CHWs: A Foundation for Healthier Afghan Communities

Afghanistan, October 1, 2002

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    "Mercy Corps, with the support of The NetAid Foundation, is working with the community to improve healthcare." Photo: Scott Heidler/Mercy Corps. Photo:

Dewallah district, home to about 4000 Afghan families, is in the heart of the drought-devastated southern Afghanistan. During the Soviet War, the entire population was forced to flee, across the border to Pakistan, to escape the fighting. Now, after the recent war, many families have returned - to ruined homes and arid lands that are impossible to farm.

"It is very difficult here, but at least we are home now," says Gulab Mohammad, a recent returnee to the village. "And we are all working hard to improve our village and solve the many problems we face."

Mercy Corps, with the support of The NetAid Foundation, is working with the community to improve healthcare. Located almost an hour's drive from the closest hospital or healthcare facility, the district relies on a network of Community Healthcare Workers (CHW) for basic health services. These CHWs act as a bridge between their local communities and the hospitals and Basic Healthcare Units Mercy Corps operates in neighboring communities. There are over 160 CHWs working as part of the Mercy Corps Afghanistan Health Initiative in Helmand province.

Male and female volunteer CHWs provide community members with education and awareness about safe motherhood, hygiene, sanitation, preventative healthcare, vaccinations, first aid, nutrition, mother-child health, and reproductive health. Female CHWs also provide birthing assistance. For more complex cases, CHWs refer patients to the network of hospitals and BHUs.

With the assistance of NetAid, Mercy Corps has launched a recent initiative to provide refresher training to its network of CHWs, as well as re-supply each CHW with medical kits that contain items such as soap, bandages, aspirin, cotton and surgical blades to assist in home deliveries.

The training the CHWs of Dewallah have received is evident in the words of the workers, as well as from the training certificates they proudly display. Honkem Bibi, a former traditional midwife, has been a CHW for the past year. She enthusiastically highlights the lessons she has learned in her recent training course. "We have learned about microbes and dirty water, the importance of vaccinations and many things about deliveries and post-natal care," she says. "Before we used scissors to cut the umbilical cord, but now we know to use a clean, new razor to help prevent tetanus."

According to Judith Lane, Mercy Corps Health Program Manager, post-natal care is a major focus of training for the female CHWs who perform deliveries. Some traditional practices and beliefs often put the baby and mother at great risk. "Traditionally women would not wash their newborns for at least one week after delivery," says Lane. "They believed washing would cause the baby to catch a cold. Our training emphasizes the need to wash babies immediately after birth, using salt and boiled water to prevent any infections."

Perhaps of greatest concern, was the practice of not giving a newborn child any breast milk for at least 24 hours after birth. It was believed that it could cause the child to be lazy. In lieu of breast milk, newborns were typically given water, which is often contaminated. This practice deprived children from receiving colostrum, the first breast milk that contains antibodies to protect the newborn against communicable diseases and diarreha.

Lane stresses teaching best practices to CHWs who perform deliveries. "We encourage mothers to immediately begin breastfeeding after delivery," she notes. "This protects the newborn, as well as helps the mother. The suckling promotes contraction of the uterus and helps dispel the placenta, preventing against post-partum infection. Furthermore, putting the baby to the breast helps prevent hypothermia and promotes maternal-child bonds."

The CHWs are not paid for their work. They receive medical supplies, training and a certificate. Honkem Bibi explains why she does this volunteer job: "I want to learn more about health, so I can help my family and my community."