The COVID-19 outbreak hit Afghanistan at the end of February 2020, exacerbating the issues of a fragile health system weakened by decades of conflict and underinvestment. The dispersed population of Afghanistan often lacks access to health services due to distance, insecurity, and costs, with out-of-pocket expenditure around 77% according to Afghanistan’s 2019 National Health Accounts (NHA) report. Shortages of equipment, supplies, and qualified workforce further compromise the quality of services. In a socio-economic context marked by widespread poverty, malnutrition, deeply entrenched patriarchal norms, lack of safe drinking water, and poor housing and sanitation, the spread of COVID-19 intensified an already dire situation.

Pandemic-related restrictions led to loss of household and community incomes, disrupted food systems, and exacerbated poverty levels, resulting in a nutrition crisis. Additionally, there was a documented increase in domestic violence across all provinces, further hindering women's and girls' access to services.

The Minister of Public Health quickly acknowledged the COVID-19 crisis, stating in March 2020 that up to 80% of the Afghan population could become infected. An emergency response plan was developed. In this context, the EU implemented a robust and targeted response to support Afghanistan, allocating EUR 70 million to tackle the health and socio-economic impacts of COVID-19. This Intervention is part of the EU's support for the COVID-19 response, alongside two other interventions implemented by the World Health Organization (WHO) and the Aga Khan Foundation (AKF).

The Intervention derives from the Commission Implementing Decision on the special measure in favour of Afghanistan for 2020. It is financed under the Development Cooperation Instrument through a Financing Agreement with Afghanistan and implemented countrywide, coordinated from Kabul under UNICEF's leadership. Part of the Implementing Decision is executed through direct awards to NGOs based in Afghanistan in a "direct management" modality. It is also implemented through indirect management with WHO and UNICEF via Contribution Agreements. This ROM review report corresponds to the intervention implemented by UNICEF, with a total EU budget contribution of EUR 35 million and a 36-month implementation period.

Partnerships are established with diverse governmental and non-governmental organisations (NGOs) to implement the Intervention. For the nutrition component, partners include the Ministry of Public Health (MOPH), Afghanistan Institute of Nutrition & Home Economics (AINHE), Bakhtar Development Network (BDN), Agency for Assistance and Development of Afghanistan (AADA), MOVE Welfare Organization, Aga Khan Foundation (AKF), HEALTHNET TPO, Just for Afghan Capacity and Knowledge (JACK), Care for Afghan Families (CAF), Afghan Youth Services Organization (AYSO), and World Vision International Afghanistan. For the water, sanitation, and hygiene (WASH) component, partners include the Ministry of Rural Rehabilitation and Development (MRRD), Danish Committee for Aid to Afghan Refugees (DACAAR), ACTED, Extenders/Facilitators, Kandahar Refugee Organization (KRO), Human Resource Development Agency (HRDA), World Vision International Afghanistan (WVI), Citizens Organization for Advocacy and Resilience (COAR). For the gender component, partners include the Ministry of Public Health (MOPH), Social and Humanitarian Assistance Organization (SHAO), Afghan Women Educational Center (AWEC), Voice of Women (VWO), Human Resources Development Agency (HRDA), and Vision Development Organization (VDO).