Afghans are in desperate need of high quality culturally sensitive health care and health education that is easily accessible to women and children in the communities where they live. Afghanistan still has one of the highest rates of infant mortality and maternal death with a woman’s life time risk of death in childbirth being 1 in 11(Merlin Report 2011).
AIL considers access to health care a human right and takes a holistic approach to providing health care incorporating health education at every opportunity. Health education is integral to all of AIL’s activities, as knowledge about health empowers individuals to care for themselves and their families. AIL was the first organization to teach about health at Learning Centers and in schools and began providing health training to teachers in public schools in cooperation with the Ministries of Health and Education in Herat.
AIL provides health education and services to hundreds of thousands of Afghan women and children annually through its local clinics, mobile clinic outreach program, schools and Learning Centers. AIL has four clinics in Afghanistan: two in Kabul Province and two in Herat Province providing medical treatment, health education to every patient, and reproductive health services many women each month. In addition AIL provides partial support to a third clinic in Herat province.
The clinics treat numerous ailments from colds to injuries and provide vaccinations and reproductive services. AIL’s approach is to link healthcare and education programs creating a more pervasive care model, while delivering health services AIL also models and teaches human rights, women’s rights, peace, democracy, and leadership. With new skills and information, Afghans are becoming healthier, empowered to take care of their health and all aspects of their lives and through this are becoming hopeful for the future. Together, they are creating a healthier, democratic, rights-based, and self reliant culture in Afghanistan.
More in-depth health education workshops are offered through the clinics covering the subjects of reproductive health, school health, and lessons for expectant mothers. These workshops are very popular. ( see Health Training page) AIL disseminates health education wherever possible and so health lessons are given by its teachers and by Community Health Workers (CHWs).
The Community Health Worker Program
Working with the Herat Ministry of Health, AIL runs Community Health Worker (CHW) posts with trained CHWs. Each CHW team has two members, a male and female. They are chosen by each village, work at the village level and need to have some education in some cases, the female members have been educated in AIL centers. The basic training takes several months and after thisg, the CHWs meet monthly with clinic staff and are given additional training when needed. CHWs refer villagers to the clinics, give first aid, provide contraceptives that have been prescribed through the clinic, work with malnourished children and their mothers and give health education on a number of different topics. The CHW program has been very successful, particularly in the area of health education. The CHWs are the closest to the people in the community and are most likely to know when there is a health situation that needs to be referred to a clinic, even when the patient does not initially seek their help. Since they are trusted, patients are more likely to seek further medical treatment with their recommendation which is a great help in these rural settings. CHWs are a great early intervention and help to prevent health problems reaching crisis levels for families.
A perfect example of the impact of the Community Health Workers is described in the story below:
From an AIL clinic health worker
One day I went to a health post that is located in village for monitoring. After knocking on the door it was opened by Wakil, one of the CHWs of our Health post. We entered to a small room on the wall of which there were lots of pictures. After greeting, I checked CHW’s community map. Wakil and his wife who were potential and proactive workers of the post exchanged a glance at each other and Wakil said,
“A family has come to our neighborhood. My wife and I went to their house yesterday and introduced ourselves. I told them about our work. While we were returning to our home my wife told me that there was a pregnant woman in the family exactly in her last month of her pregnancy. Therefore, I told them to go to clinic for delivery. They refused and said that they never go to any clinic since their husbands don’t permit them. After leaving the house my wife asked, “Should I add them to the community map?” Of course why not, Wakil has replied.’
After listening to them, I told Wakil to try to convince her husband. Then I returned home from the clinic. The next week, Wakil called me and said, “The woman has delivery pain and my wife and other women neighbors are in their house. Unfortunately, her husband isn’t allowing us to take her to the clinic.” I told Wakil, “I am coming there now and maybe I can convince her husband.” I set out for the woman’s house by motorcycle and got there in a short time since it was not so far from our house.
When I arrived there I entered the house with Wakil. Then Wakil introduced me to the husband and said, “My friend is the health visitor of the community from the clinic.” After Wakil’s speech I said, “Dear Sir, we are all human and we should understand the pain and sadness of each other”. Then I got right down to business and said, “As Wakil Ahmad and his wife told you that there is a health clinic which has professional doctors and midwives. The women part is separate from the men part. There are two delivery rooms that no one can enter there except the female personnel. There is an ambulance at your service with no charge to take the pregnant woman with her 2-3 companions to clinic that returns them to their house. In this place, the blood pressure of the patient is checked and, if it is necessary, drugs and IV fluid would be prescribed for her. After the delivery the new born baby will be vaccinated and a vaccine card is given to complete other period of vaccine.”
As you have seen in past years, because of the lack of vaccinations and health services most families lost their children because of various illnesses like measles, whooping cough, etc. However, currently the mortality rate has decreased due to the health services by opening clinics and health posts in the rural areas; even in remote villages.” I uttered all the words in an encouraging tone. The husband, with long beard and scorched face indicating his poverty, was sitting and listening to my speech. After some moments in silence, he said, “The poor woman has been suffering from the pain since last midnight… OK, please get the ambulance and take her to the clinic.”
I got the driver and asked him to come to the given address as soon as possible. Fortunately the ambulance was not so far from the clinic. Therefore, the driver said that after taking the medical staff he would come right away. The woman was taken to the clinic in 15 minutes. I went to the clinic as well. She delivered at about 10:30 am and was taken back to her house.
After two days, while I was walking home, the husband was standing by the cracked wall of his house and pointed at me to stop. I went to him and he seemed so happy that didn’t even greet me. He started appreciating and said that they were so happy because of the clinic‘s personnel, especially the midwives. Then he told me if you and Wakil did not tell us about clinic and its services our patient would be dead. After that I told him that we have done our responsibility.