REACH employed an integrated system of community-based health care to increase the use of health services. This system promotes relationships among health facility staff, community health workers, shura-e-sehi (community health committees), and community members to achieve:
Identifying and training community health workers to provide health services at the community level was one of REACH’s great successes. NGO grantees trained nearly 6,300 community health workers, more than half of whom are female. Trained in three phases, these workers spend two months in their communities between training sessions to practice the skills learned. Training started with simple skills such as home and personal hygiene and progressed to more complex tasks, such as supplying contraceptives and managing childhood illnesses.
Because these workers are accessible to their neighbors and provide competent care, they now provide most of the essential health services at the village level, while referring serious cases, which previously would have gone untreated, to nearby health facilities. The numbers of cases of acute respiratory infection and diarrhea referred by community health workers increased fivefold in only one year.
Afghanistan’s low literacy rate makes community maps powerful tools for tracking household use of health services. These maps assist community health workers in planning and managing their activities while also linking their efforts with those of local health facilities.
To implement community mapping, REACH staff taught community health workers to:
TAI under REACH program established and trained shura-e-sehi (community health committees) to forge strong relationships between local health facilities and the communities they serve and to personally reinforce health messages. REACH promoted women’s participation in these committees. While some were male-only groups, others brought together men and women at the same time and place, and others had men and women meeting separately. REACH trained its NGO grantees to provide leadership training for nearly 6,000 shura members (21 percent of whom are women). TAI also trained community health supervisors to help the shuras to promote health services, review the performance of community health workers, and conduct effective monthly meetings.
Afghanistan’s low literacy rates makes community maps powerful tools for tracking household use of health services. These maps assist community health workers in planning and managing their activities while also linking their efforts with those of local health facilities. Health workers draw a community map, including landmarks and houses, showing each household’s health needs and use of services.