CHWs are largely volunteer members of the community, nominated by a Village Health Council (VHC), and trained, supervised and supported by the organization implementing the BPHS. They are reimbursed for their trip to health facilities, and provided toothbrush and toothpaste, hand soap, and towel for their own use. Most CHWs are illiterate; few of them can read and write.
In Table 8, we compare the tasks designed in the BPHS with the ones CHWs actually undertake. For example, female CHWs participate in female-only events and meetings. CHWs participate in national campaigns only when they are asked or employed to do so. Mental health and tuberculosis carry stigmas, and thus are rarely reported or dealt with by CHWs, leading to their claim not to have many cases of those illnesses. We tentatively conclude that, based on our sample to date, active CHWs undertake most of the tasks they have been assigned in varying degrees, and only when the social/cultural context allows.
In collaboration with village elder/leader and village council, CHWs also form a Village Health Council (VHC). These VHCs are male only, female only, or of mixed-sex, with one VHC in each village or catchment area. CHWs convene meetings of VHCs on a monthly basis, in which they discuss health issues of the village. Male only VHCs often discuss environmental health issues such as water for drinking and for irrigation, electricity, and roads for quick and easy access to the health facilities. Female only VHCs generally focus on maternal and child health such as breastfeeding, a good source of nutrients for mothers and children, antenatal and postnatal care visits, family problems (convincing mother-in-laws and husbands to allow them to access health care services), and provision of vehicles for transportation of pregnant women to the health facilities.
CHWs also attend a monthly refresher training/meeting at the HF to refresh their knowledge, and to discuss village health problems at the facility. Most CHWs attend the monthly meetings for a number of reasons. First, they are paid a travel stipend, but they usually walk the trip between the village and the health clinic for lack of transportation and save the money. Second, the monthly meeting refreshes the relationship of the CHW with the health facility, which in turn boosts the status of the CHW in the community on their return.
“…because people think we might have brought [back] drugs or something to give them like brochures or posters.” (Male CHW)
Third, CHWs refresh their knowledge of the services they provide and learn new information. Finally, for female CHWs, going to clinic gives them a sense of freedom and empowerment.
“Women do not go outside without their men’s permission, it is like taking a break, going to clinic.” (Female CHW)
Full version of CHWs of Afghanistan http://www.conflictandhealth.com/content/8/1/26