Country and region: Afghanistan
Organisation: World Vision
Point person and role: Rosanna Keam, WASH Sector Lead
Population served by the programme: 45,196
Unique characteristics of the setting: This is a rural setting and it currently experiencing a large influx of Afghan returnees who are crossing the border from Iran on a daily basis. All major cities were in lockdown until at least late May, so the provision of materials at household level was prioritized.
Number of cases and deaths due to COVID-19 at time of publishing: 26,874 cases, 504 deaths.
Image: Community midwife conducting COVID-19 awareness sessions with women in a WVA Family Health House (HFF) in Herat Province.
Briefly describe the key components of your COVID-19 response project:
World Vision Afghanistan (WVA) began its response in February 2020. Although there was no new funding at that point in time, we adapted existing projects to respond swiftly. WVA is one of the 7 NGO members of the COVID-19 National Taskforce in Afghanistan. Currently our COVID-19 response activities include:
- Training World Vision Afghanistan’s mobile health teams to deliver risk prevention messaging.
- Training 600 health care providers on COVID19 prevention and control.
- Donating personal protective equipment and disinfection equipment (masks, gloves, hand sanitizer and liquid bleach) to health centers and mobile health teams.
- Conducted a knowledge, attitudes and practices (KAP) survey by phone to understand current behaviours and beliefs.
- Developed banners and other IEC materials for use in public places. These focus on COVID-19 preventative behaviours and have been placed in health care facilities airports, places of worship, and the Iran Border Transit Centre.
- Distributing hygiene kits to returnees from Iran and IDPs as well as 3000 street children.
- Trained 60 faith leaders on COVID-19 symptoms and prevention so that they could actively share this information with communities.
What process did you use when designing your COVID-19 response programme?
We designed our response based on guidance from the Global WASH Cluster and World Vision’s Global WASH programmatic recommendations for COVID-19. This was contextualized and aligned with the recommendations coming from the national COVID-19 Taskforce. We liaised directly with the local Department of Public Health in Herat to adapt our longer term programming to the COVID-19 response, which involved incorporating the Department of Public Health’s COVID-19-specific messaging into our existing hygiene kit distributions, hygiene promotion, and health project activities. Our role in national coordination mechanisms has been key and has encouraged all stakeholders to make our response efforts cohesive.
It’s important to note, however, that it hasn’t been a linear process. For example, we started implementing some activities while still developing our response plan because we had to get the work off the ground quickly. This allowed us to provide feedback to higher-level processes and standards setting, while ensuring that programs are adapted as evidence and experience improve.
To shape our project design, WVA conducted a KAP survey via phone to understand priority needs as well as knowledge and attitudes about COVID-19 transmission dynamics and prevention measures.
What is one thing that has been working really well so far and is there something other programmes could learn from this?
WVA conducted a COVID-19 K survey via phone in April. This was the first time WVA conducted a survey via telephone interview. WVA applied J-PAL best practice for telephone interviews and detailed guidance was developed for Monitoring and Evaluation (M&E) officers prior to data collection. A pilot study was conducted to test the tool and determine the time for the completion of the survey. The telephone interviews were conducted in full compliance of WVA research ethics, with verbal consent being obtained from the beneficiaries prior to administering COVID-19 related questions. Participants were selected from three provinces of Afghanistan (Herat, Badghis and Ghor). The data was collected through mobile data collection software KOBO. The data was then cleaned and transferred into SPSS for further data analysis and reporting.
The results of the survey showed that 55% of respondents reported attending mosque in the last 3 days, but only 8% of people reported hearing COVID-19 messages from religious leaders so we recognized there was a gap in information provision from religious leaders. Full results from the KAP survey are available here.
In coordination with the regional WHO office, Ministry of Hajj and Religious Affairs, WVA trained 60 faith leaders (who had previously been involved in a WVA training on protection and gender) on COVID-19 information and prevention measures. These faith leaders have been communicating this messaging and delivering IEC materials to their congregations. IEC materials have also been placed outside places of worship.
Engagement of faith leaders on the subject of COVID-19 has been welcomed by communities and the faith leaders themselves. As the faith leaders have a strong knowledge of Islamic scripture but limited information on COVID-19 prevention measures, the training was welcomed by faith leaders, as well as the government, resulting in messages on COVID-19 from an Islamic perspective being shared with their respective communities.
Left image : WVA WASH Facilitator conducting COVID-19 awareness raising and risk communication sessions in communities in Herat Province.
Right image: Faith leader educating internally displaced people (IDP) settlement representatives on how to protect themselves and others from COVID-19 in a Herat Province IDP settlement.
What is one challenge that you have encountered and how are you trying to overcome this?
People in communities have been reporting that they cannot wash their hands frequently because they don’t have access to enough safe water. Prior to the COVID-19 pandemic WVA was already constructing 12 community water networks to support this need, with 20 more planned to enable that access. WVA is exploring measures to see if this construction work can safely continue and even accelerate during this rime so that these networks can start delivering adequate quantities of water to residents. We are also piloting household connections to reduce the risk of transmission at communal water points.
How have you been engaging communities throughout your programme and what feedback have you received?
WVA has a set of existing monitoring and accountability mechanisms which are designed to seek feedback from populations about our programmes. For example, WVA has in-person helpdesk established at hygiene kit distribution sites, a phone hotline and a complaints box for people to share their concerns or feedback. The hotline and complaints box enable anonymous, confidential feedback. During our activities we have actively shared the details of the complaints and feedback mechanisms. What we have found so far is that the most preferable method of registering feedback is through face-to-face communication at the help desk. The majority of feedback has been queries about the quantity, quality and type of kit items.
WVA is planning to conduct more COVID-19 KAP surveys in the future under new grants. WVA is also conducting monthly context monitoring surveys via mobile phone interview with community leaders in order to obtain information about contextual changes that might influence WVA’s programming. This is also a chance to receive feedback from communities about their satisfaction with WVA’s work. WVA has also taken part in the recent Afghanistan Joint Market Monitoring Initiative (JMMI) assessment, conducted by the Afghanistan Cash and Voucher Working Group (CVWG) in collaboration with REACH, to understand the impact of COVID-19 on local markets. WVA is also taking part in WVA’s global child protection research to understand the impact of the COVID-19 pandemic on child wellbeing.
Case study written by Rosanna Keam, WASH Sector Lead at World Vision.