
UNFPA
should
re-­‐prioritise
which
RH
areas
its
resources
are
used
for
and
reconsider
the
choice
of
service
delivery
versus
technical
assistance
activities
to
have
the
largest
strategic
impact.
Ownership
and
sustainability
should
be
reviewed
in
all
projects,
particularly
in
service
delivery
projects
such
as
the
support
to
emergency
obstetric
care
(EmOC)
centres.
UNFPA
has
not
had
transparent
and
gradual
handover
plans
to
ensure
the
future
support
of
these
centres
and
the
counterpart
has
not
been
sufficiently
involved
during
the
project
to
take
over
management
after
UNFPA’s
support
ends.
To
ensure
UNFPA’s
sustainability
of
impact,
there
should
be
a
stronger
awareness-­‐raising
and
education
component
across
all
projects
to
increase
utilisation
and
demand
for
services.
e) Mobile
Health
Units
Mobile
Health
Units
(MHUs)
have
been
highly
effective
in
providing
health
care
to
remote
and
scattered
populations.
This
directly
assists
in
reducing
the
causes
of
maternal
mortality
with
activities
such
as
providing:
education
on
RH
issues,
access
to
antenatal
care
(ANC),
postnatal
care
(PNC)
and
delivery
services,
and
information
on
family
planning
methods
to
increase
birth
spacing
and
reduce
the
fertility
rate.
However,
implementation
has
been
challenging.
Due
to
the
demand
for
curative
services,
little
time
was
spent
on
preventive
measures,
i.e.
education
and
awareness-­‐
raising,
and
teams
have
faced
issues
in
planning
their
time
effectively
to
account
for
the
difficult
geography
and
harsh
weather
conditions.
UNFPA
should
advocate
for
the
inclusion
of
MHUs
and
sub-­‐centres
in
the
standard
Basic
Package
of
Health
Care
Services
(BPHS)
donor-­‐financed
package,
by
presenting
the
successful
results
of
the
MHU
programme.5
This
will
ensure
sustainability
and
a
more
integrated
and
effective
national
health
system.
5
To
date,
USAID
still
does
not
provide
financing
for
MHUs
through
its
standard
BPHS
donor
package.
Previously,
donors
were
concerned
that
in
the
past
MHUs
did
not
always
provide
services
to
areas
outside
of
the
reach
of
stationary
facilities.

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f) Population
and
Household
Census
UNFPA
is
the
only
UN
agency
globally
focused
on
PDS
issues,
among
which
figures
the
collection,
analysis
and
dissemination
of
population
and
development
data,
e.g.
through
national
population
and
housing
censuses.
It
is
well
positioned
in
Afghanistan
with
experience
from
other
countries
to
be
able
to
provide
the
right
level
of
technical
assistance
to
the
conduct
of
the
Census.
As
a
result
of
UNFPA’s
support,
the
capacity
of
CSO
has
increased
with
higher
skilled
employees
and
improved
management
in
some
departments.
UNFPA
has
stood
out
as
providing
long-­‐term
and
focused
assistance
to
CSO
by
amalgamating
capacity
building
methods
that
included
coaching,
theoretical
training
and
on-­‐the-­‐job
training
at
various
levels
of
the
institution;
in
Kabul
and
in
the
provinces.
Despite
substantial
efforts
from
CSO
for
Census
preparation
activities
the
decision
was
made
to
postpone
the
Census
in
2008
due
to
(i)
security
issues,
(ii)
CSO
capacity
limitations
and
(iii)
political
issues
resulting
from
the
concurrent
voter’s
registration
in
the
2009
Presidential
elections.
UNFPA
must
improve
its
external
communications
with
CSO
stakeholders
to
raise
its
profile
and
improve
the
visibility
of
the
progress
of
the
Census
and
the
challenges
being
faced.
g) Religious
Leaders
UNFPA’s
global
strategy
of
promoting
male
involvement
in
response
to
GBV
and
RH
has
been
adopted
through
its
religious
leaders
programme.
This
evaluation
has
shown
that
religious
leaders
(and
community
leaders)
are
key
gatekeepers
within
the
community
on
providing
information
and
advice
on
health
and
family
issues.
Although
only
male
community
members
tend
to
have
direct
access
to
these
resources,
UNFPA
has
been
relevant
in
deciding
to
work
with
religious
leaders
on
trying
to
change
behaviours
towards
GBV,
family
planning
and
RH
issues.
The
main
focus
of
work
with
the
religious
leaders
was
done
through
the
“Healthy
Family,
Fortunate
Society”
programme,
to
address
violence
against
women
and
to
promote
healthy
family
relationships.
17
provinces
were
targeted,
with
initial
good
feedback
from
participants,
but
lack
of
further
support
or
follow-­‐up
to
ensure
a
long-­‐term
impact.
Work
with
religious
leaders
has
been
a
popular
theme
over
the
years,
and
is
a
strategy
that
has
been
adopted
by
a
number
of
agencies
to
transmit
messages
to
the
Afghan
population
on
a
wide
range
of
issues.
UNFPA
should
continue
to
support
the
involvement
of
religious
leaders
as
a
vehicle
to
promote
behavioural
change
but
create
a
longer-­‐term
and
interactive
training
programme
with
regular
feedback
from
participants.
The
programme
should
look
for
potential
synergies
with
other
agencies’
work.
h) Humanitarian
Assistance
Effective
humanitarian
assistance
requires
rapid
mobilisation,
large
resources,
quick
access
to
communities
and
experience
dealing
with
complex
emergencies.
UNFPA’s
focus
during
CP2
has
been
on
RH,
with
the
distribution
of
RH
kits
in
emergencies.
UNFPA
has
neglected
its
niche
PDS
mandate
whereby
it
could
rapidly
provide
data
to
help
agencies
make
informed
decisions
about
emergency
interventions.

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i) Youth
Information
Centres
(YICs)
With
68
percent
of
the
population
below
the
age
of
25,
it
was
relevant
for
UNFPA
to
address
issues
facing
youth,
including
Adolescent
Reproductive
and
Sexual
Health
(ASRH),
through
working
directly
with
the
Deputy
Ministry
of
Youth
Affairs
(DMoYA).
However,
UNFPA
must
review
whether
YICs
are
the
most
effective
and
efficient
way
to
promote
ASRH
awareness
and
should
consider
adding
components
to
its
current
field
activities
instead
of
creating
new
mechanisms,
or
alternatively
link
with
other
actors
working
on
youth
issues,
such
as
UNICEF.
j) Gender
Based
Violence
UNFPA’s
partnership
with
the
Ministry
of
Women’s
Affairs
(MoWA)
has
not
yet
reaped
the
expected
results.
This
can
partly
be
explained
by:
(i)
the
low
institutional
capacity
of
MoWA,
(ii)
limited
technical
assistance
which
was
short-­‐term
and
mostly
project-­‐oriented,
and
(iii)
poor
coordination
mechanisms
between
international
partners.
UNFPA’s
support
in
the
field
of
gender
has
been
somewhat
inconsistent
during
CP2,
close
to
a
patchwork
of
activities
drawn
from
its
RH
and
PDS
components;
it
is
advised
that
UNFPA
simplifies
the
number
of
activities
under
the
gender
programme
component,
as
well
as
form
a
closer
working
relationship
with
the
counterpart,
MoWA.

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2 Introduction
2.1 Purpose
of
the
Evaluation
The
United
Nations
Population
Fund
(UNFPA)
in
Afghanistan
has
just
completed
its
second
country
programme
(CP2)
and,
as
such,
the
CO
extended
the
call
for
bids
and
commissioned
Altai
Consulting
to
conduct
this
external
evaluation
to
understand
the
lessons
learnt
from
CP2
in
order
to
further
inform
the
design
and
implementation
of
its
third
country
programme
(CP3).
The
evaluation
provides
a
comprehensive
overview
of
UNFPA’s
activities,
UNFPA’s
positioning
amongst
other
development
players,
programme
alignment
with
the
government
development
and
poverty
reduction
strategies,
coordination
with
key
stakeholders,
sustainability
of
projects
implemented
and
the
overall
impact
of
UNFPA
in
Afghanistan
during
CP2.
Key
users
of
this
evaluation
may
include
senior
management
of
UNFPA
Afghanistan’s
CO
and
the
Government
of
the
Islamic
Republic
of
Afghanistan
(GIRoA)
including
the
primary
UNFPA
counterparts:
Ministry
of
Public
Health
(MoPH),
Central
Statistics
Organization
(CSO),
Ministry
of
Women’s
Affairs
(MoWA)
and
Deputy
Ministry
of
Youth
Affairs
(DMoYA).
Other
users
of
the
evaluation
include
the
UNFPA
Division
of
Oversight
and
the
UNFPA
Regional
Office
for
Asia
and
the
Pacific
to
promote
institutional
learning.
The
evaluation
(1)
provides
these
users
with
sufficient
information
to
make
an
informed
judgment
about
the
past
performance
based
on
the
following
OECD/DAC
criteria:
relevance,
efficiency,
effectiveness,
impact
and
sustainability/ownership;
and
(2)
provide
strategic
recommendations
for
the
implementation
of
the
next
country
programme.
Additionally,
this
report
includes
a
baseline
assessment
of
the
following
reproductive
health
output
indicators
for
CP3:
1. %
women
and
men
of
reproductive
age
who
can
name
at
least
three
modern
contraceptive
methods
2. %
of
people
above
12
years
of
age
who
know
three
danger
signs
during
pregnancy
and
know
where
to
access
health
facilities,
including
Mobile
Health
Units
and
Community
Midwives,
for
reproductive
health
services
3. %
of
young
people
who
both
correctly
identify
ways
of
preventing
STIs,
including
HIV,
and
who
reject
major
misconceptions
about
HIV
4. #
of
influential
males
who
are
against
gender-­‐based
violence
These
indicators
were
measured
in
a
qualitative
and
quantitative
way,
some
through
the
community-­‐based
survey
and
others
through
interviews
and
focus
group
discussions.
The
current
status
of
these
indicators
can
be
found
in
Appendix
B.

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2.2 Methodology
and
Tools
The
evaluation
design
was
based
on
a
combination
of
secondary
research,
and
qualitative
and
quantitative
approaches.
Data-­‐collection
methods
included
a
review
of
policy
documents
and
project
reports/data,
key
informant
interviews
(KIIs),
focus
group
discussions
(FGDs),
field
observations
and
a
community-­‐based
survey.
The
evaluation
used
a
multi-­‐layered
approach
looking
at
the
strategic
and
organisational
levels
in
Kabul
and
at
the
implementation
level
in
UNFPA
provinces.
At
each
level
the
programme
was
assessed
against
the
five
OECD/DAC
criteria.
Secondary
Research
The
evaluation
began
with
an
extensive
document
review
including
all
UNFPA
project
and
country
programme
documents,
implementing
partner’s
reports,
GIRoA
strategy
documents
(ANDS,
MoPH,
UNDAF)
and
other
relevant
documents
(Afghan
Health
Survey,
NRVA,
Maternal
Mortality
study
etc.).
Qualitative
Research
The
qualitative
research
took
place
at
(1)
the
central
level
in
Kabul
and
(2)
the
field
level.
In
Kabul
over
35
key
informant
interviews
were
conducted
with
government
counterparts
(MoPH,
MoWA,
MoHRA,
DMoYA),
donors
(EC,
USAID,
DFID),
UNFPA
programme
and
support
staff,
relevant
UN
agencies
(UNICEF,
WHO,
UNIFEM
and
UNAMA),
implementing
partners
and
other
key
players
in
the
fields
of
RH
and
gender.
The
second
part
of
the
qualitative
work
took
place
in
four
provinces
(Bamiyan,
Badakhshan,
Faryab
and
Nangarhar)
and
was
focused
on
understanding
the
impact
of
CP2
on
beneficiaries
of
UNFPA
services
(e.g.
MHUs,
CME
centres,
EmOC
centres,
youth
information
centres
and
religious
leaders).6
Over
45
KIIs
were
conducted
with
implementing
partners,
provincial
government
representatives,
provincial
UN
and
NGO
representatives,
health
practitioners
and
local
community
and
religious
leaders.
In
addition,
20
focus
group
discussions
were
conducted
with
beneficiaries
of
UNFPA
interventions
and
key
informants
such
as
health
practitioners.
Quantitative
Research
To
assess
the
effectiveness
and
the
impact
of
CP2
at
the
beneficiary/community
level,
the
evaluation
team
administered
a
survey
in
the
three
provinces
where
core
activities
have
been
implemented
by
UNFPA
(Bamiyan,
Badakhshan
and
Faryab).
Locations:
In
each
province
a
total
of
15
villages
were
selected,
11
of
which
were
villages
served
by
UNFPA’s
MHUs,
and
four
of
which
were
not
served
and
used
as
a
comparison
group.
The
11
villages
were
selected
based
on
a
random
sampling
methodology
from
the
pool
of
UNFPA-­‐served
villages.
Originally
select
villages
were
disregarded
if
they
were
more
than
four
hours
by
car
from
the
provincial
centre
(due
to
time
constraints)
or
considered
unsafe
by
the
evaluation
team,
and
a
second
round
of
random
selection
took
place.
Timeline:
The
field
work
in
the
four
provinces
was
conducted
between
22
June
and
2
August
2010.
6
Interviews
and
focus
group
discussions
were
conducted
in
Jalalabad
for
researching
the
Youth
Information
Centres
and
the
work
with
Religious
Leaders.

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Sampling:
The
sample
pool
consisted
of
450
interviews
(150
in
each
province),
120
of
which
were
the
comparison
group.
A
combination
of
random
and
purposive
sampling
was
used:
• Purposive
sampling
for
gender
and
youth:
50
percent
male,
50
percent
female;
as
a
youth
representation
was
important,
the
percentage
of
respondents
was
monitored
closely
to
ensure
that
at
least
30
percent
of
the
sample
was
youth.
However,
this
target
was
reached
without
the
need
for
purposive
sampling.
• Random
sampling
for
participant
selection:
a
modified
kish
grid
method
was
used
–
only
those
household
members
present
at
the
time
of
the
interview
were
put
into
the
kish
grid
for
random
selection.
This
method
was
used
due
to
the
time
constraints
of
the
field
work.
Tools:
The
survey
questionnaire
contained
68
questions
lasting
on
average
45
minutes
to
administer.
A
field
test
of
the
survey
was
implemented
in
Kabul,
the
results
of
which
were
used
to
improve
the
questionnaire
and
methodology.
The
questionnaire
allowed
us
to
measure
community
perceptions
about
health
care;
knowledge,
awareness
and
usage
of
reproductive
health
services
and
family
planning
methods;
and
the
role
that
MHUs
have
played
in
contributing
to
health
care.
GPS
coordinates
were
gathered
for
each
location
visited.
Data
processing:
Data
from
the
surveys
was
coded
and
entered
into
an
SPSS
database
for
analysis.
2.3 Limitations
and
Constraints
The
major
constraints
of
the
evaluation
were:
1. Scope:
During
the
course
of
CP2,
UNFPA
has
implemented
a
wide
range
of
activities
across
different
sectors
and
geographic
areas
with
a
variety
of
implementation
modalities.
This
evaluation
is
meant
to
be
a
strategic
exercise
at
the
programme
level
and
therefore
it
does
not
involve
detailed
evaluations
of
all
individual
activities
and
projects
in
this
portfolio.
2. Lack
of
a
baseline
data:
UNFPA
did
not
have
any
baseline
data
for
its
CP2
indicators,
and
so
it
was
difficult
to
measure
any
impact,
or
attribute
impact
to
UNFPA
for
that
matter.
When
conducting
interviews,
the
recall
method
was
used
to
try
to
assess
how
the
situation
has
changed
since
2006.
3. Sampling:
Villages
were
selected
randomly
at
first,
but
a
number
of
villages
had
to
be
excluded
from
the
sample
due
to
security
and
time
constraints.
The
criteria
for
conducting
research
in
the
village
was
that
it
was
secure
and
it
was
not
more
than
a
four
hour
drive
from
the
provincial
centre.
4. Access
to
desk-­‐based
information:
the
CO
provided
a
number
of
strategic
documents
(CP2,
CPAP2,
sectoral
AWPs,
COAR
2008,
COAR
2006-­‐2009),
as
well
as
selected
project
documents
(mostly
final
reports)
for
the
PDS,
Emergency
Preparedness,
Gender
and
Fistula.
Project-­‐
level
detailed
proposals,
monitoring
and
final
evaluation
reports
were
not
available
for
most
of
the
other
RH
activities.
There
was
no
mid-­‐term
review
for
CP2,
and
no
project-­‐level
external
evaluation
reports.
The
evaluation
team
did
not
have
desk
access
to
information
pertaining
to
project
rationale,
potential
needs
assessments
or
lessons
learned
from
the
initial
years
of
projects
implemented
in
the
2006-­‐2009
period.
As
a
consequence,
the
evaluation
team
could
not
easily
assess
the
rationale
for
changes
between
AWPs,
integration
of
sustainability
and
ownership
in
the
design
of
project
and
adequacy
and
relevance
of
staffing,
particularly
related
to
technical
assistance.

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5. Limited
institutional
memory:
the
Afghanistan
CO
has
had
a
high
staff
turnover
over
the
period
2006-­‐2009,
which
has
hampered
the
development
of
institutional
memory.
A
similar
problem
was
faced
when
evaluating
the
external
environment
during
the
2006-­‐2009
period,
as
few
staff
remained
from
those
posted
in
partner
organisations
such
as
UNICEF,
WHO,
UNDP,
and
to
some
extent,
in
the
government
counterparts.

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3 Strategic
Overview
This
strategic
overview
provides
a
high-­‐level
summary
of
findings
from
CP2
looking
at
relevance,
positioning,
ownership
and
sustainability,
alignment,
coordination
and
technical
assistance
of
the
programme.
More
detailed
findings
and
evidence
can
be
found
in
the
thematic
sections
of
the
report.
3.1 Context
(2006)
Gender-­‐based
violence,
reproductive
health
and
population
issues
continue
to
affect
the
population
of
Afghanistan.
Health
conditions
in
Afghanistan
are
among
the
worst
in
the
world.
Reproductive
Health
The
maternal
mortality
rate
(MMR)
in
Afghanistan
is
the
second
highest
in
the
world
(1,600
per
100,000
live
births)
after
Sierra
Leone,
and
in
some
provinces,
including
one
of
UNFPA’s
focus
provinces,
Badakhshan,
is
the
highest
in
the
world.7
Underlying
causes
of
this
high
maternal
mortality
include:
limited
access
for
women
to
healthcare
largely
because
of
a
limited
availability
of
female
health
workers;
lack
of
physical
access
to
health
services
due
to
poor
road
conditions,
difficult
geography
and
bad
weather
conditions;
and
limited
EmOC
services.
Social
reasons
include
child
marriage;
lack
of
information
about
and
access
to
family
planning
services;
malnutrition;
and
lack
of
education.
In
March
2003,
BPHS
was
launched
in
Afghanistan,
aimed
at
providing
nation
access
to
healthcare
and
reducing
mortality
and
morbidity.
Although
there
is
a
clear
focus
on
reproductive
and
maternal
health
within
the
BPHS
guiding
principles
that
has
had
some
positive
impact
on
women’s
health,
maternal
health
indicators
remain
substandard
as
a
result
of
cultural
practices
and
lack
of
capacity
within
the
health
system.
In
Afghanistan,
the
contraceptive
prevalence
rate
(CPR)
was
10
percent
in
2005,
one
of
the
lowest
globally,
which
contributes
to
frequent
childbirth
and
negatively
impacts
maternal
mortality.8
Awareness
of
family
planning
methods
is
still
low
and
in
most
rural
areas
there
are
still
large
cultural
and
religious
barriers
to
using
non-­‐traditional
contraceptive
methods.
Gender
Equality
Women
continue
to
face
pervasive
human
rights
violations
and
remain
largely
uninformed
of
their
rights
under
Afghan
law.
Discrimination
is
more
acute
in
rural
areas.
Women
in
urban
areas
continue
to
make
strides
towards
greater
access
to
public
life,
education,
health
care,
and
employment.
However,
the
denial
of
educational
opportunities,
limited
employment
possibilities,
early
childhood
marriage,
and
the
threat
of
violence
continue
to
impede
the
ability
of
many
women
to
improve
their
situation.
Youth
The
age
structure
of
Afghanistan
is
very
young,
with
over
60
percent
being
younger
than
15
years
of
age.
Adolescents
(age
10-­‐19)
and
youth
(age
15-­‐24)
comprised
of
at
least
28
percent
of
the
total
population.9
In
2003,
the
male
literacy
rate
stood
at
43.2
percent
and
female
literacy
rate
at
14.1
percent,
while
only
8
percent
of
rural
women
are
literate.
Therefore
with
such
a
large
part
of
7
Afghanistan
Maternal
Mortality
Study,
Center
for
Disease
Control
and
Prevention,
2002
8
Multi
Indicator
Cluster
Survey,
CSO/UNICEF
2003
9
Best
estimates
of
social
indicators
in
Afghanistan,
GIRoA/UNICEF,
August
2005

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the
population
under
24,
attention
to
this
age
group
is
critical
for
the
successful
development
of
Afghanistan.
Population
and
Development
Strategies
Availability
of
up-­‐to-­‐date
and
evidence-­‐based
data
in
Afghanistan
is
lacking.
In
2006
the
results
of
the
CSO
household
listings
were
released
along
with
the
publication
of
34
socio-­‐economic
and
demographic
profiles,
an
initiative
led
by
UNFPA
and
funded
by
donors.
However,
a
full
household
and
population
Census
has
never
been
conducted
despite
the
attempt
in
1979.
This
demographic
data
is
desperately
needed
for
the
GIRoA,
donors
and
other
development
actors
to
form
effective
policy.
CP2
started
in
2006
and
ended
in
2009
to
become
in
phase
with
the
GIRoA
strategic
development
and
poverty
reduction
plans,
namely
the
Afghanistan
National
Development
Strategy
(ANDS)
and
United
Nations
Development
and
Assistance
Framework
(UNDAF).
With
its
global
mandate
of
working
in
three
core
areas
–
reproductive
health
(RH),
gender
equality
(GE)
and
population
and
development
strategies
(PDS),
UNFPA’s
presence
is
vital
in
Afghanistan.
3.2 Activities
UNFPA’s
CP2
has
had
a
wide
range
of
different
activities
taking
place
across
a
range
of
sectors
and
geographic
areas.
Activities
have
been
evaluated
rather
than
outputs
as
the
results
framework
for
CP2
was
extremely
weak,
with
no
baseline
data
available.
Additionally,
the
timeframe
of
the
assignment
required
a
more
focussed
approach.
The
activities
to
be
evaluated
in
this
report
are
summarised
below
in
table
1.
CP2
aimed
at
providing
strategic,
policy
and
technical
support
to
relevant
governmental
institutions,
under
the
ANDS
framework
in
UNFPA’s
three
core
areas.
Projects
have
been
implemented
at
the
community
level
in
mainly
three
provinces
(Faryab,
Bamiyan
and
Badakhshan)
while
more
limited
activities
took
place
in
Daikundi
and
Logar,
through
national
and
international
NGOs10
.Other
activities
have
taken
place
at
the
central
level
in
Kabul,
providing
technical
assistance
and
capacity
building
to
GIRoA
ministries.
The
following
were
the
objectives
of
CP2:
ü Outcome
1:
Create
an
enabling
environment
that
promotes
reproductive
health
and
reproductive
rights
ü Outcome
2:
Increased
access
to
high-­‐quality
reproductive
health
services
and
information
for
men,
women
and
adolescents,
with
a
special
focus
on
vulnerable
groups
ü Outcome
3:
Strengthened
demand
for
reproductive
health
services,
especially
among
women
ü Outcome
4:
Improved
institutional
mechanism
and
socio-­‐cultural
practices
that
promote
and
protect
the
rights
of
women
and
girls
and
advance
gender
equality
10
These
have
included
AADA,
ADRA,
AKHS,
BDN,
CAF,
MedAir,
Merlin
and
MRCA,
selected
after
a
systematic
assessment
by
UNFPA
of
a
number
of
organisations
in
Afghanistan
looking
at
their
capacities
and
alignment
with
the
UNFPA
mandate.

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ü Outcome
5:
Improved
availability
and
utilisation
of
population
data
disaggregated
by
gender,
age
and
geographical
area.
Table
1:
Summary
of
UNFPA
themes
and
activities
evaluated
in
this
report
Theme
Activities
Reproductive
Health,
Reproductive
Health
Commodity
Strategies
(RHCS)
and
Family
Planning
• RH:
Campaign
to
end
fistula;
Community
Midwifery
Education
(CME);
Emergency
Obstetric
Care
(EmOC);
technical
and
management
capacity
building
to
MoPH
and
Provincial
Health
Directorates
(PHD);
technical
assistance
on
RH
strategy
development
• RHCS:
Technical
assistance
to
MoPH
for
strengthening
RHCS
management
including
training
and
provision
of
equipment
and
software;
development
of
RHCS
strategy
• Family
Planning:
Establishment
of
FP
training
facilities;
communications
campaigns;
training
of
health
workers
on
FP
methods
Mobile
Health
Units
• Provision
of
basic
health
care
to
communities
outside
of
catchments
areas
of
stationary
facilities
under
the
BPHS
by
means
of
mobile
health
teams
across
UNFPA
focus
provinces
Afghanistan
Population
and
Housing
Census
• Supporting
the
Afghanistan
Population
and
Housing
Census
to
improve
availability
and
utilisation
of
population
data
disaggregated
by
sex,
age,
and
geographical
area
Religious
leaders
• Advocacy
and
awareness
sessions
about
GBV
for
religious
leaders
and
other
influential
males
in
17
provinces
and
36
districts,
family
planning
in
Islam
book
developed
and
published,
awareness
campaigns
through
mass
media
Humanitarian
Assistance
• Development
of
disaster
management
plans
in
relation
to
RH
and
provision
of
RH
kits
for
emergency
situations
Youth
Information
Centres
(YICs)
• Establishment
of
five
YICs
in
Kabul
(two),
Herat,
Mazar
and
Jalalabad
as
a
vehicle
for
the
dissemination
of
ASRH
information,
advocacy
for
gender
equality
and
life
skills
training
Gender-­‐based
violence
(GBV)
• Strengthening
the
technical
and
management
capacity
building
of
MoWA
and
DoWA
• Establishment
of
centre
for
information
management
and
media
in
MoWA
• VAW
issues
incorporated
into
the
training
curriculum
for
health
service
providers
• Inclusion
of
gender
and
ethics
modules
in
police
academy
training,
support
to
women
in
prisons

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3.3 Positioning
After
an
extensive
review
of
the
RH,
gender
and
PDS
players
through
interviews
in
Kabul
and
the
provinces,
it
was
found
that
UNFPA
is
known
mostly
for
its
work
in
family
planning
and
support
for
the
Afghanistan
Population
and
Housing
Census,
and
hardly
recognised
at
all
for
its
work
on
gender
issues
or
on
other
RH
issues.
The
reproductive
health
field
contains
large
players
such
as
USAID-­‐HSSP11
,
WHO
and
UNICEF,
who
have
much
larger
budgets
and
resources
than
UNFPA
and
therefore
a
bigger
footprint
in
Afghanistan’s
RH
services
sector.
Statistics
and
data
is
a
field
of
comparative
advantage
for
UNFPA,
and
among
UN
agencies
and
the
donor
community
UNFPA
is
well
known
for
its
active
support
in
the
Census
work.
However,
due
to
the
non-­‐completion
of
the
Census,
this
is
sometimes
perceived
as
a
failure.
Among
the
seven
themes
listed
in
Table
1,
UNFPA
has
selected
a
variety
of
implementation
modalities
ranging
from
(1)
Service
delivery
/
direct
implementation,
(2)
Direct
Financial
support,
acting
as
a
donor
with
limited
technical
input,
(3)
Technical
assistance,
through
remote
assistance
or
UNFPA
staff
based
at
ministry,
short-­‐term
and
long-­‐term
consultancies
and
(4)
Paying
salaries
of
government
staff.
Often,
UNFPA
has
positioned
itself
somewhere
between
(1)
and
(2),
providing
services
to
the
community
through
implementing
partners
instead
of
technical
assistance
and
institution
building
at
the
government
level.
It
is
well
known
that
service
delivery
is
expensive
in
Afghanistan,
so
UNFPA
should
decide
if
this
really
is
the
best
choice
of
implementation
modality.
The
government
has
not
yet
managed
to
provide
the
entire
population
with
access
to
health
care;
this
has
resulted
in
certain
UN
agencies
(including
UNFPA)
as
well
as
other
development
actors
attending
to
some
of
these
gaps
by
means
of
service
provision.
UNFPA
chose
service
delivery
as
a
complementary
activity
to
technical
assistance
to
make
a
visible
and
practical
contribution
to
reducing
MMR
and
to
build
models
for
replication
through
the
BPHS.
Projects
such
as
EmOC
centres
especially
and
MHUs
to
a
certain
extent
have
an
immediate
and
direct
impact
on
the
reduction
of
maternal
mortality
in
the
communities
they
are
working
in,
which
can
be
reported
to
donors.
According
to
UNFPA,
the
MHU
project
should
be
considered
as
a
pilot
project,
which,
if
successful,
will
be
operationalised
and
funded
by
BPHS
donors
that
not
already
fund
it.
Furthermore,
according
to
UNFPA
staff,
MHUs
were
to
be
an
interim
solution
until
Family
Health
Houses
were
to
be
established
through
the
deployment
of
local
women
from
the
remotest
communities
in
these
communities
upon
their
graduation
from
CME.
These
facilities
would
then
be
periodically
backstopped
(supplies,
refresher
training,
report
taking,
etc.)
by
a
limited
number
of
mobile
teams.
11
Health
Services
Support
Program
began
in
2006
to
improve
service
delivery
and
quality
of
basic
health
services
in
Afghanistan,
and
to
generate
demand
for
those
services.
HSSP
supports
BPHS
implementers
to
improve
planning,
management,
implementation
and
monitoring
of
the
delivery
of
BPHS.HSSP
is
implemented
by
Jhpiego
in
partnership
with
Save
the
Children
and
Futures
Group.
“They
[UNFPA]
need
to
focus
on
their
mandate
and
realise
what
their
comparative
advantage
is.”
— USAID representative
"UNFPA’s
comparative
advantage
is
in
surveys
and
statistics,
information
management
and
family
planning”
—
UNAMA representative

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Piloting
innovative
pro-­‐poor
and
inclusive
approaches,
that
are
then
integrated
into
‘systems’
and
‘system
funding’,
is
a
common
strategy
for
UN
agencies.
In
this
case,
the
monitoring
systems
were
not
strong
enough
to
provide
data
and
success
stories
for
evidence-­‐based
advocacy
with
key
BPHS
donors.
Fistula
is
another
niche
field
for
UNFPA.
However,
UNFPA
has
had
little
visibility
or
impact
in
this
field
due
to
having
spread
resources
too
thinly.
Most
notably,
UNFPA
has
not
commissioned
a
fistula
prevalence
study
to
understand
the
prevalence
in
Afghanistan
and
to
provide
the
data
required
for
advocacy
and
support
towards
ending
fistula
in
Afghanistan.
Table
2
provides
a
summary
of
the
key
development
players
and
government
counterparts
in
each
of
the
three
core
UNFPA
areas.
Table
2:
Summary
of
key
development
players
in
core
UNFPA
areas
UNFPA
Core
Area
Key
development
players
Major
Government
Counterparts
1. Reproductive
Health
UNICEF
WHO
USAID
–
Health
Services
Support
Program
(HSSP)
BPHS
donors:
USAID,
World
Bank,
European
Commission
MoPH
DMoYA
2. Gender
Equality
UNIFEM
UNDP
GTZ
Asia
Foundation
Afghanistan
Independent
Human
Rights
Commission
MoWA
MoHRA
3. Population
Development
Strategies
DFID
European
Commission
Japanese
Government
CSO
Finding
1:
UNFPA
is
a
relatively
small
player
in
the
fields
of
gender
and
reproductive
health.
When
UNFPA
has
found
a
niche
area,
it
has
not
allocated
the
sufficient
human
and
financial
resources
to
it
and
instead
allocated
the
majority
of
its
resources
to
areas
that
larger
and
stronger
players
are
already
supporting,
thus
making
its
impact
in
its
comparative
advantage
smaller
than
it
could
be
and
visibility
relatively
small.

23. Altai
Consulting
UNFPA
Afghanistan
2
nd
Country
Programme
Evaluation
Page
23
of
107
3.4 Ownership
and
Sustainability12
UNFPA
has
had
mixed
success
ensuring
the
sustainability
of
its
projects.
UNFPA’s
support
to
CSO
can
be
considered
sustainable,
for
instance,
the
GIS
department
that
was
created
continues
to
function
well
today
and
supports
all
areas
of
CSO’s
work.
UNFPA’s
long-­‐term,
committed
approach
to
the
CSO
has
reaped
benefits
in
contrast
to
other
agencies’
approaches
which
have
been
shorter-­‐term
with
less
focus
on
building
capacity
and
more
focus
on
delivering
a
product/report.
Similarly
when
UNFPA
has
been
supporting
MoPH,
this
has
usually
been
product-­‐oriented,
for
example,
the
RH
Strategy
development
or
the
Human
Resources
Development
Plan,
focusing
on
the
end
product
and
not
on
the
process
of
building
capacity.
Less
successful
projects
in
terms
of
sustainability
include
some
of
the
EmOC
centres
and
the
YICs.
This
assistance,
although
effective
at
the
time
of
financial
support,
is
only
short-­‐term,
affects
a
relatively
small
population
and
has
potential
negative
effects
once
UNFPA
stops
funding.
During
this
evaluation,
documentation
for
sustainability
plans
was
not
seen,
and
feedback
from
donors
and
implementing
partners
has
shown
that
hand-­‐over
plans
for
some
of
UNFPA’s
EmOC
centres
have
not
been
clearly
communicated.
UNFPA
has
justified
funding
MHUs
based
on
a
humanitarian
need
to
provide
life-­‐saving
services
to
areas
lacking
accessible
health
care.13
However,
MHUs
are
a
part
of
BPHS
and
need
to
be
funded
under
it
to
be
sustainable.
With
UNFPA
funding
MHUs
instead
of
the
BPHS
donor,
and
in
Badakhshan
funding
a
non-­‐BPHS
implementing
partner,
this
could
be
considered
a
less
sustainable
solution
compared
to
having
the
BPHS
donor
fund
MHUs
and
using
the
BPHS
implementing
partner
to
operate
the
MHUs.14
Finding
2:
UNFPA
has
adopted
a
sustainable
approach
to
supporting
CSO
which
has
resulted
in
increased
capacity
and
ownership
at
CSO.
This
is
a
positive
long-­‐term
result,
despite
the
short-­‐term
failure
of
not
running
the
Census
as
planned.
However,
when
providing
services
at
a
community
level,
UNFPA
has,
at
times,
not
considered
sustainability
leading
to
a
sudden
lack
of
assistance
in
a
community
after
withdrawal.
12
As
project
documents
and
project
reports
were
not
available,
the
consultant
was
not
able
to
assess
if/how
sustainability
and
ownership
are
taken
into
consideration
as
projects
are
being
designed.
The
comments
included
in
this
section
mainly
relate
to
field
observations
and
feedbacks
from
interviews.
13
The
MoPH
definition
of
‘access’
to
health
care
is
being
able
to
reach
the
nearest
health
facility
within
2
hours
by
local
means
of
transport.
14
In
Badakhshan,
the
BPHS
implementer
is
a
partner
to
the
UNFPA
MHU
provider
and
is
sub-­‐contracted
to
operate
two
UNFPA
funded
MHU.
“It
is
OK
to
do
service
delivery,
but
UNFPA
need
to
make
sure
they
have
an
exit
plan
that
is
gradual
and
clearly
communicated”
— UNFPA regional technical
advisor

24. Altai
Consulting
UNFPA
Afghanistan
2
nd
Country
Programme
Evaluation
Page
24
of
107
3.5 Alignment15
UNFPA
CP2
was
developed
in
May
2005,
as
the
Afghan
government
was
putting
together
the
first
poverty
reduction
strategy
papers
(PSRP),
the
Interim
Afghanistan
National
Development
Strategy
(I-­‐
ANDS)
and
the
Compact
(both
in
2006).
These
were
the
first
comprehensive
efforts
that
looked
at
the
reconstruction
and
development
needs
in
a
consultative
and
inclusive
manner.
Succeeding
the
2002-­‐2005
National
Development
Framework
(NDF),
the
I-­‐ANDS
benefited
from
four
years
of
reconstruction
efforts
and
subsequent
experience
from
government
and
non-­‐government
agents
in
assessing
needs
in
a
much
clearer
and
focused
way,
and
in
developing
relevant
strategies.
By
the
middle
of
2008,
the
I-­‐ANDS
was
finalised
into
the
ANDS,
which
has
become
the
official
PRSP
for
Afghanistan
for
2008-­‐2013.
Both
the
I-­‐ANDS
and
the
finalised
ANDS
are
anchored
targeting
the
Millennium
Development
Goals
(MDG).
The
fluidity
of
the
national
development
framework
between
2006
and
2009
has
created
an
unusual
and
challenging
environment
for
any
agency
with
a
mandate
to
support
government
institutions
and
strategies.
In
the
absence
of
a
detailed
action
plan
and
programme
prioritisation
at
the
national
level,
“alignment”
de
facto
was
reduced
to
fitting
agencies’
existing
strategies
into
fairly
wide
sectoral
frameworks.
For
most
UN
agencies,
and
UNFPA
in
particular,
this
represented
both
an
opportunity
and
a
challenge.
UN
agencies,
if
they
had
the
vision
and
the
capacity,
had
enough
space
to
push
and
promote
key
policy
issues
that
were
not
yet
outlined
in
the
national
plans
(such
as
family
planning,
in
the
case
of
UNFPA),
but
the
loose
framework
also
meant
that
coordination
and
harmonisation
would
be
rather
erratic
during
a
few
more
years.
UNFPA’s
CP2
three
core
mandates
(RH,
GBV
and
PDS)
correctly
fit
into
the
Afghan
development
framework
and
objectives.
Indicators
related
to
each
of
these
areas
show
some
improvements
at
the
national
level,
which
is
an
encouraging
sign.16
Nonetheless,
the
situation
in
terms
of
maternal
care,
RH
in
general,
gender
equity,
and
access
to
reliable
statistical
data,
contributes
to
put
Afghanistan
towards
the
bottom
of
the
list
of
countries
(181
out
of
182)
in
terms
of
general
human
development.
UNFPA
and
the
ANDS
Under
the
ANDS
framework,
UNFPA
areas
of
intervention
fit
into
Pillar
Two
(Governance,
Rule
of
Law
and
Human
Rights)
and
Three
(Economic
and
Social
Development);
and
in
sector
strategies
Two
(Governance),
Four
(Education),
Five
(Health)
and
Seven
(Social
Protection),
with
Gender
being
a
cross-­‐cutting
issue.
15
OECD
DAC:
“International
actors
align
when
they
base
their
overall
support
on
partner
countries’
national
development
strategies,
institutions
and
procedures.
Alignment
includes
the
support
and
use
of
national
systems”
16
See
Impact
section
for
the
changes
in
these
indicators
“Family
Planning
is
not
a
sensitive
issue
any
longer;
people
want
to
reduce
their
family
size
mostly
for
economic
reasons
and
for
the
search
of
a
better
lifestyle.
But
access
to
information
and
services
is
not
so
easy
and
straightforward,
here
in
the
city,
and
of
course
even
more
in
the
rural
areas”.
— Deputy Minister of MRRD
"…better
obstetric
care
will
bring
down
the
unacceptably
high
levels
of
maternal
and
infant
mortality
rates"
— National Development
Framework, April 2002