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AFG Coverage Assessment (SLEAC) Report in Badakskhan province (Oct, 2015)


The project, of which the current assessment is a part, intends to contribute to improving the performance of IMAM services in Afghanistan, through the provision of in-depth information on coverage, identification of barriers and boosters to access, and definition of recommendations for a durable scale up of nutrition service delivery. The main objectives of this assessment were to collaborate with the Swedish Committee for Afghanistan (SCA) in order to: 1. Classify coverage of each zone 2. Estimate coverage in the province 3. Identify key factors influencing coverage 4. Outline evidence based recommendations 5. Train partner staff in coverage methodologies


SLEAC uses a two-stage sampling process. Stage one samples villages across the area to be classified (in this case zones). The sampling process ensures a random and spatially representative sample. Stage two samples SAM children at village level. This step ensures an exhaustive sampling of all SAM cases in each village selected. Some specific technical considerations were made to adapt the sampling to the Afghanistan context

Key findings: 

The coverage estimation for Badakhshan province is 20.7% (CI 95% 15.93%-25.53%). Across the province, the most commonly cited barriers to access related to difficulties caregivers have in accessing health centres. In many cases, this was due to physical access over long distances since there is a lack of transport available and road conditions are poor. Without transport, the average time taken to get tohealth centres was found to be 3-4 hours on foot. The experience of caregivers at clinic level also was found to have a bearing on coverage. In some central areas in particular, bad (unfair or rude) treatment by health centre staff was cited by informants a reason for not going to the health centre. The lack of support to care for other children in the family was also found to be an inhibiting factor in accessing treatment. Throughout the zones, caregivers having little information about the treatment services available, was also an important factor preventing them from taking their child suffering from SAM to the health centre, and in more secure and remote areas in particular, the lack of awareness of malnutrition and poor treatment seeking behaviour was demonstrated. Qualitative information also demonstrated the limited level of involvement of community health workers (CHWs) in nutrition activities, including sensitization, screening and referral. Findings that influence coverage positively related to the constructive roles of various community members in sharing information, indicating how important other villagers, friends and relatives are in facilitating a child reaching admission to SAM treatment. In addition, sensitisation activities in Zone One, including training of school staff and community visits by midwives, seem to have positively influenced admissions to the program.

Sample size: 
Assessment Report: 
Publicly Available
Assessment Questionnaire: 
Available on Request
Assessment Data: 
Available on Request
Assessment Date(s): 
18 Oct 2015

Level of Representation

District / Province / Locality / County
Report completed
Unit(s) of Measurement: 
Collection Method(s): 
Structured Interview
Field Interview
Population Type(s): 
All affected population
Leading/Coordinating Organization(s): 
Action against Hunger