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Cited by 75Global Health Workforce IssuesGlobal Maternal and Child HealthHealthcare Systems and Reforms

Community health workers of Afghanistan: a qualitative study of a national program

Open access
Najafizada, Said Ahmad Maisam, Labonté, Ronald, Bourgeault, Ivy Lynn·2014·Conflict and Health
DOI 10.1186/1752-1505-8-26PMC PMC4405840
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Abstract

BACKGROUND: 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. 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. METHOD: Our 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. RESULTS: There 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. CONCLUSIONS: This 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.

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  • In both the LHW and CHW programs, CHWs perform similar functions ranging from health education and awareness; diagnosis and treatment of prevalent diseases such as diarrhea, malaria, respiratory illnesses, and intestinal worms; directly observed therapy for tuberculosis; either antenatal or postnatal health care; and referrals to health care facilities.

    “In both programs, CHWs perform similar functions ranging from health education and awareness; diagnosis and treatment of prevalent diseases such as diarrhea, malaria, respiratory illnesses, and intestinal worms; directly observed therapy for tuberculosis; either antenatal or postnatal health care; and referrals to the health care facilities [5,6].”

    From Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study (2020) · cites this paper as [6]

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  • The study highlighted that the CHWs hoped that the app would help address the need to constantly prove their efforts to their supervisors and dedication to the program, especially in Afghanistan, where they are volunteers.

    “The study also highlighted that the CHWs hoped that the app would help address the need to constantly prove their efforts to their supervisors and dedication to the program, especially in Afghanistan, where they are volunteers [6].”

    From Operability, Usefulness, and Task-Technology Fit of an mHealth App for Delivering Primary Health Care Services by Community Health Workers in Underserved Areas of Pakistan and Afghanistan: Qualitative Study (2020) · cites this paper as [6]

    The Results sections on Volunteerism and Supervision describe Afghan CHWs as volunteers whose activities supervisors review monthly. They do not say CHWs felt a need to constantly prove their effort or dedication, or hoped an app would help them do so (searched for the app and for proving work to supervisors). (LLM, conf=0.88)

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  1. [20]WHO Primary health care: report of the International Conference on Primary Health Care, Alma-Ata, USSR, International Conference on Primary Health Care 1978 Alma-Ata USSR

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Authors
Najafizada, S. A. M., Labonté, R., & Bourgeault, I. L.
Affiliations
University of Ottawa (CA)
ORCID
Venue
Conflict and Health
Publisher
Springer Science and Business Media LLC
Published
2014-12
Volume
8
Issue
1
Pages
26-26
ISSN
1752-1505 (ISSN-L)
DOI
10.1186/1752-1505-8-26
PMC
PMC4405840
OpenAlex
W2075756105
Cited by
75
References
18
Citations by year
2026: 6 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 7 · 2021: 4 · 2020: 12 · 2019: 13 · 2018: 7 · 2017: 6 · 2016: 6 · 2015: 1
FWCI
7.56
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Conflict and Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • uO Research (University of Ottawa) (submittedVersion, public-domain)
Funders
International Development Research Centre
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
Keywords
community health workers, Afghanistan, gender dynamics, female health workers, maternal and child health, post-conflict health systems, rural health workforce, health workforce retention, volunteering, community participation, traditional leaders, drug supply, health system strengthening

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