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Community health worker service delivery for maternal and child health: an observational study from Afghanistan
  1. Clare B Kelly1,
  2. Shafiqullah Hemat2,
  3. Malalai Naziri3,
  4. Khaksar Yousufi3,
  5. Karen M Edmond1
  1. 1Department of Women's and Children’s Health, Faculty of Life Sciences & Medicine, King's College London, London, UK
  2. 2Ministry of Public Health, Kabul, Afghanistan
  3. 3UNICEF, Afghanistan, Kabul, Afghanistan
  1. Correspondence to Professor Karen M Edmond; karen.edmond{at}kcl.ac.uk

Abstract

Objective To understand the reach of the community health worker (CHW) programme in remote and non-remote districts of Afghanistan.

Methods Using data collected from the Ministry of Public Health’s National Health Management Information System, we conducted a population-based study from 2018 to 2019 in 401 districts across 34 provinces of Afghanistan. We assessed the availability of CHWs, antenatal visits (ANV) and postnatal visits (PNV) conducted by the CHWs, and the availability of CHW supplies. Districts were classified as remote if the district centre was >2 hours by any form of transport from provincial capital, and non-remote if <2 hours. Data were analysed using multivariable regression models.

Results 15 562 CHWs were working in the districts of Afghanistan, 13 482 (87%) in remote and 2080 (13%) in non-remote districts. The mean of the proportion of CHWs per pregnant woman was higher in remote (0.019 (SD 0.011)) compared with non-remote (0.012 (SD 0.006)) districts (adjusted mean difference (AMD) 0.008, 95% CI 0.004 to 0.01). The mean of the proportion of ANVs received from a CHW per pregnant women was higher in remote (0.88 (SD 0.82)) compared with non-remote (0.62 (SD 0.50)) districts (AMD 0.28, 95% CI 0.02 to 0.54). The mean of the proportion of PNVs received from a CHW per pregnant women was higher in remote (0.54 (SD 0.53)) compared with non-remote (0.36 (SD 0.25)) districts (AMD 0.19, 95% CI 0.02 to 0.36). The mean of the proportion of CHWs who reported that they had stocks of cotrimoxazole and oral contraceptives in the previous month per district was higher in remote compared with non-remote districts.

Conclusions In Afghanistan, the CHW programme appears to be effective and proportionate to need in remote regions.

  • child health services
  • global health
  • health services research
  • healthcare disparities

Data availability statement

Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Data availability statement

Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Footnotes

  • Contributors CBK and KME conceptualised and wrote the first draft of the paper and analyses. All the other authors wrote and commented on the manuscript. All authors reviewed and approved the final manuscript. KME is the guarantor of this study

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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