Afghanistan has the highest maternal mortality rate in the world and is second for under-five mortality. Poor and improper nutrition among women of reproductive age can lead to pregnancy-related complications, there is an acute shortage of health facilities and trained staff – particularly female staff – access to antenatal care and essential medicine is limited, and most of the population lacks access to basic health and sanitation services.
In order to address these health challenges, the Afghan Red Crescent Society has adopted an integrated methodology to addressing health issues – the community-based health and first aid (CBHFA) approach.
In a country with the challenges of poor infrastructure, extreme poverty, high illiteracy and gender inequalities, the National Society has learnt that putting women at the centre of maternal, newborn and child health interventions is critical. Female volunteers are being trained and empowered at the local level to raise awareness around health-seeking behaviours and contribute towards reducing maternal mortality.
Female trainers who work on the condition that they are accompanied by their male relatives have travelled to remote regions of the country to sensitize community leaders about the benefits of involving women in health promotion.
The National Society has been able to recruit and train women in remote villages, where one of the main challenges has been a high illiteracy rate. In Afghanistan 50 per cent of the men and 85 per cent of women are illiterate. To ensure that the volunteers learn the key health messages accurately, the Red Crescent trainers use innovative ways of teaching, such as using simple visual aids adapted to the local context to promote behavioural change in health, first aid and safety practices.
The Afghan Red Crescent Society has 25 male and 11 female CBHFA master trainers and some 22,000 trained volunteers, including more than 2,000 women, in 34 provinces. In addition, the society provides health services through its 47 basic healthcare clinics and 17 mobile health teams.
Communities benefit from the key health messages that are being delivered by female volunteers. Women living in remote villages are being trained in performing simple health interventions – such as diarrhoea treatment with oral rehydration solution. Volunteers are referring women to health clinics for antenatal care, prenatal care and family planning.
Using culturally-sensitive approaches and addressing gender-specific barriers, the National Society has not only been able to develop women’s confidence and recognition within their communities, but has also encouraged them to seek health support. With the success of training female volunteers in northern Afghanistan, the National Society has decided to apply the same approach in other areas of the country.
Trained volunteers from the same community as those they are helping, who speak the same language, can help reach the most inaccessible, poor and vulnerable populations and contribute towards universal health coverage.