Adroit Associates is conducting an impact assessment of the Family Health House (FHH) model implemented by AFGA with support from IPPF. The study evaluates how effectively the model expands access to essential sexual and reproductive health and maternal-child health services in underserved and hard-to-reach communities.
The assessment is designed to generate actionable evidence on service delivery performance, community acceptance, and sustainability of the model. It explores how decentralized, community-based healthcare delivery can address systemic access barriers and improve health outcomes among vulnerable populations.
Project Context
Afghanistan is currently experiencing a severe humanitarian and public health crisis, with millions lacking access to essential healthcare services. Structural barriers — including geographic isolation, financial hardship, and restrictions affecting women’s mobility — limit access to care, particularly in rural areas. The shortage of female healthcare providers further restricts women’s ability to seek culturally appropriate services.
In response, the Family Health House (FHH) model was developed as a localized healthcare solution embedded within communities. Through this approach, trained midwives deliver integrated SRH and MCH services directly within villages, significantly reducing access barriers and improving service utilization.
FHHs provide a range of services including antenatal and postnatal care, family planning, safe delivery support, basic gynecological services, psychosocial support, and child health services. The model emphasizes trust, accessibility, and culturally appropriate care, particularly for women who cannot easily access formal health facilities.
The assessment examines the extent to which this model improves healthcare access, strengthens health-seeking behaviors, and contributes to better health outcomes in a complex and restrictive operating environment.
Project Objectives
The assessment aims to evaluate the effectiveness, accessibility, and sustainability of the FHH model in delivering community-based healthcare services.
It focuses on measuring service utilization, client satisfaction, and changes in health-seeking behavior, as well as understanding the operational performance of FHH facilities and midwives. The study also examines the model’s contribution to improving maternal and child health outcomes.
Additionally, the assessment explores key implementation challenges, scalability potential, and the role of community trust and engagement in sustaining service delivery. Particular emphasis is placed on gender-responsive programming and equitable access for marginalized populations.
Methodological Approach
Adroit Associates applies a mixed-methods research design that integrates quantitative measurement with qualitative insights to ensure a comprehensive assessment.
The quantitative component includes 102 client exit interviews and structured facility observations across selected provinces, using digital data collection tools to ensure accuracy, consistency, and real-time monitoring.
The qualitative component includes narrative interviews with midwives and Key Informant Interviews with stakeholders from IPPF, AFGA, UNFPA, and community leadership. These engagements provide in-depth perspectives on service delivery, operational challenges, and community dynamics.
A stratified sampling approach ensures geographic diversity and representation across different operational contexts. The evaluation framework is guided by OECD-DAC criteria — Relevance, Effectiveness, and Efficiency — while integrating Gender Equality and Social Inclusion (GESI) and Do No Harm principles.
Comprehensive quality assurance mechanisms — including enumerator training, field supervision, validation checks, and ethical safeguards — ensure the reliability and integrity of collected data.
Impact and Strategic Significance
The assessment is expected to generate critical insights into the effectiveness of community-based healthcare delivery models in fragile and resource-constrained settings. Preliminary findings indicate that FHHs play a vital role in improving access to essential health services, particularly for women and underserved populations.
The model demonstrates strong potential in increasing service utilization, strengthening trust between healthcare providers and communities, and addressing cultural and logistical barriers to care. It also contributes to improved health awareness and adoption of positive health practices.
At the same time, sustainability challenges — such as funding dependency, operational constraints, and workforce limitations — highlight the need for strategic investments and policy support.
The study provides evidence-based recommendations to strengthen community health systems, scale effective service delivery models, and inform donor strategies and national health planning. It reinforces Adroit Associates’ expertise in delivering high-quality, context-sensitive assessments in complex humanitarian environments.