JezK

Edit File: 1629386560.M67070P961603.mocha3025.mochahost.com,S=32063,W=32659:2,S

Envelope-to: nooromari@jack.ngo,
 ahmad@jack.ngo,
 finance.manager@jack.ngo,
 quraishi@jack.ngo
Delivery-date: Thu, 19 Aug 2021 11:22:40 -0400
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From: AHO Afghanistan <aho.afghanistan@gmail.com>
Date: Thu, 19 Aug 2021 19:47:37 +0430
Message-ID: <CABckiUJ4UwUhVFh8t+Jo2r1f2R5+H+V+1xx=UQmGmVQkK6-vTQ@mail.gmail.com>
Subject: Alliance of Health Organizations (AHO) Members / BPHS and EPHS
 Implementing NGOs Concerns
To: hahmadzai@worldbank.org, hsamaha@worldbank.org, bhamid@worldbank.org, 
	mfrough@worldbank.org, hsadat@worldbank.org, ekraban@worldbank.org, 
	eds01@worldbank.org, Sayed Ghulam <gsayed@worldbank.org>
Cc: Pmo MoPH <Pmo.moph@gmail.com>, Ahmad Wali Rasekh <Rasekh.pmo@gmail.com>, 
	hassan2 gcmu <Hassan2.gcmu@gmail.com>, "Dr. Yasamin Yousofzai" <yyousofzai@aada.org.af>, 
	"Dr. Muhammad Najeeb Baleegh" <nbaleegh@aada.org.af>, qmnoori@aada.org.af, 
	naseem <naseem@healthnettpoaf.org>, "Dr.NajeebUllah" <najeeb@healthnettpoaf.org>, 
	farhadpaiman@gmail.com, "drshekibfalah@gmail.com" <drshekibfalah@gmail.com>, 
	Masoud Sarwari <masoudsarwari@gmail.com>, Raz Mohammad Dalili <dalili.kabul@gmail.com>, 
	Ebadullah Hedayat <ebadhedayat@gmail.com>, Ahmad Abid Humayun <sdo.programs@gmail.com>, 
	Aziz Naderi <sdokabul@gmail.com>, 
	"Dr. Ebadullah Hedayat" <health.deputydirector@sanayee.org.af>, caf.director.general@gmail.com, 
	"Dr. Nasir Hamid" <caf.operation.director@gmail.com>, "Dr. Qawi Qadiri" <q.qadiri@bdn.org.af>, 
	"Mdr. Saboor" <mdrsaboor@baran.org.af>, Hashimi <hashimi@baran.org.af>, 
	"Dr.Mohammad Asef Tajzad" <dr.tajzad@baran.org.af>, Ahmad Shah Pardis <ahmadshah.pardis@sca.org.af>, 
	khalid.fahim@sca.org.af, Samiullah Hasanzoi <samiullahhasanzoi@gmail.com>, arwahab@gmail.com, 
	abdul.rashid@mmrca.org.af, Abdul Majeed Siddiqi <majeed.hntpo@gmail.com>, 
	Asmand <fareed@ahds.org>, zarjan@cha-net.org, 
	Taj Mohammad Bassiry <bassiry@cha-net.org>, Zabiullah <hmis@cha-net.org>, 
	Said Iftekhar Sadaat <iftekhar.sadaat@sca.org.af>, movewelfare@yahoo.com, shdpkbl@gmail.com, 
	shdp.hc@gmail.com, ORCD Afghanistan <info@orcd.org.af>, 
	Ezatullah Roshan <finance@orcd.org.af>, Mirwais Sidiqi <m.sidiqi@orcd.org>, shdpkbl.tm@gmail.com, 
	laily_temor@yahoo.com, 
	"Dr.Jumakhan Nasir Khairzada" <general_director@saf.org.af>, Program_director@saf.org.af, 
	Mohammad Hussain Hasseen <mh.hasseen@bdn.org.af>, Maroof Abdul <pdd.kbl@gmail.com>, 
	Nooromari <nooromari@jack.ngo>, ahmad@jack.ngo, finance.manager@jack.ngo, 
	quraishi@jack.ngo, drhumayoon2010@gmail.com, 
	"Dr.Mohammad Jan" <mjan@hewad.org.af>, "Dr. Aziz ur Rahman Rahman" <aziz.ur@brac.net>, anwar.hassanzai@sca.org.af, 
	Mohammad Tahir Qarizada <t.qarizada@orcd.org>, Nasrullah.org@akdn.org, 
	Humayoon Helal <humayoon.helal@akdn.org>
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*Dear World Bank Colleagues,*

We, the Health NGOs, appreciate that you are aware of the recent political
change that has been taking place very quickly. This has led to uncertainty
about the future of the SEHATMANDI project implementation in Afghanistan.
Hereby, we would kindly like to request the World Bank to provide us with
clarification on its position on the future modalities of funding and
implementation of the SEHATMANDI program. This would enable us to convey
clear messages to our staff at the provincial level and avoid any
interruption in service delivery during this critical time.

Further, we would like to request the World Bank to address the remaining
operational concerns which have been encountered over the current and last
period:

1.        *Contract provision:*     Although the contracting process has
been completed including the contract negotiations, the NGOs have not yet
received the signed copy of the contract from the MoPH.  The NGOs continue
the services provision as usual from 1st July 2021 to date and all the
Health Facilities (HFs) across the country are functional and expenses are
made. When and how the contract will be signed, as it is a high financial
risk towards organizations.

2.      *Force majeure:* Force majeure is a contractual requirement, which
ought to be respected. MoPH request to redirect resources towards Covid-19
which resulted in stopping the services effected performance and it never
compensated. . The Covid-19 pandemic and lock down had an impact on client
numbers. Clients numbers in quarter 2 and quarter 3 of 2020 down which
resulted in a significant reduction of service delivery and meeting the
targets. Thus, the income for the project is reduced and in addition to
that hike in prices and instructions of MoPH for prioritizing the services,
aggravating the situation. NGOs did ask MoPH to not consider P4P for
quarter 2 and quarter 3 of 2020, but so far, no response. The issue of
force majeure and recommendation was part of mid-term review last year, and
so far, no action, besides repeated requests from NGOs, has been taken.
NGOs recently received a letter from MoPH to stop elective surgeries, where
it is linked with payment, if this is stopped, from where the fund for
salary of staff and cost of services will come, this is not considered. The
Covid- 19 pandemic and its impact on health service delivery should be seen
as a force majeure. However, this was ignored and thus should be considered
as a breach of contract.

3.      *Payment delay:*      The payment of instalments to NGO=E2=80=99s h=
ave been
delayed despite the fact that NGOs carry the burden of the financial
liabilities by having to pay for the staff salaries, medicines, oxygen
supplies and other medical and non-medical needs of the HFs.

Payments are linked to third party verification which is delayed. In
addition, the instalment schedule is not in line with the expenses, and due
to delays, it is not possible for many NGOs to pay salaries and other
expenses on time. Therefore, a revised instalment schedule and more
assurance for an on time verification and payment, is needed. However, this
is not considered for the extension period and there is a great need to do
so in order to prevent financial bottlenecks and secure smooth program
implementation

4.     *Budget implications: **The* extension budget is kept the same as it
was during the last 30 months of SEHATMANDI. It does, therefore, not
accommodate the inflation rate, hike in prices and the additional
conditions to increase salaries during the extension period. It is simply
not possible to run the services with the same budget, due to reasons given
above in addition to security issues and an increased demand. Although this
has been previously discussed during face to face and online meetings there
has been no response from the MoPH and/or the World Bank. Some national and
international NGOs are thus forced to withdraw and others are considering
the withdrawal if the environment and conditions are not feasible to
implement the SEHATMANDI during the extension. Withdrawal of NGOs will
result in unnecessary and unwanted delay in service delivery and anyone who
will implement, will be facing serious challenges resulting in
dissatisfaction of the community. In addition, the collateral and direct
damage to health facilities due to war, did require and will require a
major rehabilitation work. This was not supported through SEHATMANDI but we
urge that it should be foreseen in the extension period. A budget revision
for the extension period is therefore urgently needed and we, hereby,
request the World Bank to address this issue.

5.   *Quality and quantity of pharmaceuticals:*     NGOs are blamed for
inadequate quality of pharmaceutical. However, pharmaceutical quality is
the responsibility of MoPH as it provides the quality certificate. There is
a great need to ensure improved quality control and licenses to import
pharmaceuticals into the country.     In addition, NGOs have set targets,
where payment is based on the targets defined, and thus the supply. NGOs
request for proper target setting for extension period based on actual
needs, to be able to supply enough pharmaceuticals. The issue of over-caps
(ceiling for P4P) is important and besides many promises by MoPH we do not
see any action so far. Without resolving the cap issues for indicators, it
is not possible to resolve the quantity of pharmaceutical supplies.

6*.*      *Standard Operating Procedures:* NGOs raised issues on third
party monitoring reports, deductions issue, and SoP problems. NGOs do
request that these issues will be considered and properly addressed during
the extension period

NGOs, both national and international, have made significant contributions
to improve the performance of the health sector over the last two decades
by mobilizing resources and developing trust of donors and the
international community.  Therefore, considering their professional
experiences in health service delivery is of utmost importance to ensure
the functioning of the health system in future.

On behalf of NGOs, I hereby request the World Bank to consider the concerns
mentioned above and engage with NGOs to discuss the future challenges and
implementation modalities.

We want to improve the health system and healthcare in the country and I am
looking forward to receiving your response

Yours sincerely

Dr. Sharaf Sharifi

AHO Coordinator

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<div dir=3D"ltr"><div><p class=3D"MsoNormal" style=3D"margin:0in 0in 0.0001=
pt;line-height:normal;background-image:initial;background-position:initial;=
background-size:initial;background-repeat:initial;background-origin:initial=
;background-clip:initial;font-size:11pt;font-family:Calibri,sans-serif"><sp=
an lang=3D"EN-GB" style=3D"font-size:12pt">Dear World
Bank Colleagues,

<p class=3D"MsoNormal" style=3D"margin:0in 0in 0.0001pt;line-height:normal;=
background-image:initial;background-position:initial;background-size:initia=
l;background-repeat:initial;background-origin:initial;background-clip:initi=
al;font-size:11pt;font-family:Calibri,sans-serif">We, the
Health NGOs, appreciate that you are aware of the recent political change t=
hat
has been taking place very quickly. This has led to uncertainty about the f=
uture
of the SEHATMANDI project implementation in Afghanistan. Hereby, we would
kindly like to request the World Bank to provide us with clarification on i=
ts
position on the future modalities of funding and implementation of the
SEHATMANDI program. This would enable us to convey clear messages to our st=
aff
at the provincial level and avoid any interruption in service delivery duri=
ng
this critical time.=C2=A0

<p class=3D"gmail-MsoListParagraph" style=3D"margin:0in 0in 0.0001pt 0.25in=
;line-height:normal;background-image:initial;background-position:initial;ba=
ckground-size:initial;background-repeat:initial;background-origin:initial;b=
ackground-clip:initial;font-size:11pt;font-family:Calibri,sans-serif"><span=
 lang=3D"EN-GB" style=3D"font-size:12pt">1.=C2=A0=C2=A0=
=C2=A0=C2=A0=C2=A0 =C2=A0=C2=A0C=
ontract provision:
=C2=A0=C2=A0=C2=A0 Although the contracting process has been
completed including the contract negotiations, the NGOs have not yet receiv=
ed
the signed copy of the contract from the MoPH.=C2=A0 The NGOs continue the =
services provision as
usual from 1st July 2021 to date and all the Health Facilities (=
HFs)
across the country are functional and expenses are made. When and how the
contract will be signed, as it is a high financial risk towards organizatio=
ns.

<p class=3D"gmail-MsoListParagraph" style=3D"margin:0in 0in 0.0001pt 0.25in=
;line-height:normal;background-image:initial;background-position:initial;ba=
ckground-size:initial;background-repeat:initial;background-origin:initial;b=
ackground-clip:initial;font-size:11pt;font-family:Calibri,sans-serif"><span=
 lang=3D"EN-GB" style=3D"font-size:12pt">2.=C2=A0=C2=A0=
=C2=A0=C2=A0=C2=A0 Force majeure: Force majeure is a contractual
requirement, which ought to be respected. MoPH request to redirect resource=
s towards
Covid-19 which resulted in stopping the services effected performance and i=
t
never compensated. . The Covid-19 pandemic and lock down had an impact on
client numbers. Clients numbers in quarter 2 and quarter 3 of 2020 down whi=
ch resulted
in a significant reduction of service delivery and meeting the targets. Thu=
s,
the income for the project is reduced and in addition to that hike in price=
s
and instructions of MoPH for prioritizing the services, aggravating the
situation. NGOs did ask MoPH to not consider P4P for quarter 2 and quarter =
3 of
2020, but so far, no response. The issue of force majeure and recommendatio=
n
was part of mid-term review last year, and so far, no action, besides repea=
ted
requests from NGOs, has been taken. NGOs recently received a letter from Mo=
PH
to stop elective surgeries, where it is linked with payment, if this is
stopped, from where the fund for salary of staff and cost of services will
come, this is not considered. The Covid- 19 pandemic and its impact on heal=
th
service delivery should be seen as a force majeure. However, this was ignor=
ed
and thus should be considered as a breach of contract.

<p class=3D"MsoNormal" style=3D"margin:0in 0in 0.0001pt 0.5in;line-height:n=
ormal;background-image:initial;background-position:initial;background-size:=
initial;background-repeat:initial;background-origin:initial;background-clip=
:initial;font-size:11pt;font-family:Calibri,sans-serif">=C2=A0

<p class=3D"MsoNormal" style=3D"margin:0in 0in 0.0001pt 0.25in;line-height:=
normal;background-image:initial;background-position:initial;background-size=
:initial;background-repeat:initial;background-origin:initial;background-cli=
p:initial;font-size:11pt;font-family:Calibri,sans-serif">4.=C2=A0=C2=A0=C2=A0=C2=
=A0=C2=A0Budget
implications: T=
he extension budge=
t is kept the same as it was during
the last 30 months of SEHATMANDI. It does, therefore, not accommodate the
inflation rate, hike in prices and the additional conditions to increase
salaries during the extension period. It is simply not possible to run the =
services
with the same budget, due to reasons given above in addition to security is=
sues
and an increased demand. Although this has been previously discussed during
face to face and online meetings there has been no response from the MoPH a=
nd/or
the World Bank. Some national and international NGOs are thus forced to
withdraw and others are considering the withdrawal if the environment and
conditions are not feasible to implement the SEHATMANDI during the extensio=
n. Withdrawal
of NGOs will result in unnecessary and unwanted delay in service delivery a=
nd anyone
who will implement, will be facing serious challenges resulting in
dissatisfaction of the community. In addition, the collateral and direct da=
mage
to health facilities due to war, did require and will require a major
rehabilitation work. This was not supported through SEHATMANDI but we urge =
that
it should be foreseen in the extension period. A budget revision for the
extension period is therefore urgently needed and we, hereby, request the W=
orld
Bank to address this issue.

<p class=3D"MsoNormal" style=3D"margin:0in 0in 0.0001pt 0.25in;line-height:=
normal;background-image:initial;background-position:initial;background-size=
:initial;background-repeat:initial;background-origin:initial;background-cli=
p:initial;font-size:11pt;font-family:Calibri,sans-serif">5.=C2=A0=C2=A0 <b=
>Quality
and quantity of pharmaceuticals:=C2=A0=
=C2=A0=C2=A0=C2=A0 NGOs are blamed for inadequate quality of
pharmaceutical. However, pharmaceutical quality is the responsibility of Mo=
PH
as it provides the quality certificate. There is a great need to ensure
improved quality control and licenses to import pharmaceuticals into the
country. =C2=A0=C2=A0=C2=A0=C2=A0In addition, NGOs have set targets, where
payment is based on the targets defined, and thus the supply. NGOs request =
for
proper target setting for extension period based on actual needs, to be abl=
e to
supply enough pharmaceuticals. The issue of over-caps (ceiling for P4P) is
important and besides many promises by MoPH we do not see any action so far=
.
Without resolving the cap issues for indicators, it is not possible to reso=
lve
the quantity of pharmaceutical supplies.

<p class=3D"MsoNormal" style=3D"margin:0in 0in 0.0001pt;line-height:normal;=
background-image:initial;background-position:initial;background-size:initia=
l;background-repeat:initial;background-origin:initial;background-clip:initi=
al;font-size:11pt;font-family:Calibri,sans-serif">NGOs,
both national and international, have made significant contributions to imp=
rove
the performance of the health sector over the last two decades by mobilizin=
g
resources and developing trust of donors and the international community.=
=C2=A0 Therefore, considering their professional
experiences in health service delivery is of utmost importance to ensure th=
e
functioning of the health system in future.=C2=A0

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