Community Health Workers in Afghanistan - BRAC Volunteer Drew Kinder Reports from the Field

Drew Kinder, a long-time volunteer and friend of BRAC, first in Uganda, recently volunteered with BRAC's programs in Sri Lanka and Aghanistan. Below is a post from Drew's blog about Community Health Workers in Afghanistan.

“Nay, Nay, Nay” four burqa clad Community Health Workers exclaimed in unison when asked if they do it for the money. With faces hidden behind traditional hijabs, their passion was clear. “We do it for God,” said one. “When our people are free from disease, we are free from disease.”

Community Health Workers in Parvan Province

When BRAC came to Afghanistan in 2002 it was the first NGO to widely use female Community Health Workers (CHW) where literacy was not mandatory. Lessons learned from this experience contributed to the adoption of female CHWs in Ministry of Public Health policy. It is estimated that 33% of all CHWs currently in Afghanistan have been trained by BRAC.

Community Health Workers (65% female) are generally selected from the community they serve. Each CHW is responsible for delivering basic health services to 100-150 households (containing 1,000 to 1,500 inhabitants total). They visit 5-10 homes a day for 15-30 minutes each.

CHWs perform the following services on their house-to-house visits:

• Health and nutrition education
• Treatment of common ailments
• Non-clinical family planning methods distribution
• Identify Suspected TB patients
• Implement DOTS (Directly Observed Treatment Shortcourse) for TB
• Distribution of oral rehydration supplies and iodized salt
• Mobilize children for immunizations (EPI, Expanded Programme on Immunization)
• Education about health and hygiene
• Acute Respiratory Infection (ARI) and diarrhea medicine
• Referring complicated diseases to other medical professionals
• Distribute personal hygiene products, ex. tooth paste, sanitary napkins, etc.

BRAC Community Health Workers receive two levels of training. Their initial training lasts for a total of 8 weeks to teach the CHWs basic preventive and curative diseases and to perform standardized CHW services. CHWs also receive monthly refresher training at a fixed facility near their home.

CHWs are volunteers. They are incentivized for various services, such as attending monthly review meetings ($2 US), reporting a suspected TB case ($1), and completing TB treatment ($3). They also distribute heath care products, which they receive free and then sell at a 25% mark-up over BRAC’s low wholesale cost.

The story of Farida is typical of the thousands of Community Health Workers trained by BRAC.

Farida in Balkh Province

“I first met Taman when I was a new Community Health Worker and he was only 15 months old. He had pneumonia. A mullah told his mother he would recover, so she refused my advice to take him to the hospital. He was much worse when I visited the second time. This time I convinced his mother, and doctors at the hospital saved Taman’s life,” Farida says.

“From then on people in the village followed my advice,” she says.

Farida has been a BRAC Community Health Worker in the city of Balkh, Afghanistan for four years. She refers patients to a BRAC managed District Hospital.