I visited Afghanistan at the end of February, to see the work CARE is doing there on increasing household incomes, health, education, and emergency response, all with a focus on women and girls. My arrival was delayed by heavy snow. The effect of this weather on people in other parts of Afghanistan was infinitely worse.
At least 30,000 people are currently affected by heavy snow and rain. CARE is leading the response in Parwan province and supporting efforts in other provinces. Our staff have conducted needs assessments. In the areas they have visited most of the houses they have seen were partly or completely destroyed by avalanches and floods. People are in urgent need of shelter and food, heating and warm clothing. Other agencies are supplying food and blankets, so CARE is starting by distributing tarpaulins and materials so people can fix their houses. CARE is also planning to distribute hygiene items.
Working with communities to improve health
This week the world has celebrated International Women’s Day, and CARE marked the day with our Walk In Her Shoes Walk for Women in London. The messages there have a big resonance for our work in Afghanistan. We have supported healthcare in Afghanistan since the 1960s. We have had a focus on supporting widows from the civil wars since 1991. CARE has supported girls’ education since 1994. In all of these efforts, we have learned that engaging men and boys is both necessary and eminently possible.
While I was in Kabul, I visited one of our community health outreach programmes. This is funded by 20% of GSK’s profits in Afghanistan. Community health outreach is an approach I am very familiar with. It’s very effective. CARE does this in many countries and I saw some excellent examples in Bihar, India, funded by my two former employers, the Gates Foundation and DFID, who also fund this approach in many countries. But there were two interesting innovations in Kabul.
How to improve the health of the urban poor
Firstly, this programme is focused on the urban poor. The Afghan government and donors are funding a rural community health programme to provide basic health services. But the urban poor in Afghanistan were being left out. And we know that more and more people are moving to urban areas, all over the world, including in Afghanistan.
One of the advantages of working in an urban setting is efficiency. In the last three years the project has trained 12 volunteer community-based educators and four community midwives to deliver community-based maternal and child health services in an area with a population of 60,000. And they are making a big difference…
Country-wide, Afghanistan has some of the worst maternal, neonatal and under-5 mortality rates in the world. The rates in Kabul were better than in the country as a whole, but the rates in Kabul have been reduced even further – by a third – during the three-year project. Deaths of babies within 28 days of birth is now down to the same rate (4 per 1,000) as the USA! And child vaccination rates are up from 72% to 93%.
I met many of the volunteers (see photo) and midwives. One volunteer said that the big difference came because the volunteers kept asking about the health of women in their communities, so both the women and the men realised that a woman’s health must be more valuable than they had ever thought before. One of the midwives was keen to use mobiles more and I told them about work CARE is doing in Bihar with mobile phone voicemail advice and said we would try to copy that here. It was a good example of the value of CARE being an international NGO.
Involving men has benefits for everyone
The other innovation is one of the reasons why this programme has been so efficient. In addition to training the community-based educators, CARE has trained 291 Family Health Action Group members and 100 male health committee members on the danger signs of birth complications and how to address the underlying barriers preventing women and their families from accessing quality healthcare. These committee members encourage people in their communities to seek health services – and where culture is a major barrier to women accessing health care, engaging men in this way is an effective way to increase women’s access to health.
The male health shura committee leaders that I met (see photo) were primarily interested in supporting the welfare of their whole communities, not only men. One of them noted that in addition to the health, hygiene and nutrition improvements, one of the main benefits is that they were also seeing less domestic violence and conflict. And they told me that without me asking a question about it first.
The lessons of this programme are that a community-based approach and engagement of women and men to define priorities and work through differences should be at the heart of both development efforts, and wider efforts to bring peace to Afghanistan.
As CARE and other agencies look towards the World Humanitarian Summit in 2016, we need to bring the learning from programmes like this one in Afghanistan into discussions on how to empower local communities – and the affected men and women themselves – in contexts affected by conflict and natural disasters. A big debate is how can the humanitarian aid system be made more local? How can it involve local authorities, civil society structures and affected communities themselves? We are learning lots about this in Afghanistan and that needs to be brought into and inform the outcomes of the summit in 2016.