The nutrition revolution in Afghanistan

How a Community Based Nutrition Programme reaches mothers across the country

By: Letizia Dell'Asin and Monique Awad
Belgis
UNICEF Afghanistan/2020/Letizia Dell'Asin
06 December 2020

Mazar, Afghanistan, 6 December 2020 – Balqis, a 38-year-old woman, works as a community health worker in Sajadia village at the outskirts of Mazar, northern Afghanistan. "Every morning, mothers bring their children to my home for screening. When needed, I refer them to the basic health centre in our community," says Balqis.

"I lived in Iran for 20 years, and when I returned to Afghanistan, I wanted to get involved in community work," she adds.

Balqis's passion to serve her community dates back to the day she visited a health facility and received her tetanus shot as a pregnant mother.

"I remember visiting a health facility to get my tetanus shot. That's when I spoke to a nurse and I shared my desire to become more involved," says Balqis with pride. "I wanted to learn how to support my children’s health, and I went on to support many more children in my community."

One morning, Fatima, a mother of 8-month-old boy, Ajmal bring her baby to Balqis's home. Balqis takes the mother and child to a side room next to her living room, where walls are plastered with educational posters and her tools laid down in a corner. Balqis screens the child for malnutrition by measuring his height, weight and mid-upper arm circumference.

Balqis jots down Ajmal’s 8 kilograms on the healthy green middle strip of the growth chart on her wall.

"Fatima, I am pleased to inform you that your baby's weight is normal," says Balqis. "Continue breastfeeding your baby and add well-cooked and mashed foods, eggs, and squashed banana or orange."

Balqis poses in her 'office'.
UNICEF Afghanistan/2020/Niazmal
Balqis poses in her 'office'. Her home acts as the health post in her community. The walls of this room are covered with information materials she uses to provide awareness sessions in her community

Community health workers provide basic health care to the most vulnerable children in their community.

In 2004, there were no community health workers (CHWs) in Afghanistan. Today, in a country where much of the population lives in remote and hard-to-reach areas, they provide the first level of health care. Balqis is one of more than 28,000 CHWs across the country. She works in a pair with her sister in law, promoting healthy lifestyles and behaviours in her community, encouraging appropriate use of health services, treating and referring children with common childhood illnesses.

"Community health workers are part of the national basic package of health services," says Suzanne Fuhrman, Nutrition Manager with UNICEF Afghanistan. "In a context like Afghanistan, they are critical in providing the first line of care at community level, especially for hard to reach children."

Balqis (right) and her community health supervisor Nasreen (left) show the food groups wheel.
UNICEF Afghanistan/2020/Letizia Dell'Asin
Balqis (right) and her community health supervisor Nasreen (left) show the food groups wheel. They use it to teach mothers about a balanced diet. In the corner, a cooker used during food demonstrations (Photo: Letizia Dell'Asin).

"I teach mothers on what to feed their babies, and I continuously promote exclusive breastfeeding for the first six months, while continuing to breastfeed up to two years and adding complementary feeding," says Balqis.

"With my sister-in-law, Khadija, I organize educational sessions based on foods that are available, and affordable."

The Public Nutrition Directorate of the Ministry of Public Health introduced the Community Based Nutrition Programme (CBNP) in 2017, supported by UNICEF and other partners. It aims to improve the diets and feeding practices of young children. It builds on the existing community-based healthcare platforms in Afghanistan, as close to the community as possible. It builds on CHWs like Balqis, who monitor children’s growth, promote breastfeeding, provide nutrition education, and promote better weaning practices.

Since CBNP was introduced in Afghanistan in 2017, UNICEF has trained more than 12,000 CHWs and volunteers. This means that nearly 150,000 children under 24 months are benefitting from the improved nutrition knowledge in their community.

Last year, Balkh province, where Mazar is located, was one of two provinces selected for a CBNP process evaluation.

"The evaluation reflected the power of this programme to improve nutrition outcomes at community level, especially among the most vulnerable," says Fuhrman. "About 9 out of 10 mothers said they were following the advice of their community health worker in regards to feeding and caring for their babies."

As of 2020, UNICEF and other partners have launched and implemented the CBNP in 19 of the 34 provinces across the country.

"The CBNP tools are easy to use," says Balqis. "I am so very proud to advance the nurtritional situation of children in my community."

In 2019, and with thanks to UNICEF Global Thematic Fund for Nutrition supported by the Government of the Kingdom of the Netherlands and other partners, UNICEF supported the CBNP evaluation in Balkh and Laghman provinces. The findings of the evaluation continue to support ongoing advocacy to expand the programme across the country.