Afghan Health System
have a national Strategy that is Basic Package of the Health Service (BPHS), Health Post is the first step for providing of Primary Health Care Services.
Community-based basic health care services are provided by community health workers
(CHWs) at their own homes recognized as community Health Post. Usually, a Health Post is staffed by a female and a male community health worker. If two (male and female) CHWs could not be available, one CHW may provide Health care services, but every effort should be made to provide two CHWs (a male and female) for every Health Post.
A Health Post will cover a catchment area of 1,000 to 1,500 people, which is equivalent to 100 or 150 families. In case of need, the coverage level of the Health Post can be changed. Health education and promotion of health habits in the community is the first and most important responsibility of the Health Post. In addition, the Health Post provides preventive care such as drug distribution and birth spacing devices, mothers’ health care and limited curative services like diagnosis and treatment of common disease
in children and adults.
The main responsibilities of a Health Posts are as follows:
Health education and changing of health habits of the community;
Referral of patients to health facilities;
Provision of first aid
Treatment of common illnesses;
The Community Health Worker is an important member of the health system, provides basic health care services from his/her home, which is recognized as a health post. The CHW is from the same area he/she is supposed to serve (familiar with the culture and language of the people), train for four- six months to deliver Basic Health Services. The CHWs are selected by the community they serve and supervised and monitored by the Community Health Supervisor from the nearest health facility.
Now there are about 15000 Health Posts, serving for rural population in Afghanistan, but there are still many un-served areas. Health posts through trained CHWs providing health care services to 45% sick children and covering 69% family planning, but some concerns are there about quality of the care they provide. CHWs workload is also a matter of concern, but not a major problem yet. CHWs motivation needs to be taken very seriously because they are volunteers. Recognition of their role in the health system
, respect, honor, update of knowledge, and supportive supervision are important types of compensation. It is also very important to be specific about the different types of “incentives”, including reimbursement of expenses, rewards for good performance or performance based financing to keep them in their volunteer role.
Urban CBHC program for poor urban populations, which is focusing on female CHWs, started in Kabul city, but other big cities are not covered yet. Nomad CBHC program for Nomad populations started but needs to have more CHWs for many un-served areas of Nomad populations
For establishment of a health post, in view of the following points a CHW should be identified and introduced by the community:
Be a resident of the locality;
Be 20 to 50 years of age;
Be volunteer, active and interested to serve as CHW;
Be respectable in his/her locality and enjoy the support of his/her community members;
Women should be encouraged to volunteer for being provided with training as CHWs (According to the guideline of the Ministry of Public Health, at least 50% of CHWs to be trained should be female.);
Basic literacy is preferable.