On a bumpy dirt road, protected by high brick walls, lies Razia*’s house. She has been living in the small village in Paktia province for several years with her late husband, sons, daughters-in-law and grandchildren. Although someone unfamiliar with the area might not find any difference between Razia’s house and others, it has enormous significance for the community: Razia’s house is what is known as a Community Health Post. A Community Health Post is run by community members, such as local health workers and volunteers. There, trained community members provide basic health services to people living in remote villages who otherwise do not have access to health facilities and services.
The 55-year-old Razia has made the large entrance room of her house available for community service. The room is decorated with flowers and colorful posters that provide information about health issues. The room is furnished with Afghan toshaks, traditional floor seating, to create a comfortable and welcoming atmosphere. “My late husband was a Community Health Worker, and I decided long ago to assist him in his honorable duty. Our relatives and other community members are in need of help! For some remote villages, the distance to the nearest hospital is very long, they do not receive any support,” explains Razia.
The lack of health facilities combined with a record high poverty rate makes it difficult for families to afford the high cost of transportation. “On average, a family has to spend 1,000 AFN for a trip to the hospital. People here are farmers, some daily workers. Most have no income, let alone any savings,” Razia adds.
But it’s not just proximity to the nearest health facility that poses a major challenge for remote communities. The lack of health education and fear of social stigma also pose a serious health risk to the community.
“People in our village have never been properly educated about health. They use tobacco, soil or dirty clothes on their wounds to stop the bleeding. Since my son and I took a first aid course and received a first aid kit from PUI, we know how to properly and hygienically treat wounds, injuries and stop bleeding. When families and community members come to our Health Post for first aid, they are surprised by our skills.
They ask what my job is, where I got the equipment, and how I learned to provide first aid. We explain to them that their methods are harmful to their health and that it is important to ask us for help,” says Razia.
The community greatly appreciates the volunteer service of Razia and her son.
Their Health Post is open day and night for everyone. The two Community Health Workers usually assist 2-3 people per day with consultations, referrals to the hospital and first aid.
But their work doesn’t stop there. 1-2 times a week, Razia and Fazal* travel to some neighboring villages in the mountains. There, they inform families about community services and free primary health care, and they distribute medicines, which they regularly pick up at the hospital before their visits.
Fazal, father of two little girls and one boy, is a trained pharmacist and nurse and supports his mother in her weekly visits.
“It is important to visit the villages in the mountains because there are no Community Health Workers or Health Posts. We pay the transportation costs out of our own pockets, even though it is a big financial burden for us. But the families need our support. We treat their injuries, bring them medicines, especially painkillers and antipyretics, we provide referrals to hospitals when we can’t provide the care ourselves, and we educate people about communicable diseases and how important it is to report them. Many people are reluctant to tell us their symptoms because they are afraid of being stigmatized. That’s why we tell people to keep an eye on the health of their relatives and neighbors. We give them simple examples, like letting us know if someone has been coughing for 14 days or more. In this way, we were made aware of a woman with a chronic cough and referred her to the hospital where she was treated for tuberculosis. Now she is much better and knows she doesn’t have to be ashamed,” explains 30-year-old Fazal.
Community-provided health services help build trust between the community and the health system. People feel more comfortable using health services and trust health care providers like Razia and Fazal. They help overcome some of the cultural and social barriers that can prevent people from seeking health services. Community health services strengthen communities and make them more resilient. By training and supporting local health workers and volunteers, communities can take control of their own health and wellbeing which helps to build resilience communities and improves long-term health outcomes.
“If one day I am no longer able to provide the services, I hope my children will continue them. But I hope that I can support my community as long as possible! In fact, it would be good if I could get more training on health education so that we can advise our community on other issues like nutrition and pregnancy,” says Razia.
*all names have been changed