Afghan Women Improving Health

Afghan Community Health Worker with Baby

The Need: Death during childbirth is an every day occurrence in Afghanistan, which has among the highest rates of maternal and child mortality in the world. Many deaths can be prevented by changes in lifestyle and basic health care in the home.

To change health behaviors and provide services at the village level, the Afghanistan Ministry of Health extends a Basic Package of Health Services (BPHS). One strategy is to train local people as Community Health Worker (CHWs).

A More Sustainable Approach: While many organizations partner with the Ministry of Health to train CHWs, a concern is that the results will not be sustained.

A key distinction of Future Generations approach is the premise that CHWs need more than just knowledge and skills; they need the motivation and self-confidence (empowerment) to take initiatives back to their communities and accomplish changes for themselves.

To facilitate an empowerment-based training approach, Future Generations Senior Health Advisor, Dr. Carl Taylor, worked with a female Afghan medical doctor, Dr. Shukria, and others develop a new, culturally-appropriate approach to training and empowering CHWs.

This new approach includes:

  • women’s only health workshops for 10-20 older women selected by their village councils;
  • a learning approach, known as Pregnancy Histories, that helps each woman understand why her own children died during pregnancy;
  • the formation of Women’s Action Groups (or Family Health Action Groups) to implement health-related community workplans; and
  • the training of a local woman as a Community Statistician to help communities monitor their progress.

Impact to Date: From 2005-2006, a nine-month pilot of this approach in Bamyan and Ghazni Province achieved results twice as quickly as standard government programs across ten health indicators.

Results from an independent evaluation conducted by Johns Hopkins University in 2008 showed that:

  • child mortality declined by 46 percent, and
  • women continued their volunteer efforts for two years without any outside assistance.

In 2010-2011, the Afghanistan Ministry of Health expands the success of Family Health Action Groups to help support and sustain the efforts of Community Health Workers in nine provinces.

 


The stories of village women trained as CHWs show that when empowered, women can motivate entire communities to change their habits. 

The Stories of Women, collected and recorded by Dr. Zarghouna:

A spring in Sya Dara 

In the workshop, the new CHWs heard about safe drinking water. Coming home, Fatima realized that her village water source, the spring, was not clean, in fact, it was very dirty. She gathered some women to talk about the problem, and they decided to ask the men to help clean the spring and cover it. Day after day passed, and the men did nothing. Finally, Fatima gathered three of her neighbour women, and they went themselves to clean up the spring. Some men observed that something was going on. They came over:
- Men: What are you doing?
- Women: We are cleaning the spring.
- Men: You are not able to do it.
- Women: We are able. We asked you to do it, but you do nothing. Therefore, we had better do it ourselves.
- Men (among themselves): This is not good. This is not women’s work. It is a shame for us. It is better we do it.
- Fatima: Great! Remember also that it needs to be covered. If it remains open, it will quickly become dirty again.
So they did. The day after, the spring was clean and covered with a lid of mud.
In the next workshop Zarghouna, the trainer, heard this story. She asked:
- What happened then? Have you had much diarrhoea in the village lately?
- Fatima: Do you know, just within a few days the diarrhoea stopped. It has not been a problem after we cleared the spring. Then to the trainers: You are sharp people; we need to learn more from you!

A birth complication in Sya Dara

In Sya Dara, there was a delivery complication. A mother was bleeding a lot, and the placenta would not come out. The family would not call for the help of Arefa, their neighbor who was a half-trained CHW, because the families were quarrelling. Then the sister-in-law of the mother spoke out:
- This neighbour has gone to some training, she has learned from the doctors, she may know what to do.
The father of the newborn baby refused: -No, we should not. They are not good people. We do not want them to help us.
But the bleeding continued and the sister-in-law when to fetch Arefa. But Arefa’s husband did not want her to assist.
- Arefa’s husband said: Do not go. We have a fight going with them.
- Arefa: I do not care. This is a mother of many children. If I do not go and she dies, I will carry the guilt.
So, she went. She washed her hands and asked the sister-in-law to bring boiled water so the mother could wash her breast. Then she put the baby to the breast. Normally, mothers start breastfeeding the third day, so this was very uncommon. However, the family accepted it. Still the placenta did not come, and there was an ongoing haemorrhage. Arefa did the next step she had learned in the CHW training course, uterus massage. After a short time the placenta came, and finally the bleeding stopped. The mother and child were alive. The neighbours re-united and ended their quarrel.

Rehydration in Rostam

In a wedding in Rostam one child had severe diarrhoea and vomiting. The child was very sick, and the mother was worried. Zahra, a freshly trained CHW, was there. She asked for wheat flour, salt and water, and prepared a soup for cereal-based rehydration, as she had learned in the workshop.
- Mother: Do not give it. He will vomit more!
- Zahra: We will give a little bit at a time.
- Mother: No, no, the vomiting will get worse.
- Zahra: Even if he vomits, a little will remain in his stomach. He needs it so he does not get too weak. This will make him stronger.
- Mother: Is it true? Ok, you can give a little bit.
Zahra gave a little bit at a time, but the child threw up again and again. Then they realized that the child had a high fever, and that he should be brought to the clinic. Zahra was worried.
- Zahra: Quickly, boil some water; put it in a big pan to cool it down. Then bring it on the trip, and give the child a little many times on the way, so he does not get too dry.
The mother did so. When she arrived to the clinic and the doctor saw that she had brought water and flour soup, he was impressed, and asked from where she got the idea. Then, he talked well about the CHW that she had a good understanding, and it was wise to listen to her.