Female Community Health Workers and Health System Navigation in a Conflict Zone: The Case of Afghanistan

Abstract

Afghanistan ranked 171st among 188 countries in the Gender Inequality Index of 2011 and has only 16% of its women participating in the labor force. The country has been mired in violence for decades which has resulted in the destruction of the social infrastructure including the health sector. Recently, Afghanistan has deployed community health workers (CHW) who make up majority of the health workforce in the remote areas of this country. This paper aims to bring the plight of the CHWs to the forefront of discussion and shed light on the challenges they face as they attempt to bring basic healthcare to people living in a conflict zone. The paper discusses the motivations of Afghani women to become CHWs, their status in the community and within the health system, the threatening situations under which they operate, and the challenges they face as working women in a deeply patriarchal society within a conflict zone. The paper argues that female CHWs should be provided proper accreditation for their work, should be allowed and encouraged to progress in their careers, and should be instilled at the heart of healthcare program planning because they have the field experience to make the most effective and community oriented programmatic decisions.

Afghanistan's humanitarian crisis and its impacts on the mental health of healthcare workers during COVID-19

“…Afghanistan's remarkable advances in public health celebrated over the past two decades were vastly conceivable due to the efforts of women, including doctors, nurses, midwives, and community health laborers. Four out of 100 extraordinary nurses and midwives leaders over the world in 2020 have been recognized from Afghanistan (Parray et al ., 2021 ). At the same time, female HCWs continue to struggle between the expanding health needs of the population amidst ongoing political conflict (Parray et al ., 2021 ).…”

“…Four out of 100 extraordinary nurses and midwives leaders over the world in 2020 have been recognized from Afghanistan (Parray et al ., 2021 ). At the same time, female HCWs continue to struggle between the expanding health needs of the population amidst ongoing political conflict (Parray et al ., 2021 ).…”

“…Amidst these concerns, gender inequality is prevalent in HCWs, with Afghanistan ranked as 171st among 188 countries in the Gender Inequality Index (Najafizada et al ., 2014 ; Parray et al ., 2021 ). Despite this, an optimistic attitude and continual resilience demonstrated by community care workers, of which half are women, continues to help in the delivery of essential healthcare services (Najafizada et al ., 2014 ; Parray et al ., 2021 ). The diligence needed to stay motivated during the pandemic emerges from a sense of service and empowerment for female HCWs.…”

The Role and Impact of Female Health Workers on the Well-Being of Global South Communities: A Call for Gender-Transformative Action

“…The Basic Package of Health Services for the Afghanistan (BPHS) initiative only requires the CHWs to undergo highly targeted, multi-phase training for a minimum period of eight weeks to learn about the management of basic illnesses [37]. Because of limited female mobility in Afghanistan, due to cultural and religious norms, the BPHS initiative employs CHW couples/partner groups, whereby female CHWs are often accompanied by a Mahram -usually their husband, brother, or father who acts as a male religious guardian, in order to ensure that health services are delivered efficiently [38].…”

“…The stigma and fear of retaliation inhibit female health workers from reporting workplace violence and sexual harassment. Violence and harassment -often from male colleagues, male patients, and even random members of the community -harm women physically and psychologically, cause attrition, low morale, and their ill-health impacts their ability to deliver the quality of care necessary for caring for others [38].…”