Equity and Coverage. Afghanistan Participants: Dr. Hafez Rasooly, APHI Dr. Zabih ullah Maroof, Consultant Dr. SM Moazzem Hossain, UNICEF

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1 What we Learnt in Pelotas and How did we apply for Afghanistan Data Equity and Coverage Afghanistan Participants: Dr. Hafez Rasooly, APHI Dr. Zabih ullah Maroof, Consultant Dr. SM Moazzem Hossain, UNICEF Acknowledgement: Mrs. Arzumand Rizvi & Zaid Shakoor Bhatti, AKU Cesor Victora, Aluiso, Yvon & all Facilitators

2 Location of Afghanistan and Security Risks AFGHANISTAN

3 Lesson learned 1 Simplicity, Punctuality and Hospitality Introduction to Countdown: General Introduction and In-Depth Country Case Studies Review of Niger case study Source of Data such as MICS and DHS and their Quality Assessment (Design, sampling techniques, geographic coverage data collection techniques, monitoring and other quality issues) Learn about Countdown Coverage Indicators We did mapping of our national surveys

4 Mapping of the Data Source AHS 2007 AHS2012 NNS 2004 MICS 2003 MICS 2010 AMS 2010 NRVA 2012 NRVA 2007 Intervention definition Maternal and newborn health Table 4.7 Table 5.9 table 4.9, page page84, no Skilled attendant at birth* matches, Absent pg 2 report RH9 yes page table page 22 Treatment of HIV* Absent Absent Absent Absent no absent AHS 2007 AHS20 NNS MICS 2003 MICS 2010 AMS 2010 NRV NRVA A NRVA 2005 Prevention of mother-to-child transmission of HIV* Antenatal care (at least one visit) Antenatal care (four or more visits)* Absent Absent Absent Absent no absent table 4, page Table 5.3 Table 4.3, 64 ( by nurse, page84, no Absent Pg 3 report RH6 yes page 38 page 17 midwife, table doctor) Absent Absent Absent Absent RH7 yes table 44, 71 absent Intervention definition Demand for family planning satisfied* Absent Absent Absent Absent RH4 yes absent page 83, no table Intermittent preventive treatment for Absent Absent Absent Absent no absent absent malaria during pregnancy table4.10, Caesarean section rate Absent Absent Absent Absent RH9 yes absent page 81 Table 5.5 table 4.4, table 4.6, page Neonatal tetanus protection Absent Absent CH3 absent page 43 page Maternal and newborn health table4.11, page 84 Postnatal care for mothers Absent Absent Absent Absent no absent (recalculate) Postnatal care for babies* Absent Absent Absent Absent no absent absent Child health Table 5.10 Table 4.8, table8.4, page78 Measles immunization coverage Absent pg 10 report ch2 absent page 49 page 25 (recalculate add kuchi to rural) Three doses of combined table8.4, diphtheria/ Table 5.10 Table 4.8, page78 page 25, Absent pg 9 report ch2 absent tetanus/pertussis vaccine page 49 (recalculate add PENTA3 immunization coverage (DTP3)* kuchi to rural) Three doses of Haemophilus influenzae Absent Absent Absent Absent no absent type B (Hib3) immunization coverage Careseeking for pneumonia Absent Table 4.13, page 32, calculation Absent Absent ch7 absent required to recalculate Antibiotic treatment for Absent Absent Absent Absent ch7 absent pneumonia Oral rehydration therapy and Absent Absent Absent pg 13 report ch6 absent continued feeding Oral rehydration salts Absent Absent Absent Absent ch6 absetn Antimalarial treatment Absent Absent Absent Absent no absent Insecticide-treated net use Question 826 Absent Absent Absent no absent page 108 Early initiation of breastfeeding Table 5.12 Absent PStBFed Absent nu2 absent page 53 Exclusive breastfeeding (for first table8.6, Table 5.12 Table 4.9, six months of life)* Absent Absent nu3 page81, age is page 53 page months Introduction of solid, semisolid or Table 5.12 Table 4.9, table8.7, soft page 53(6-9 page 27. Absent Absent nu6 page82, age is foods month) 6-9 months (6-9months) Table 5.10 Table 4.8. page 25, table8.3, Vitamin A supplementation (two nu10 (1 page77, only page 49(one (one dose PVitANID Absent doses) dose) one viamin A dose) only last 6 dose exists month) Water and sanitation Use of an improved drinking water Question ws8 (to figure 6.8, Absent Absent pg 78 report table22.4, page23 source 203A page 96 calculate) page63 Use of improved sanitation Question pg 81 report figure 6.8, Absent Absent ws8 table2.5, page24 facilities 203A page 96 (can calculate) page63 Skilled attendant at birth* Treatment of HIV* Prevention of mother-to-child transmission of HIV* Antenatal care (at least one visit) Table 5.9 page 45 Absent Absent Table 5.3 page 38 Table 4.7 match es, page 22 Absen t Absen t Table 4.3, page 17 Abse nt Abse nt Abse nt Abse nt pg 2 report RH9 yes table 4.9, page 79 Absent no absent Absent no absent Pg 3 report RH6 yes table 4, page 64 ( by nurse, midwif e, doctor) page84, no absent table page84, no table

5 CD Indicators For Equity Graph from MICS 2010 Report CPR CPR moder n only Region Central Central Highlands Area Educat ion Wealth index quintil es East North North East South South East West Urban Rural None Primary Secondary + Missing/DK Poorest Second Middle Fourth Richest ANC1 ANC4 + + SBA Caesa rian Sectio n Eearly PNC Initiati Wo on of me BF n PNC Babie s DPT3 Polio Measl es BCG Full Immu nizati on VAS OR& F Total ORS Cares eekin g Pneu U5M monia NMR IMR R Impro ved Drinki ng water Impro ved Sanita ry Faciliti es EBF 0-6 mont hs Mini mum Diet Frequ ency HH witho ud Iodize d Salt

6 Lesson learned Mortality estimation, will seek help from external source- Mortality Groups Non survey coverage data (Child Info, CHERG, LiST, JMP, IGME, ) Role of equity analysis ( CIX, five dot plots, SII) Co-coverage and Composite Coverage Index? LiST : an very effective tool for projection and assess the effect of intervention on outcome indicators

7 Outcome from STATA- Five Dot Equity Graph CPR ANC 1+ SBA C-SECTION Early BF BCG DPT3 Measles Care pneum. ORT diarrhea Q1 Q2 Q3 Q4 Q5 Graph command by Int'l Center for Equity in Health

8 0 Cumulative percent Concentration Index CIX for WQ and age at first marriage: Concentration index = (0.0063) CIX for WQ and ANC 1+: Concentration index = (0.0343) Source : Afghanistan Mortality Survey (AMS 2010) Cumulative percent ranked by economic status

9 -.5 0 ANC SII WQ with ANC 1+ anc1 Coef. Std. Err. z P>z [95% Conf. Interval] SII anc1 Coef. Std. Err. z P>z [95% Conf. Interval] RII Fractional rank Wealth Indes Fitted

10 Mean age at first marriage SII WQ and Age at first Marriage agfm Coef. Std. Err. t P>t [95% Conf. Interval] SII agfm Coef. Std. Err. t P>t [95% Conf. Interval] RII Fractional rank Wealth quantil Fitted

11 Percentage Outcome from the LIST ,5 Percentage of lives saved due to increasing Hib and Antibiotic treatment coverage in under-fives with Pneumonia , ,5 99 Time scale

12 Next Step Formation of the Case Study Group with more clarification of the Global Count Down Group Leaders Assign Four Focal person to lead each of the clusters (Coverage, Equity, Financing and Policy/Program Analysis) Meeting of the Case Study Group and Start working on Analysis with a Lead for overall Case Study Update and brief the larger Afghanistan Count Down Working group