Afghanistan: Close Ties between Health Centers and Community Promote Health in Panjshir Province


  • "We come here any time there is an illness or an emergency." Public awareness health campaigns are proving effective in Panjshir Province as villagers are seeking treatment in health centers.

  • This is the result of the close collaboration between health centers, community health workers and councils fostered by the System Enhancement for Health Action in Transition (SEHAT) program.

  • The program aims to expand the scope, quality, and coverage of health services provided to the population, particularly for the poor.

ROKHA DISTRICT, Panjshir Province – The boiling water, spilled while making the morning tea, burnt Homira’s foot so badly that her husband had to rush her to the hospital. Two female nurses are busy treating her in the emergency section of Rokha District Hospital (DH). She lies on the bed, her face in pain, groaning softly. A doctor gives her an injection to reduce her pain.

“We come here any time there is an illness or an emergency,” says Homira, 42, as she leaves the Intensive Care Unit (ICU) after receiving treatment. She seems happy as she limps down the hall. “When we come to the hospital the doctors and nurses treat us very well and the services are good,” adds Homira, a mother of four.

Inside the hall there are many men and women waiting their turn to be examined by the doctor. Abdul Saeed, 35, is with his wife, who has come for an antenatal examination. He talks about the quality of medicine they have received from the hospital and how it has helped them to get well quickly. “The doctors and the hospital are meeting most of our needs,” he says. “We are thankful for the free, high quality medicine, since the price is too high in the market and we cannot afford it.”

Saeed, who is from Dara Abshar district, is at the Rokha DH because of the public awareness campaigns conducted by voluntary Community Health Workers (CHWs). “I found out about the benefits of coming to the healthcare center six years ago, and now I bring my wife to Rokha DH to the midwifery section,” he says.

Rokha DH is a 40-bed hospital in the Rokha district of Panjshir Province. It is one of the 20 health centers across the province covered by the System Enhancement for Health Action in Transition (SEHAT) Program. Under SEHAT, health centers work closely with CHWs and Health Community Councils (HCCs).

In Panjshir Province, there are 140 health posts, each of which teams up with two CHWs, a woman and a man. The CHWs conduct public awareness campaigns in the villages and occasionally provide medicine to locals, though their main purpose is to refer villagers to the health centers.

“The CHWs are playing a great role in the villages,” says Dr. Abdul Samad, 58, head of Rokha DH. “They go to people’s houses, especially those who are poor and don’t know much about healthcare, and provide them information. This is vital work that cannot be done in the health centers.”

SEHAT aims to expand the scope, quality, and coverage of health services provided to the population, particularly for the poor. It supports the provision of a Basic Package of Health Service and Essential Package of Hospital Services to the entire country.

Unlike many other provinces where the Ministry of Public Health has contracted nongovernmental organizations to implement the program, SEHAT is being implemented in Panjshir Province by the provincial directorate of public health.

SEHAT is supported by the International Development Association (IDA), the World Bank Group’s fund for the poorest countries, and the Afghanistan Reconstruction Trust Fund (ARTF), in partnership with multiple donors.

Spreading Health Care Knowledge

Rokha hospital was established more than 30 years ago, but only became a district hospital in 2011. The hospital covers a local population of 30,000, as well as those who come from the rest of the province, receiving an average of 120 patients a day. They are served by 48 employees, including doctors, nurses, midwives, laboratory staff, a dentist, and a pharmacist.

Every month, health center staff hold meetings with HCCs to ensure good collaboration between locals and the health centers, and to get community feedback. Through these meetings, people share their challenges and take responsibility for spreading health care knowledge among villagers through every possible channel. “Luckily, people are cooperative,” says Dr. Shirdel Danish, director of the Directorate of Public Health in Panjshir Province. “If there are any problems with a health center, they share it with our staff so that we can solve it and the health center can perform their role effectively.”

Although there is close collaboration between the communities and health centers and better quality services, awareness of health care in the area still needs improvement. There are some families in isolated villages, for example, who do not know much about healthcare and the services provided by health centers.

“Sometimes when people come to the health center because of their health, especially those from isolated villages, we find other health problems that they think are normal,” says Dr. Mahmood, 38, a pediatrician in Rokha DH. For example, he says, “I have seen many children whose mothers come to the health center for their own health problems but had not realized that the children are suffering from malnutrition as well.”