Afghanistan is a nation that has been in struggle for quite a long time, bringing about the demolition of a lot of its social framework including their health framework. In 2003, after the mediation of US-driven NATO constrains, the new government with assistance from its worldwide accomplices composed a Basic Package of Health Services to give administrations to the dominant rural provincial populace; its particular center is on women along with children (Mansoor, Hill & Barss, 2012). The workforce to convey these administrations comprises of Community Health Workers (CHWs). In this paper, the point is to plan and creating training package for health workers in the rural areas of Afghanistan. This report will depict the procedure or technique to build up the preparation program alongside investigation of dynamics in terms of gender of the workforce. The discussions identified with this project will recognize facilitators and difficulties to the system. For the advancement of training program, distinct subjective study is utilized that includes an investigation of approach and managerial reports, inside and out meetings and center gatherings, and non-member perception.
Background and Literature ReviewBackground
Perry, Zulliger and Rogers (2014) defined Afghanistan as a country that has been involved in major conflicts and wars that have resulted in significant destruction of the infrastructure and society of the country. The major destruction and loss was identified in the health system of the country. According to Viswanathan et al., (2012) the US led NATO force’s intervention has led the Afghanistan’s government to take initiative and support the rural population of Afghanistan. The healthcare services and training sessions are mainly focused to the children and women of Uruzgan. The training packages developed for the children and maternity care of the women focuses on providing training, guidance, exploring the gender dynamics and assisting the rural communities to overcome the challenges and issues faced in the rural areas.
Kok et al., (2015) cited that since the years 2001, the Ministry of Public Health Department of Afghanistan has witnessed a devastation in the health sector and system. In this support, Perry and Zulliger (2012) claimed that the collapse of Taliban has initiated the risk and potential challenges on improving the health of the country. The health system has devastated potentially with the various challenging indicators that were not addressed by the government. Ventevogel et al., (2012) have illustrated the three significant indicators that affects the health of the rural workers in Afghanistan.
Figure 1: Factors affecting the Health of the Afghanistan
(Source: Fogarty et al., 2014, pp. 36)
According to Turkmani et al., (2013) the ratio of maternal mortality has been recorded as the highest with 1600 deaths per 10,000 births at Afghanistan. On the other hand, Newbrander et al., (2014) showed that in 2002, Afghanistan was recorded as the fourth highest for witnessing 257 and 165 deaths per 1000 in children and infant mortality. According to the heath record of Ministry of Public Health in Afghanistan, the country has observed that less than 10% of the population was given access to the healthcare services.
Further, the healthcare services at Afghanistan was not unique when judged by the source of the situation, that is the emerging and continuous conflict the country has faced in the past years. On a contrary, Petit et al., (2013) claimed that the healthcare services and situation in the rural places at Afghanistan was enhanced at a significant rate during the period of 2003 to 2011. Although, it cannot be ignored that the conflicts and Taliban rule has devastated the social system and devastated the health of the country at a miserable level. According to Newbrander et al. (2014), the long lasting impact of the conflict has reduced the rate of income that has resulted in the lower infrastructural growth especially in the rural areas. Moreover, the shortage of the human resources during the post conflict period was identified as one of the major hindrance of the improvement of Afghanistan. Howard et al., (2014) exclaimed that the dysfunctionality of the public-health sector at Afghanistan often attracted various NGOs (Non-Governmental Organization) to operate in Afghanistan working for their personal interest. Furthermore, the qualified health personnel, health clinics and resources were not available to the rural community of the country. CHWs (Community Health Workers) were majorly deployed by the government for assisting the rural children and women from overcoming the situation. Mansoor et al., (2013) cited that the CHW were trained for supporting and supervising the communities with the formal healthcare services to the people. As a newest division of the public healthcare services, the government has taken initiative to introduce CHWs.
With a total population of about 30 million of multilingual and multiethnic people, Afghanistan has bene considered as a country with the lowest HDI (Human Development Index) (Fehling et al., 2013). In addition to that, the HDI was recorded majorly against the women in the country. A study conducted by Wood et al., (2013) have revealed that only 6% of the total population of women have secondary education in the country, in addition to that, 16% of the women population was recorded for participating in labor. Rasooly et al., (2014) cited that throughput the country, the culture of gender segregation was widely practices depending upon the urban-rural difference, ethnicities and economic condition.
Fayaz et al., (2014) showed that during the Taliban and Civil war the women of Afghanistan were restricted to participate in the political, economic and social life and were bared to their household activities. Furthermore, the lack of baseline data and updated information about the epidemiology have made the children and women vulnerable to various deceases that can be easily prevented and treated with the right resource ad medical equipment. Najafizada, Labonte and Bourgeault (2014) cited that most of the diseases can be prevented by the vaccines was seen at Afghanistan.
According to Byrne et al., (2014) the Russian invasion and war against insurgency and terrorism have destroyed the infrastructure of the society at a significant rate. During 2003, the Afghanistan Government was provided with the support BPHS (Basic package of Health Services) and non-governmental institutes to support the rural population of Afghanistan with significant focus to the children and women. Carvalho, Salehi and Goldie (2012) showed that the health care packages were not delivered promptly to the women and children residing in the rural areas due to lack of capacity of Afghanistan’s government.
According to Singh et al., (2012) the services provided through the CHWs are usually compromised during the delivery. The local volunteers at Afghanistan are helping the local community by counselling, supervising and supporting the children and women in need. The healthcare organization in the Afghanistan is currently providing the community with health facilities, hand soaps, toothbrush and towels. The CHW are working throughout the country working for improving the developing communities. Edward et al., (2015) showed that almost 50% of the total CHWs working for enhancing the healthcare situation at Afghanistan are women. Furthermore, strong and reliable financial source ae required for committing the training and medical support to the rural communities. In spite of the different pr0cess and initiative of the government of Afghanistan, the health condition is still compared with the devastating countries throughout the globe. Haver et al., (2015) compared the result of the country prior to the training and healthcare initiatives and concluded that concurrent factors have resulted in the improvement of the fragile processes for healthcare improvement. In addition to that, the acceptable services to the rural community has stabilized the healthcare and social environment during the post-conflict situation.
This project has been estimated to take up to 164 days that is beginning from 01 March 2016 to 14 October 2016. The initial phase was to determine the key stakeholders and participants required for the successful accomplishment of the project. The design of the study involved various key areas such as Philosophy, Data collection and analysis methods.
Research Philosophy: This study is conducted with the help of Post-Positivism philosophical approach. This approach is considered appropriate for this study as it involves both application of philosophy and scientific approach (Colvin, 2014). This approach assists the researcher to determine the scientific methodology to be used in the study along with determination of impact upon the wellbeing of the society.
Analysis methods: There are two types of analysis method for a particular research study. The lack of knowledge to identify the proper analysis method may result into collection of inaccurate data thus resulting into inappropriate results (Rahimzai et al., 2014). The two analysis methods are Qualitative and Quantitative. This study follows the Qualitative method as it involves gathering of data form secondary sources means study of various available case studies and results of various other studies related to the particular topic.
Data Collection Methods: For a particular research study, there are two types of method for data collection. In this study, the data is collected form secondary sources to identify the present and past status of the health systems in the rural areas of Afghanistan (Mohammad et al., 2014). The data is being collected in context to every BPHS (Basic Package of Health Services) facility for determining the Active health facilities and health posts along with rural and total population.
The aggregate number of dynamic BPHS offices expanded from 1200 in 2007 to 1829 in 2011 – a 66% expansion. The BPHS offices frequently reporting expanded more than fourfold, from 1079 to 1689. The normal number of provincial populace per dynamic BPHS office diminished from 14,789 to 10,849. The quantity of reported dynamic wellbeing presents expanded from 9,702 on 12,213 in the same period; some portion of which is because of the expansion in number of reporting offices; however, after redress this would in any case demonstrate a more than fourfold increment in wellbeing posts. The entire above chart demonstrates the patterns by year. All numbers recommend expanded access of the populace to the administrations gave by BPHS offices and wellbeing posts. The Survey Details are given below:
Figure 2: Active BPHS Health facility register data per year
Active BPHS Health facility register data per year chart shows that the detail value of the register process. All the data was given as per year wise. In the year of 2007, the total value of Active BPHS health facility register is 1200. In the year of 2008, the total value of Active BPHS health facility register is 1493. In the year of 2009, the total value of Active BPHS health facility register is 1687 (Mohmand, 2013). In the year of 2010, the total value of Active BPHS health facility register is 1837. In the year of 2011, the total value of Active BPHS health facility register is 1829. Moreover, the change factor is 1.7.
Figure 2: Active health facilities reporting data per year
Second chart is shows that the detail value of Active BPHS health facility reporting data. All the values are shown by year wise. In the year of 2007, the total value of Active BPHS health facility report is 1079. In the year of 2008, the total value of Active BPHS health facility report is 1326. In the year of 2009, the total value of Active BPHS health facility report is 1511. In the year of 2010, the total value of Active BPHS health facility report is 1671. In the year of 2011, the total value of Active BPHS health facility report is 1689. Moreover, the change factor is 4.31.
Figure 3: Active health posts reporting per year
Third chart is shows that the detail value of Active health posts reporting data. All the values are shown by year wise. In the year of 2007, the total value of Active health posts reporting is 9702. In the year of 2008, the total value of Active health posts reporting is 10922. In the year of 2009, the total value of Active health posts reporting is 11147 (Edward et al., 2015). In the year of 2010, the total value of Active health posts reporting is 11426. In the year of 2011, the total value of Active health posts reporting is 12213. Moreover, the change factor is 18.35.
Figure 4: Rural population per BPHS facility year wise
Fourth chart is shows that the detail value of rural population per BPHS facility data. All the values are shown by year wise. In the year of 2007, the total value of rural population per BPHS facility is 14789. In the year of 2008, the total value of rural population per BPHS facility is 12223. In the year of 2009, the total value of rural population per BPHS facility is 11124. In the year of 2010, the total value of rural population per BPHS facility is 10505 . In the year of 2011, the total value of rural population per BPHS facility is 10849. Moreover, the change factor is 0.71.
Figure 5: Total population per BPHS facility year wise
According to the fifth chart, the detail value of total population per BPHS facility data. All the values are shown by year wise. In the year of 2007, the total value of total population per BPHS facility is 18677. In the year of 2008, the total value of total population per BPHS facility is 15437. In the year of 2009, the total value of total population per BPHS facility is 14049. In the year of 2010, the total value of total population per BPHS facility is 13267. In the year of 2011, the total value of total population per BPHS facility is 13702. Moreover, the change factor is 0.72.
Figure 6: Total population chart year wise
According to the sixth chart, the detail value of total population data. All the values are shown by year wise. In the year of 2007, the total value of total population is 22,412,820. In the year of 2008, the total value of total population is 23047394 (Cheng et al., 2015). In the year of 2009, the total value of total population is 23699935. In the year of 2010, the total value of total population is 24370952. In the year of 2011 the total value of total population per is 25060917. Moreover, the change factor is 1.22.
In this section, the discussions are carried out to determine the present status and achievement of the various deliverables for the project. According to the timeline developed for the project it has advanced towards completion however, there are certain activities left such as preparing the lesson plans and development of a plan to implement the training package for rural health workers in Afghanistan. The activities up to the conduction of literature review and collection of data has been achieved until now for advancement of the project. From the above achievement of the project deliverables, it can be ensured that the project will be successful with the proper implementation of the training package among the rural health workers in Afghanistan.
Conclusion and Recommendations
The training of the rural health workers is an important aspect for success of the project. The rural health workers are to be trained by the Government organization that has been contracted for implementation of the training package. The focus should be given to attract the community leaders as they can assist in both conveying the importance of health and implementation of the training package. The training will comprise of three round for 18 days involving 2 months of fieldwork in between each training. The rural health workers are to be provided with easy to understand picturesque manual that will consist of wide range awareness on public health as well as educational tasks. It will also comprise of various direct services like planning of family, nutrition along with upliftment of maternal and child health. The rural health workers that will successfully identified as capable after the 18 days training will start to serve the population.
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