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Afghanistan

Community health workers in the frontlines of health care

The jagged peaks of the majestic Do-Shakh Mountains envelop the village of Chaka, located in Gozarah District in the ancient western Afghanistan Province of Herat. Here, as in many parts of rural Afghanistan, harsh weather, inadequate roads and political instability hamper the regular provision of social services, including health care. These challenges have prompted the country’s Ministry of Public Health to expand health-care services through a nationwide network of community-based health workers, a programme that has been in place, in its current form, for the past six years. The Government of Afghanistan, supported by the Danish Afghan Committee (DAC), runs this initiative across the district.

In Chaka, a village with a population of about 1,750, community health workers Abdul Qayum Habibi and Shafiqa Habibi, a married couple, work together to provide essential health care and referrals. Selected by the local shura, or village council, according to criteria such as literacy, the trust and respect of the community and their level of commitment as volunteers, they are two of four community health workers here. The shura also preferred each pair of community health workers to be a married couple or close relatives, residents of the village and between 25 and 50 years of age.

After their selection, the couple undertook a six-month training course based on a standard curriculum endorsed by the Ministry of Public Health. During the course, they learned about common health problems, first aid, raising health awareness in the community and making referrals to the nearest health centre, a two-hour walk away. Alongside his new responsibilities, Abdul Qayum continues his work as a schoolteacher in the village, while Shafiqa is also a housewife and mother.

Providing health care as a couple

It is unusual for women to venture outside their homes to work in many parts of rural Afghanistan. Health care provided by couples, therefore, has distinct advantages, both for the providers and the recipients. In Chaka, not only does Shafiqa have the opportunity to work for the health of her community, but she is also able to bring health messages home to women who are barred by tradition from contact with men other than those in their families. “It is difficult for women to work with men,” Abdul Qayum explains. “At least as husband and wife we can work together, where I work with the men and my wife works with the women.” Shafiqa agrees “As a couple, both men and women in our village feel comfortable coming to us discussing their health problems,” she says. “In our village, I work with children and women of all ages. We have cases of diarrhoea, pneumonia and also many children facing malnutrition. I also talk to mothers about the importance of breastfeeding.”

“Locals know their own problems better than outsiders”

Across the country, community health workers contribute significantly to national immunization days by helping identify families with children under age five. They also work closely with health centres, particularly when patients need more immediate treatments. Dr. Abdel Ahad, head of Gozarah Hospital and district focal point for community health workers, believes that health workers are best able to serve their community’s needs when they are also residents of the community. “In the villages of Herat Province, locals know their own problems better than outsiders,” Dr. Ahad says, but he admits that the programme faces challenges in the form of financial constraints. “The community health worker programme is one of the most effective programmes in Afghanistan, but the challenge is that the health workers are very poor economically and we cannot pay them. They are volunteers. More support from the Government and partners is needed.”

The role the programme plays in imparting valuable health advice at the grass-roots level is essential in a country still reeling from years of political instability. Abdul Qayum comments on the positive impact of the programme in Chaka. “Compared to the Taliban time, many things have changed,” he says. “People are now receiving more support and even medicine.”

Like this dedicated couple in Chaka, community health workers across rural Afghanistan enter into a transparent and vital contract with their community, delivering health messages and services where they are needed most.