Afghanistan Health Emergency Response (HER) Project

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[Revised Operation Abstract as of June 2025]In the face of the unfolding crisis in Afghanistan, the World Bank (WB) along with international partners, has found pragmatic ways to provide support for essential basic services to the Afghan people. The WB has reached more than 25 million Afghans following a stepwise approach. First, Approach 1.0 (November 2021) supported the provision of humanitarian gap financing. Approach 2.0 (March 2022) supported the delivery of basic services and livelihoods support for critical health, food security, jobs, education, Non-Governmental Organization (NGO) capacity development and water services. These were provided nationwide at scale, off-budget and outside of Interim Taliban Administration (ITA) control through United Nations (UN) agencies and international NGOs using the “principled approach” of delivery by and to women adopted by the international community. Interventions under both Approaches were financed through the ARTF, with the Global Financing Facility for Women, Children and Adolescents joining to support health services. Approach 3.0 (February 2024) supports utilizing IDA financing to complement trust fund financing of the basic services and livelihoods projects. The proposed health activities are consistent with Approach 3.0. The Afghanistan Health Emergency Response (HER) project is designed to address fundamental health and nutrition needs while maintaining progress achieved over the past two decades. The project's development objective is to enhance the utilization and quality of essential health and nutrition services. It comprises three components, implemented by UNICEF (components 1 and 2) and WFP (component 3), with WHO contributing to the management of infectious disease outbreaks.Component 1 focuses on the urgent provision of essential primary and secondary health services. It finances the delivery of the Basic Package of Health Services (BPHS) and Essential Package of Hospital Services (EPHS) across 17 provinces. Service Providers (SPs) operate under performance-based contracts managed by UNICEF. This component is divided into three subcomponents:• Subcomponent 1.1: This subcomponent aims to enhance the utilization and quality of BPHS and EPHS, incorporating High Impact Value Added (HIVA) interventions for intrapartum and immediate postpartum care. It employs performance-based financing across 17 provinces, delivering these packages at primary health care levels and first and second-level hospitals using a pay-for-performance model.• Subcomponent 1.2: Focuses on improving maternal and child nutrition services at both community and facility levels, this subcomponent collaborates with Nutrition Counselors and Community Health Workers.• Subcomponent 1.3: This subcomponent is dedicated to strengthening the health system's capacity to prevent and respond to major infectious disease outbreaks.Component 2 is designed to strengthen service delivery and project coordination. It aims to enhance the quality of care through training and mentorship, procurement of drugs and essential equipment, financing for a third-party monitor (TPM), and performance management support for SPs, along with covering UNICEF overhead costs. This component includes five subcomponents:• Subcomponent 2.1: This subcomponent promotes quality care and strengthens healthcare worker capacity by allowing the implementing agency to contract training institutions and specialized firms for trans-provincial training, mentorship, and broader institutional investments as needed.• Subcomponent 2.2: This subcomponent supports SPs with forecasting and procurement technical assistance, including innovative solutions like portable mass-spectrometers for field-quality testing of purchased products.• Subcomponent 2.3: This subcomponent ensures that the program design elements under Component 1 translate into improved performance by SPs and support the quality of services delivered, resulting in enhanced population health outcomes.• Subcomponent 2.4: Focused on project implementation and coordination for UNICEF, this subcomponent aims to reduce duplication, plan capacity investments, and maximize the efficient use of health sector resources.• Subcomponent 2.5: This subcomponent finances the data collection of the Income, Expenditure, and Labor Force Survey (IE-LFS), providing pertinent data to inform HER project implementation and address knowledge gaps on welfare and health policy issues in Afghanistan.Component 3 aims to strengthen demand and access to enhance nutritional outcomes among the most vulnerable. It complements the health and nutrition services provided under subcomponents 1.1 and 1.2, targeting pregnant and breastfeeding women and children under two years of age in selected districts. This component comprises five subcomponents:• Subcomponent 3.1: This subcomponent finances quarterly cash transfers to pregnant and breastfeeding women and mothers of children under two years of age.• Subcomponent 3.2: This subcomponent covers all costs incurred by WFP Cooperating Partners (CPs) to develop and facilitate nutrition-sensitive Social and Behavioral Change Communication (SBCC) sessions.• Subcomponent 3.3: This subcomponent finances WFP’s verification of beneficiaries, process monitoring, and post-distribution monitoring.• Subcomponent 3.4: Focused on project implementation and coordination for WFP, this subcomponent covers operating and indirect costs.• Subcomponent 3.5: This subcomponent contributes to sustaining health and nutrition outcomes and financial protection related to access and use of health and nutrition services by building more diversified nutrition-sensitive livelihoods for selected vulnerable households.