Every thirty minutes, a woman in Afghanistan dies giving birth; one of every four Afghan children dies before age five. NGOs play a crucial role in efforts to change these statistics for the better and end the human tragedy they represent.

REACH has awarded $68 million in USAID-funded grants to 25 Afghan and international NGOs to deliver the Basic Package of Health Services (BPHS), the primary health care services selected by Afghanistan's Ministry of Public Health as having the greatest impact on the country's major health problems.

But awarding funds for BPHS delivery is just the beginning. At the outset, REACH provides a standard set of training guides to equip NGOs with the tools and information they need. With this foundation in place, REACH continues technical assistance, using both standardized and tailored approaches to build NGO capacity to deliver and expand quality health services and help them develop the technical, managerial and leadership skills they need.

The REACH NGO Development Initiative: This cross-cutting activity utilizes the resources of REACH Senior technical staff from every technical program department. Representatives meet bi-weekly to assess NGO progress.

• Through analysis and discussion of quarterly reports, the observations and experiences of technical staff and key data compiled on an "NGO score card," the NGO Development Team (NGO DT) identifies NGO needs and coordinates assistance.
• Data analysis and discussion also enables the NGO DT to acknowledge best practices and strengths among NGO grantee partners.
• A widespread approach can deliver technical assistance to all NGOs facing similar challenges, for example, in drug management or use of HMIS data for decision making. In other instances, analysis may identify specific NGOs requiring more intensive, specialized/targeted assistance. Drawing on a wide variety of technical expertise enables an holistic approach to identifying problems and finding solutions that build on each NGO's current capacities.
• Overseen by REACH Grant Officers, NGOs develop action plans, including resources required and a time line for improvement. Between July -- December 2005, six NGOs participated in targeted technical assistance to strengthen their capacity to deliver the BPHS.

The REACH Learning Center Initiative: At a time of rapid expansion and growth, NGOs have had to adapt their internal communication, training and supervisory systems to reflect an increase in important BPHS information and kinds of training tools available to assist BPHS delivery. The REACH Learning Center Initiative (LC) was launched to model appropriate strategies for expanding sound technical training and supervision across organizations.

Since November 2005, Learning Centers have been being established through a series of bi-weekly visits to four targeted health facilities in Kabul province, where REACH technical staff spend 2-3 hours working side by side with NGO supervisors to jointly assist NGO health facility staff.

Efforts focus on strengthening and reinforcing five skills and clinic activities considered vital to successful delivery of the BPHS:

• Community leadership by male and female health councils (shura-e-sahie) in the villages served by the clinic
• Performance of the clinic's Community Health Workers (CHW), including their use of tools such as community maps and pictorial registers
• The management and operation of the clinic pharmacy
• The understanding and application of data on the health status of the clinic catchment area, use of the clinic, and the health status of the patients
• Health education provided to clinic patients and visitors.

LC also allows NGO supervisors and health facility staff to test skills and gain competencies in training and supervision that can be replicated and modeled for other clinics managed by the NGO. As models of successful performance, LC clinics and their supervisory staff, along with associated health councils and CHWs, will prove valuable resources, enabling NGOs to continue and sustain capacity building at their other health facilities into the future.

REACH deems it a privilege to work with NGOs to improve the quality of health care services that are saving the lives of women and children each day in 14 provinces of Afghanistan.