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AFG Coverage Assessment (SLEAC) Report in Bamyan province (Nov, 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 Bamyan province is 41.9% (CI 95% 32.15%-51.69%). Qualitative information collected from caregivers of each uncovered case found allowed for the identification of factors inhibiting access to treatment services and therefore reasons for low coverage. Across the province, the most commonly cited barriers to access were the lack of awareness of malnutrition and caregivers having little information about the treatment services available. Qualitative information also demonstrated the limited level of involvement of community health workers (CHWs) in nutrition activities, including sensitization, screening and referral. The experience of caregivers at clinic level also was found to have a bearing on coverage. In some areas, bad (unfair or rude) treatment by clinic 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 (to allow the caregiver to go to the health centre) was also found to be an inhibiting factor.
Physical inaccessibility to the health centre was found to be a barrier to access across the province, but especially in Zone Two, where six villages included in the sampling could not be reached due to heavy snowfall. Across the province people were restricted because of lack of availability of transportation, but in Zone One physical access was more likely to be effected by the lack of finances for transportation.
Caregivers of cases found to be undergoing treatment were also interviewed to determine how they came to be admitted. These findings relate to the constructive roles of 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, activities by vaccinators were found to be an effective way to communicate messages and refer SAM children for admission.

Sample size: 
Assessment Report: 
Publicly Available
Assessment Questionnaire: 
Available on Request
Assessment Data: 
Available on Request
Assessment Date(s): 
20 Nov 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