Abstract
BackgroundAfghanistan is a country that has been in conflict for decades, resulting in the destruction of much of its social infrastructure including the health system. In 2003, after the intervention of US-led NATO forces, the new government with support from its international partners designed a Basic Package of Health Services to provide services to the majority rural population; its specific focus is on women and children. The workforce to deliver these services consists of Community Health Workers (CHWs). In this paper we aim to 1) describe the CHW program, 2) explore the gender dynamics of the workforce, and 3) identify facilitators and challenges to the program.MethodOur descriptive, qualitative study involved an analysis of policy and administrative documents, in-depth interviews and focus groups, and non-participant observation. Ethical approval for the fieldwork was obtained from the University of Ottawa, and the Afghanistan National Public Health Institute.ResultsThere are more than 20,000 CHWs across the country serving as village primary care providers, functioning as a liaison between the community and health-care facilities, and working as community developers; more than half are women. Noteworthy is a gender hierarchy: as one moves up the hierarchy of supervision and training, management and decision-making, the ratio of women to men diminishes. We found that female CHWs accomplished their tasks vis-à-vis maternal child health with greater ease than their male counterparts, as societal gender dynamics influences task allocation. Volunteerism helps to deploy a larger number of CHWs, but also makes their retention difficult. Community participation facilitates tasks of CHWs, but also poses challenges to the program, such as traditional leaders influencing the recruitment of CHWs that may not be the best choice for the community. Drug supply and support for CHWs is vital to the effectiveness of the program.ConclusionsThis case study of the decade-long, rural health workforce CHW program in Afghanistan suggests that CHWs play an important role in post-conflict, developing countries, potentially contributing to health system strengthening.
Highlights
Afghanistan is a country that has been in conflict for decades, resulting in the destruction of much of its social infrastructure including the health system
There are more than 20,000 Community Health Workers (CHWs) across the country serving as village primary care providers, functioning as a liaison between the community and health-care facilities, and working as community developers; more than half are women
We found that female CHWs accomplished their tasks vis-à-vis maternal child health with greater ease than their male counterparts, as societal gender dynamics influences task allocation
Summary
Afghanistan is a country that has been in conflict for decades, resulting in the destruction of much of its social infrastructure including the health system. The workforce to deliver these services consists of Community Health Workers (CHWs). In this paper we aim to 1) describe the CHW program, 2) explore the gender dynamics of the workforce, and 3) identify facilitators and challenges to the program. Armed conflicts leave behind devastating health and social system impacts [1]. The detrimental effects of conflict are long lasting in low-income countries because of the consequent slow reconstruction of infrastructure [2]. Community Health Workers (CHWs) have been deployed in various. Afghanistan’s Human Development Index (HDI) is one of the lowest in the world, in particular for social indicators pertaining to women. In the 1990s, during the civil war and the time of the Taliban, women were barred from social, economic, and political lives, and restricted to their homes
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