Thursday, December 10, 2015

Poverty Reduction Funds-Is there Lessons Learn of Poverty Alleviation Fund? Impact of the Poverty Alleviation Fund (PAF): Lessons from Nepal

The Impact of the Poverty Alleviation Fund, Nepal (PAF-N)
Lessons to be learnt from the Poverty Alleviation Fund[1]
by; Nahakul K.C.

1. Introduction:

What is PAF-N?

Poverty Alleviation Fund, Nepal is a programme created by the Government of Nepal to reduce extreme poverty in Nepal and to build a democratic, just, equitable and sustainable society. It is also part of the governments overall strategy to achieve Sustainable Development Goals of the United Nations.

Initially established by an ordinance in 2003, PAF Nepal has been governed by an Act since 2006. PAF is therefore an autonomous, independent and professional organization governed by a separate law.

PAF is an umbrella institution and works through Partner Organizations (POs), such as community-based organizations (CBOs), civil society organizations (CSOs), NGOs, private sector, and local government agencies - Village Development Committees (VDCs)/ District Development Committees (DDCs). An 12 members governing board, chaired by the Rt. Honorable Prime Minister, is responsible for policy guidance and programme approval.

2. Key Approaches:

Targeting the Poorest ( Antodaya): For PAF, the last household in the local socio-economic hierarchy is the  first on PAF’s priority list. To achieve this, PAF uses an inclusive bottom-up approach rather than an exclusive top-down approach.
The first approach is geographically based and targets underserved districts and VDCs and within these the target groups.  The second approach, which is not geographically based, provides financial support to organizations representing target groups for programs to address their needs or to initiatives with particular innovative ways of addressing the needs of the target population.
Social Inclusion (Samabeshi): PAF is in line with the government’s top priority of inclusive development. This requires the proportionate participation of different categories of households, and the equitable involvement of those previously alienated from the development mainstream. Dalit, Janajati, women and other disadvantaged households below poverty level are groups who have historically received far less than a proportionate share of development resources, but are now targeted by PAF.
Transparency (Pardarshita): All the activities of PAF, including those of its partners and the COs, are transparent. Transparency is promoted through social and public audits. . Regular auditing mechanisms are used at the CO’s level.

Demand Driven (Mang Anusar): PAF recognizes that the best judge of how a household will lift itself out of poverty is the household itself. Hence, the final decision on what activity to choose lies with the household.

Direct Payment (Sojhai Bhuktani): PAF believes that people are empowered, if they can make economic decisions and transactions by themselves. So, PAF involves  it’s clients  in direct procurement.
Community Institutions:  PAF works with Community Organizations (COs). Over 27, 000 COs are currently receiving support from the national poverty alleviation programme and this directly benefits 675,000 poor households or a population of 3,000,000 individuals.

Empowerment: PAF uses a demand led community-driven development (CDD) approach to empower poor and marginalized groups to drive their own development. PAF seeks to improved living conditions, livelihoods and empowerment amongst the poor with particular attention to those who have traditional been excluded by reason of gender, ethnicity, caste and location.

Partner Organizations as Facilitators;
Based on the eligibility criteria set by PAF, qualified and eligible Partner Organizations (POs) are selected from among Community-Based Organizations (CBOs), Non Governmental Organizations (NGOs), Private Sector Organizations (PSOs), and Local Government Organizations for social mobilization, technical assistance, and capacity building activities. The partner organizations carry out  social mobilization and capacity building for the community organizations and facilitate the community organizations in preparing proposals and implementing the sub-projects.

Participation and Self-help groups;
Under PAF, the selection of beneficiaries is done through a participatory social assessment followed by social mapping in the community. During project planning and design stage, communities themselves carry out resource mapping, project demand collection, project feasibility/market studies, procurement planning, among others. At the project implementation stage, the community performs procurement of goods and labors by procurement sub- committee, management and monitoring of works by monitoring sub-committee, account keeping, asset management by account sub-committee, and volunteer labor contribution and cash contribution are provided for the execution of income generating and infrastructure schemes.


3. Strategies:
The strategies of PAF will be:
I.                   To develop programmes with specific target of reducing poverty in its areas of operations within a given timeframe;
II.                   Promote community based demand driven approach using rigorous social mobilization techniques in order to reduce poverty by bringing poor at the center of development and by treating poor as subjects instead of objects;
III.                   Ensure holistic development intervention and partnership building that guarantees positive impact on the livelihood of the poor;
IV.                   Enable rural people to obtain quality basic services in cost-effective and sustainable manner with their direct involvement in identification planning, designing, executing and operating & maintaining the schemes; and
V.                   PAF as an independent, autonomous and a professional organization sensitive to the needs and aspirations of the poor.

4. Defining Levels of Poverty

PAF defines poverty based on the level of food sufficiency, as well as criteria set by the communities themselves. Those with food sufficiency of less than three months are categorized as ‘hardcore poor’. Those with food sufficiency of more than three months but less than six months are categorized as ‘medium poor’, while those with food sufficiency of over six months but less than a year are categorized as ‘poor’.

5. Major Successes in Reaching the Poor and Addressing Poverty
5.1 Up-Scaling to Cover More Districts
Using the above structure and approach PAF has successfully up-scaled its programme to cover more disadvantaged districts and communities.
Village Development Committees (VDCs)/Municipalities within the selected districts are prioritized based on district level poverty information. PAF launches its programs from the most backward VDCs/municipalities of the district. In this districts, PAF organizes interactions and hold discussions with various stakeholders in the districts, including DDC officials, government officials, representatives of NGOs and donor community, leaders of various political parties, social workers and eminent personalities, providing orientation to them on PAF’s policy, strategy, programs and program implementation procedures. They are also informed about the VDC ranking and interactions and discussions are held on it as well.
PAF has facilitated the establishment of around 27,000 Community Organizations (COs) in 55 districts out of 75 districts where it is operating. There are almost 400 local and national NGOs as partner organization of PAF.
Beginning with the poorest six districts in 2004, fund has helped a total of 6,75000 beneficiaries’ households, of which approximately 75 percent are women, and 55 percent come from communities that have been marginalized traditionally or excluded due to harsh topography, caste, and ethnicity. It is great success of inclusiveness in Nepal.

5.2. Contribution to Poverty Alleviation - Poverty falls to 33.1 percent in six districts:

There are indications that PAF is contributing to poverty reduction in Nepal. For example, the incidence of poverty has come down by 17.40 percentage points in the last seven years in six districts where the Poverty Alleviation Fund (PAF) is operating its programmes. Poverty rate, on average, stood at 50.7 % of the population in Doti, Dailekh, Jumla, Rolpa, Rautahat and Humla districts in 2007. That rate fell to 33.1 per cent in 2014, according to the report, entitled ‘Socio-economic Changes in PAF Intervention Households in Nepal’, which was prepared by the Centre for Economic Development, and Administration (CEDA) of Tribhuvan University (TU) based on survey conducted in 3000 households.

This means that the poverty rate in the six districts declined at an average of 2.49 per cent per year between 2007 and 2014, as against national average poverty reduction rate of 0.8 per cent per annum. The national poverty rate stood at 25.2 per cent of the population in 2010-11, as per the National Living Standard Survey conducted by the Central Bureau of Statistics.

When the survey was conducted, it was found that per capita consumption had largely gone up in the six districts where the programmes of PAF were operating, indicating a rise in income level. According to the report, per capita consumption in the six districts stood at NRs 14,826 per year in the year 2007-08.. The amount went up to NRs 36,440 in 2013-14, marking a rise of 145.78 per cent in the seven-year period, or 20.83 per cent, on average, per year. Between 2003-04 and 2010-11, average per capita consumption in the country had gone up from Rs. 15,848 per year to Rs. 34,829 — up 119.76 per cent or 17.10 per cent per year.
5.3 Findings of the Office of Auditor’s General (OAG) Nepal:

The Office of Auditor’s General (OAG) Nepal conducted internal audits to see the impact of the Poverty Alleviation Programme for Nepal. Periodic performance audits from the Office of Auditor General have been carried out as usual--together with different technical audits and sustainability studies of infrastructure schemes. Periodic beneficiary assessment,-Rotating Fund status and Social Re-assessment are continuing in order to ensure and update the level of income and livelihood of the community. Social Audit/Public Hearings are in place and are continuing.

The Auditor General’s report highlights the PAF programme focused on the reconstruction and/or renovation of damaged rural infrastructure during the last decade. According to audits, the poverty level was reduced 31% to 25.4 %. The gap between rich and poor was reduced from 0.41 to 0.46 among the remote areas and tribal communities.
A study report highlights major changes at household income as follows;
*     More than 68% of the HHs have increased their income by 15% or more and Average income at HH level increased by 68.2% (in real term)


Source: CEDA-TU Report 2012

5.4. Success at the Community Level - Community Organization (CO) from Bajhang Receives an Award
Many COs have been successful in improving incomes and livelihoods with support of PAF and have also successfully implemented infrastructure subproject which have both social and economic benefits for their communities. The following is one example.

The Directorate of Agriculture Marketing, Ministry of Agriculture, Nepal has recognized "Betal Krisak Samuha", a CO from Melbisaunee-4, Velata, Bajhang with an Award.  The group had been recommended for the award by the District Agricultural Office (DAO)-Bajhang.  The Award was for being the best performing farmer’s groups in high hill category for the year 2015 and included a cash prize of Rs 10,000 and a certificate.

The President of the CO, Mr Dhanlal Bhandari took a loan of Rs 60,000 to establish a Vegetables Collection Center in Khaula. He is providing vegetables to community members at cheaper prices. He has also paid back the loan taken from his Community Organization.

PAF provided Rs 107, 198 to the "Betal Krishak Samuha" for vegetable farming and orange cultivation. The same CO received Rs 744,786 from PAF for drinking water and irrigation schemes. This included the establishment of an 8,000 liter water tank. The CO members are now using sprinkle irrigation for their vegetable nursery and are producing seasonal and off-seasons vegetables. Production is sufficient enough to be sold at the Vegetables Collection Center.

6. Role of Partners: Government, Donors, POs, and CBOs for success of PAF Nepal:
PAF’s success can be attributed to good coordination between PAF partners and each partner effectively carrying out their own roles and responsibilities as outlined below.
6.1. Role of the Government:
The government’s main role is to provide policy feedback, oversight and monitoring of PAF program activities at the central level. Office of Prime Minister and Council of Ministers, Ministry of Finance, National Planning Commission approves the annual program and budget of PAF. Office of the Prime Minister and Council of Ministers, Ministry of Finance, National Planning Commission, Ministry of Cooperatives and Poverty Alleviation and Ministry of Federal Affairs and Local Development carry out regular monitoring of the PAF activities and provide necessary feedback and suggestions for further improvement. Similarly, Office of Auditor General carries out the financial audit of PAF every year.

 

 6.2. Role of Donors:

Major donors of PAF include IDA/World Bank, IFAD and JSDF. However, a lion’s share is from the World Bank. Their major role is to provide financial support as a grant as well as technical support for the implementation of PAF program interventions. Apart from this, World Bank, IFAD and the Nepal Government carry out regular monitoring of programme activities including periodic supervision missions.

6.3. Role of Partners:
Partner Organizations (POs) selected by PAF are facilitating Community Organizations (COs) of the Poor.  Their major role is to perform facilitation, social mobilization, technical backstopping and monitoring.  The facilitation being carried out by POs are in organizing COs, their capacity development, planning activities, carryout detailed feasibility, survey design & estimates, and proposal preparation during preparatory phase, and provide technical assistance and monitoring feedback support during implementation phase.  As such, 400 Partner Organizations are working with PAF, covering a total of 2,022 VDCs.

6.4. Role of COs:
Community Organizations (COs) are the crux of PAF program, and they are always positioned in the driving seat. From inception to the end of project cycle, COs are the key stakeholder for planning, designing, managing, implementation, and monitoring of the project intervention.
Prior to the project planning and implementation, COs carry out community identification of the poor through participatory social assessment and a community organization comprising of 25-35 HHs is formed.  COs thus identified and formed as per PAF norms through the social assessment, are formally registered with PAF. Meanwhile, COs open their bank accounts in nearby Bank.

7. Lessons-Learnt

7.1. Meeting Demand without Compromising Sustainability
There is a high demand for the PAF programme at the grass root level. Communities have demonstrated their keen interest to participate in the programme and make the necessary contributions. Demand for the programme is high and it is challenging to achieve a good balance between rapid implementation and institution building. Sustainablity requires enhancing the technical capability of the community organizations. Thus, the challenge is to meet demand without compromising quality and sustainablity.
Coordinated efforts targeting effectiveness and sustainability are indepensable and enhances government ownership while diversifying activities and donors.
Programmes for urban poor have recently been  introduced. Now, PAF is linking its local level planning for rural and urban communites through ward citizen forums. Harmonization in Social Mobilization with other DDC programmes is stressed. This multiplies the benefits of PAF capacity building when COs access other DDC programmes.
PAF supported programmes need to be linked to other government, private sector and civil society institutions to help ensure sustainability post-PAF. Many COs are now linked with Financial Institutions, Private Sector and Service Agencies for additional funding of further activities. CO’s informal networks are now developed at both VDC and District level.
Decentralization can improve the effectiveness of programme activites. PAF has estbalished contact offices in every programme district and Portfolio Managers are now stationed at the distirct level. Decentralizaton is a major policy breakthrough for PAF. A MoU has been signed with Ministry of Federal Affairs and Local Development to establish a PAF office within the DDC office in the respective districts.

7.2. PAF Approach and Lessons-Learnt to Revitalize Livelihoods in Earthquake-affected Communities:
Two earthquakes hit parts of Nepal on April 25th and May 12th, severely affecting the Central and Western Development Regions. The disasters caused more than 8,600 deaths and injured over 16,500 people. The earthquakes caused significant damage to houses, agriculture, transport, irrigation, and communications infrastructure. The earthquake also triggered extensive landslides and avalanches causing further damage and disruption to essential services.

The Post Disaster Needs Assessment (PDNA) of National Planning Commission of Nepal findings highlights that the earthquakes caused major damage in the 14 most affected districts, and damage in an additional 17 districts.  This includes damage to approximately 770,000 homes, of which 550,000 have been destroyed. The PDNA report estimates the cost of reconstruction for household recovery to be US$5 billion, of which the housing sector was the most severely hit with the cost of reconstruction estimated at US$3.54 billion, followed by the education sector at US$250 million.
Description: C:\Users\apradhan\Desktop\Personal\PHOTOS\2015 Earthquake Pictures\Manegaun\IMG_2223.JPG

The earthquake has indiscriminately affected both rural and urban areas.
However, keeping in view of PAF’s mandate, the area of its focus will be the rural earthquake affected districts.

Divided in different components, the proposed scheme would cover around 4,900 existing COs in 10 districts where PAF is already operating and communities and settlements in two of the Major Crisis Hit Districts.

The Revolving Fund (RF) component will enable affected COs to resume revolving fund services by reinstating the RF’s operations to the pre-earthquake level. Earthquake effects on the RFs include: (i) damages to members’ assets financed by RF with a high likelihood of inability for the borrowers to repay according to the schedule; and (ii) damages to cash if kept where physical damages were sustained. There are also cases of losses and damages of RF records and documents. The component would recapitalize the affected RFs in almost 1,500 COs according to a clear set of rules and beneficiary selection criteria.

7. 3. Summary of Lessons-Learnt for Livelihoods:
The major lessons learnt of the livelihoods programme are as follows;

  1. Poverty reduction and improved livelihoods requires effective targeting for Prosperity Enhancement. From the beginning, PAF-N has been trying to identify and engage with extremely poor households. However, better off households have also express interest in joining the program and have become involved. Having non-poor involved trends to divert programmes from the real interest of the extremely poor households.  Inclusion is the key to mainstreaming all livelihoods activities
  2. Right balance of Social and Economic empowerment for livelihoods activities
  3. Agriculture and forest based livelihoods activities are more successful
  4. Capacity development and technology transfer is key for success
  5. Poor households require Intensive and focused support for an extended period of time.
  6. Access to finance and small-scale credit through revolving fund supports sustainable livelihoods. The organization is promoting financial cooperatives as higher level institutions to do proper fund management and develop linkages with existing financial institutions.
  7. PAF Nepal has developed exit strategies, which involves linking up with higher level institutions such as CO’s networks at VDC level to serve as a civil society platform and to develop official linkages with local government bodies.
8. Graduation Strategy:
PAF Nepal is exploring- economic based Higher Level Institutions (HLIs). Social platform type NGOs/Civil Society, exit from weak COs and going through line ministries. By doing so, PAF is really looking into the future model based on the social capital gained and accumulated so far.
The proposed Graduation Strategy will promote institutional sustainability and self-reliance of COs and other types of organizations created with the support of PAF. More specifically, the strategy will aim at equipping the COs and other PAF-supported institutions, by the end of the PAF-II closure, with the capacity to manage their own organizations and activities, and making them capable to provide services to the members for poverty alleviation and livelihood improvements on the sustainable basis.
To avoid long-term dependency on PAF there needs to be an exit strategy which is transparent and understood by COs, POs and government stakeholders. This requires an effective assessment system to determine when COs and POs are mature enough to continue without PAF support.
Participatory CO graduation assessment and exit from POs is now in place for the self-propelling and self-sustaining of community organizations. Staff and PO performance evaluation and performance based incentives need to be introduced and reward the best performers (CO,PO, Staff). The organization is conducting CO maturity assessments which helps to identify mature, semi-mature, and COs that need more support.  PAF-N has taken a  major decisions to deputize it’s portfolio managers to work with local bodies called District Development Committees (DDCs). These DDCs represent a longer term sustainable system for development and internalize all poverty alleviation intiatives within local governemnt.

9. Challenges:
The Poverty Alleviation Fund Nepal is facing major challenges. Which are as follows;
  • The April Earthquake increased poverty (2.79 %) in those 23 highly affected districts
  • The livelihoods pillars drastically go down when vulnerability goes high. For example the recent earthquakes and floods of mid and far west Nepal.
  • Funding Gap: The PAF-Nepal may face huge funding gap beyond 2017. Additional funds are needed to continue all these highly successful programme activities
  • Least Developed Country Graduation. After the graduation of LDCs, many newly emerging economies may not be able to access grants. However, this is  not practical in the context of Nepal.
  • Remittance based economic growth is not sustainable. Most youths are abroad mainly in Arabic nations, which are not a sustainable income source. Youth need economic opportunities within Nepal.

The on-going success of PAF will depend on addressing these challenges with the continued support of PAF partners.

10. References:
  1. Poverty Alleviation Act 2007; Government of Nepal
  2. Operational Manual of Poverty Alleviation Fund 2012
  3. www.pafnepal.org.np
  4. Center for Economic Development and Administration CEDA of Tribhuwan University of Nepal and Poverty Alleviation Fund of Nepal 2014
  5. Post Disaster Need Assessment Report; National Planning Commission. Government of Nepal 2015
  6. Auditor General Office impact study report 2014
  7. National Planning Commission of government of Nepal: PAF Program Evaluation; 2013
  8. Office Auditor General: Performance Audit Report 2012
  9. Overseas Development Institute ODI:  CDD /livelihoods projects in fragile and conflict affected areas of South Asia 2014

 Note: This paper was presented lessons learns of PAF Nepal in to Livelihood Asia Summit which was organized by ACCESS Development Services; www.livelihoods-india.org and www.accessdev.org on December 10-11; 2015 at Delhi, India. 





















[1] . This paper was prepared to share lessons learns of PAF Nepal in to Livelihood Asia Summit which is organized by ACCESS Development Services; www.livelihoods-india.org and


Saturday, January 31, 2015

Nepal should benefit from Afghanistan's membership in South Asia Association for Regional Cooperation ( SAARC)

 After a 12 year gap, the 18th SAARC Summit is being held in Kathmandu on 26-27 November 2014. With less than a week to go, we present a timeline of major events and achievements of past SAARC summits. Among the SAARC member state the Afghanistan is youngest nation. This SAARC summits is going to be held in Nepal. Nepal and Afghanistan can benefit from their partnership in this regional network.

Being a development aid worker and working in Afghanistan more than half decade I found there are key areas where both countries can mutually benefit. I am suggesting to my government HE. Premier, Sushil Koirala should take initiation to take lead role to talk in during HE. President, Aasharf Ghani’s during his visit in Kathmandu Nepal.

Both countries needs to create enabling environment for diplomatic relationship, it requires to have formal office set up. Both countries need to require at least consular offices both in Kabul and Kathmandu in near future it can be opened as embassy. These consular offices will be helpful to have bi-lateral relationship. Now Nepalese Embassy of Islamabad is looking to Kabul, but being an SAARC member nation it requires to have formal full time office in Kabul. These offices will be helpful to take care more than 10000 Nepalese in Afghanistan. In Kabul there is significant number of professionals and security people working in the Afghanistan.

The Afghanistan has one of the vibrant young populations in South Asia, who are having great expectations to go for abroad study. In Nepal there are plenty of government and private sectors colleges and universities who can provide high level standard education to the Afghan youths. In the same way, big number of populations of Afghanistan is going to India and Pakistan for medical facilities. Nepal can attract those populations for medical tourism.

Nepal can get high benefit from increasing number of tourists of Afghanistan. Rich Afghans are incredible to spend their money for their entertainment. Natural beauty of Nepal can easily attract to them. To promote tourism it required to make more flexibility for the issuing visa for Afghan citizens. Nepal is still enlisted to the Afghans in non-arrival state status in terms issuing visa. This requires immediate remove and treat to them equally as a other SAARC nations. The both civil aviation needs to have formal memorandum of understanding to operate air flights Kabul to Kathmandu vice vs. These air flights will be enable much better relationship among the two nations.


The Afghanistan is one of the historical country where “Silk Route” is famous for their trade and business. This “Silk Route” which is link up to Nepal and Tibet. The historical tie up trade between two countries needs to revive and promote trade and business at the private sectors level. The ‘peoples to people’ and ‘government to government’ will relationship will enhance better partnership and strengthen relationship among these two countries. 

Mr. KC is working in Afghanistan since last 5 years in various capacities at the government/UNDP and an INGO as a development practicener. He is reachable on; nahakulkc@gmail.com

Wednesday, November 12, 2014

Increasing Accountability of government through Citizen Reporting Card

Increasing Accountability of Government through Citizen Reporting Card:
What is a Citizen Report Card?
The Citizen Report Card (CRC) is a tool to assess the performance of service providers, in this case health service providers, by comparing performance across service providing organizations and generating a database of feedback on services provided to the public. This study found conducted found that the CRC process has built a bridge between health service providers and the communities they serve by gathering and publicly presenting citizens’ opinions of health care services in selected districts of Badakhshan province. The Citizen Report Card (CRC) is a tool to;
  • Collect citizen feedback on public services from actual users of a service (and not opinions from the general public)
  • Assess the performance of individual service providers and/or compare performance across service providers and
  • Generate a database of feedback on services that is placed in the public domain.
Most governments are responsible for providing essential services to the people. Governments spend huge amounts of resources to provide following services:
       drinking water
       education
       health care and
       transportation

In some instances, governments give contracts to private entities to provide services. Some central and state governments have also decentralized service provision to local units of government.
Citizen Reporting Card is a simple and participatory process whereby citizens are empowering to assess  quality and effective of public services provided by government.
What issues will a Citizen Report Card address?
The CRC addresses critical themes in the delivery of public services such as access to services, quality and reliability of services, problems encountered by users of services and responsiveness of service providers in addressing these problems, transparency in service provisions like disclosure of service quality standards and norms, and costs incurred in using a service including hidden costs such as bribes. The CRC also provides a supportive score that captures the totality of critical service-related parameters.

What kind of institutional capacity would need to conduct a Citizen Report Card?

CRCs work best when there is an explicit recognition within an organization on the need to conduct a user feedback led diagnostic or assessment exercise. Some critical institutional capacities required to make CRCs effective are:
  • Analytical staff well-versed in quantitative methods. Since a large part of the CRC
  • involves sample surveys and analysis of data, a major pre-requisite is that the organization should have either in-house capabilities to understand and interpret numbers or have resources to locate external support.
  • Dedicated resource to anchor and manage the CRC processes.
  • Dedicated resources for communication and outreach.
  • Support from the senior management

Methods
The tools of the study were jointly developed with the provincial health department of Badakhshan. During the first stage, district health centers were selected as primary sampling units by considering geographical locations and accessibility. In the second stage, approximately community 560 respondents were selected randomly. Their opinions on quality of service, satisfaction rate and main areas of improvement for health services available to them were recorded. The study was conducted by staff of Aga Khan Foundation and members of District Development Assemblies (DDAs). Selection of respondents have taken placed randomly, the interviewer waited near to the center of Clinic while patients  were examining by doctor and taking prescribed medicines from the clinic then he/she selects  two male and tow female out of 15 up to 20 patients and asking respective questions which were already determined by interviewer. Badakshan colleagues to take an action of this training at least let us start from one District Level Hospital in the region.

Results:
Based on a variety of questions that were aimed at finding out the primary reasons for visiting health centers, what kind of services were available to citizens, and the quality of services received, some of the key results were highlighted.  Results demonstrated that 67% of respondents visited their respective health care centre with the primarily to obtain medicine free of charge. A small number of visitors (11%) noted that they were able to access information about health services available at centers on information boards or displays at centers.  A majority of service users (78%) reported that their registration was completed within two hours. Most of the respondents (92%) visited doctors within an hour or less after completing registration process. However, a significant number of respondents (41%) also reported that the center's laboratory equipment were not functional.

 Approximately, 65% respondents said that the health services were had improved in comparison to the previous year. They also reported satisfaction rates on different services. The proportion of the respondents who were very satisfied or satisfied with the registration process and the health centers’ staff’s attitudes are 66% and 53%. A significant percentage of respondents reported being dissatisfied with the laboratory facilities (43%) and treatment facilities (30%) of the centers.

Conclusion

This CRC tool was introduced by AKF Afghanistan for the first time in the country primarily to create transparency, engender citizen sense of engagement in the service delivery process, and enable the health system of the government to be more accountable towards their respective citizens. In doing so, the CRC aims to improve the quality of service delivery by engendering a supply-demand relationship between government and citizens for public services.  The majority of patients reported positive experiences and overall improvement of health facilities in comparison to the previous year but felt the level of services at present did not satisfy them properly providing a crucial baseline assessment of public opinion on health service delivery in Badakhshan province.