Afghanistan

Urban Community Health Workers in Afghanistan

Building strong relationships and trust between community health workers and the communities they serve prior to public health emergencies can help ensure continuity of health seeking behaviors during times of crisis. When health services dropped during COVID-19 lockdowns, women community health workers increased services 25%.

Health-seeking significantly decreased during COVID-19 lockdown due to fear of contracting the virus, and
many of the health posts in CHWs homes were shut down at this time. In contrast, CARE-supported urban CHWs,
particularly in Kabul and Balkh, were able to continue service provision in their homes due to the strong trust
they had built with the communities they served and their recognized leadership among community members
and as part of the health system. The relationship between CHWs and local communities was complemented by
CARE’s efforts to quickly provide CHWs with personal protective equipment and build capacity on WHO
protocols for COVID-19 screening, detection, and referral of cases as well as risk communication and
community engagement. During COVID-19 lockdown, the CHWs also continued provision of SRH, GBV services,
and referrals to midwives at community-based health centers run by CARE. In addition to maintaining service
delivery, the CHWs also began offering counseling and support to local women using mobile phones. Read More...

Impact, Influence, and Innovation: Reflecting on 10 Years of the CARE-GSK Frontline Health Worker Initiative

In recognition of their critical role in health linkages and systems strengthening, CARE and GSK established a decade long strategic investment in frontline health workers (FHW) and community health workers (CHW) in 2011 called the Frontline Health Worker Initiative. Following 10 years of partnership and programming, this report explores the resulting impacts, influence, and innovation. It synthesizes reach and impact data from 13 programmes across the 9 countries included in the Frontline Health Worker Initiative between 2011 and 2021. The countries included in this initiative are Afghanistan, Bangladesh, Cambodia, Cameroon, Chad, Laos, Myanmar, Nepal, and Togo.
The data presented here is specific to the communities in which CARE delivered sexual and reproductive health, maternal and child health, nutrition, and sanitation programming with GSK’s support. The analysis is designed to identify the changes in overall health outcomes that occurred at a population level. While these findings do not necessarily imply causation, CARE’s efforts have likely reasonably contributed towards these changes within the specific communities.
The Frontline Health Worker initiative has achieved these results across multiple development and humanitarian contexts – including slow-onset and sudden shocks, conflict, and most recently the COVID-19 pandemic. Many of these results were only made possible through the long-term investment from GSK and scalable actions that were implemented across all nine countries. Critically, the Frontline Health Worker Initiative established platforms, networks and health service capacity-building that served as a catalyst for CARE to pivot towards the response to the COVID-19 pandemic quickly in the communities where these projects exist.
Learnings from this programme will serve to strengthen CARE’s private sector partnership models for future programmes to build resilience and achieve health impact in communities. Read More...

ON THE FRONTLINE: Lessons on health worker empowerment through the COVID-19 pandemic response

Around the world,frontline and community health workers serve to connecthealth services, commodities, and informationwiththose who need them. Equippedwith the relevant skills and community trust, theycanstrengthen health systems by bridginggeographic and financial accessibility gaps for rural, hard-to-reach, and vulnerable populations through last-mile health delivery. When integrated into national and local healthcare systems, community health workers can additionally help patients navigate complex systems of care and ensure care continuity across services. Historically during times of health crises, global governments and organizations have often relied on community health workforces as frontline responders to deliver life-saving care to disproportionate l y affected populations. The 2020 COVID-19 pandemic was no exception, with many countries mobilizing their existing community health worker programs or initiating new ones to assist with pandemic response . Leveraging lessons learned through its decades long support and implementation of frontline and community health worker initiatives across 60 countries, CARE developed guidelines for community-level pandemic response and disease prevention during this time. In June 2020, CARE partnered with Abbott to launch a one-year in-depth primary care response to the COVID-19 pandemic Read More...

Multi-Purpose Cash Assistance (MPCA) Post-Distribution Monitoring Report

CARE implement an emergency funding funded by Humanitarian Response in Afghanistan ERPF –CARE International to respond to urgent humanitarian crisis including drought, displacement, conflict and COVID through provision of MPCA and NFI. CARE distributed cash to 522 households of which 75% were female-headed, in Kabul and in Kandahar. The activity directly assisted around 3660 people in the two provinces of Kabul and Kandahar. The distribution was done directly to the registered beneficiaries from CARE’s team female and male staff. The distribution went on smoothly without any interruptions.
CARE conducted a need assessment prior to provide cash assistance in the target areas to identify most vulnerable female headed households and disabled male headed household for this assistance.
In second week of November 2021, CARE’s Program Quality Unit (PQ) conducted a Post Distribution Monitoring (PDM) – on a randomly selected beneficiary to ascertain area including but limited to cash receipt, cash utilization, decision level for cash expenditure and assess monitoring and accountability measures – satisfaction levels from the response. Read More...

CARE Afghanistan Multi-Sectoral Needs Assessment MULTI SECTOR NEEDS ASSESSMENT – KEY FINDINGS February 2022

The purpose of this MSNA was to identify key gaps and needs where CARE operates, with the view to inform future programming priorities and better understand the impacts of the current situation on humanitarian needs.
A total of 364 households were interviewed from 20 districts across 8 provinces (Herat, Kandahar, Ghazni, Khost, Paktia, Parwan, Kapisa, and Balkh) in December 2021. An average of 18 interviews were collected per district. The survey administered a household questionnaire and a focus group discussion (2 per community –female and male) in each district.

Key Findings on Education, Gender, Humanitarian Access, and Food Insecurity are presented here. For more data and information, please refer to the full MSNA report.

The top 5 concerns raised by the communities were all related to the consequences of Afghanistan’s current economic and humanitarian crisis:
1. food security (72% of respondents),
2. lack of employment opportunities (66%),
3. livelihood and economic empowerment (56%),
4. lack of access to humanitarian aid (36%), and
5. lack of access to shelter/ housing options (36%). Read More...

Rapid Gender Analysis, Drought in Afghanistan July 2021

Afghanistan has experienced periodic drought over the past 30 years, but none occurring simultaneously with widespread insecurity and a global pandemic—until now. The combined effects of this “triple crisis” are gravely affecting people throughout the country. Knowing that crises affect different groups of people in different ways, CARE Afghanistan conducted a Rapid Gender Analysis (RGA) from June–July 2021 to assess the gendered effects of the drought, using primary and secondary data. CARE conducted in-person surveys with 352 participants (63.5% female, 36.5% male) in Balkh, Ghazni, Herat, and Kandahar; focus group discussions with 220 women; and key informant interviews with 20 people (20% women and 80% men). Read More...

The Final Evaluation of the Opportunities for Mother and Infants Development Project

The Opportunities for Mother and Infant Development (OMID) is a three year project (from 2018 to 2021), funded by The Glaxo Smith Kline (GSK). The current phase of the project has been implemented in the two districts (16th and 17th) in Kabul city. The main purpose of the project is to improve the health and reduce the mortality among mothers, newborns and children in the most vulnerable communities through community-based interventions facilitated and delivered by Community Health Workers (CHWs) and Community Midwives (CMWs).

Overall, the project has been effective in achieving the intended outcomes. Access and utilization of Maternal and Neonatal Child Health (MNCH) services have improved as demonstrated by achievement of the project’s key performance indicators across the continuum of care.

This included increases in the %:
- of women reporting ANC utilization
- of women who undertook the first ANC visit before by the 3rd trimester of their pregnancy
- of those who knew the date that the baby was expected to arrive
- of those women who had a plan where she would deliver the baby
- of those women who believed health facility is safer to deliver there

And decreases in the %:
- of those who didn’t go for ANC and believed it is not important
- of those who didn’t go for ANC and indicated the high cost of care as reason

The community systems strengthening undertaken by the project through establishment of community based health facilities and CHWs was effective in increasing health awareness and adoption of positive MNCH behaviors and practices. Read More...

MAGNIFYING INEQUALITIES AND COMPOUNDING RISKS The Impact of COVID-19 on the Health and Protection of Women and Girls on the Move

More than one year into the coronavirus disease (COVID-19) pandemic—with some countries seemingly on their way out of the crisis while others enter new waves—evidence of its impact is growing. COVID-19 is increasing short-term humanitarian needs and negatively affecting longer-term outcomes for marginalized populations and people in vulnerable situations, significantly setting back hard-won development gains, magnifying inequalities, and compounding risks. Among those worst affected are the more than 80 million people worldwide—approximately half of whom are women and girls—who have been forcibly displaced by drivers such as persecution, conflict, generalized violence or human rights violations.1
The majority of forcibly displaced people live in resource-poor countries with weak public health and social protection systems, and economies that have been hard-hit by the pandemic.2 Yet, to date, there has only been limited research around the unique ways in which women and girls on the move are affected.3 This despite predictions of significant impacts on access to, and use of, basic health services—including for sexual and reproductive health (SRH)—and the overall protection environment, including increases in prevalence and risk of gender-based violence (GBV).
Placing gender at the center of its humanitarian and development responses, CARE undertook new research in Afghanistan, Ecuador, and Turkey between April and May 2021 to better understand how COVID-19 is impacting the health and protection of women and girls on the move. The three countries represent different types of forced displacement across multiple regions: internally displaced persons (IDPs) and refugee returnees in Afghanistan; more recent migrants and refugees due to the Venezuelan crisis in Ecuador; and longer-term Syrian refugees living under temporary international protection in Turkey. The primary data collected for this research included more than 1,000 surveys with women on the move and from host communities, to allow comparison; 31 focus group discussions (FGDs) with women and adolescent girls; and 45 key informant interviews (KIIs) with government actors, health and protection service providers, humanitarian organizations, and CARE staff. Read More...

Final Project End-line assessment of Shelter, NFI, Hygiene, SRHR and Livelihood Support for Disaster-Affected Populations in Afghanistan 2018-2020

The Emergency Shelter, NFI, Hygiene, SRHR and Livelihood Support for Disaster-Affected Populations in Afghanistan 2018-2020 Project aims to provide emergency assistance to the identified beneficiaries settled in Kabul, Parwan, Kapisa, Balkh, Ghazni, Khost and Paktya provinces of Afghanistan. The interventions covered under this project included Shelter, NFI, WASH, Livelihoods and SRHR needs of the women, men, boys and girls affected by disasters. The sample of 352 households for this end line evaluation was structured as according to the proportion beneficiaries per the different project outputs The two main output blocks of hygiene/SRHR on the one hand and different forms of cash and NFI support on the other are well captured in the end line survey. In addition to the quantitative approach, 8 FGDs, 7 KIIs and 3 IDIs conducted were conducted with the project beneficiaries, stakeholders and the GAC project team.
Read More...

Emergency Response for Drought Affected Households in Northern Afghanistan Project: Baseline Survey Report

CARE’s Emergency Response for Drought Affected Households in Northern Afghanistan (OFDA) Project has planned to assist 4,100 households in two Provinces (Balkh and Samangan) in Northern Afghanistan. This baseline study was conducted to establish baseline values for indicators of intended outcomes and collect information about the target group prior to intervention. Read More...

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