Health and Health Promotion in Developing Countries: A Case study of Community-Based Health Promotion Approaches in Afghanistan
Creators: name: Harsch, Stefanie
Publisher: name: Zenodo
Year: 2017
Subjects: Afghanistan
Health literacy
community-based health promotion

description: Community-based health promotion approaches have proven to be very appealing and effective in rural and under-resourced countries such as Afghanistan. Surprisingly, however, empirical evidence and practical recommendations are lacking for Afghanistan, a country with some of the worst health indicators worldwide (e.g., maternal mortality rate). The purpose of this mixed-method exploratory case study was to identify community-based approaches to health promotion in Afghanistan and the factors that lead organizations and activities to succeed and sustain despite challenging circumstances. The author conducted extensive secondary research, a scoping review, 28 semi-structured oral qualitative interviews with people working in health projects in Afghanistan, and obtained 22 written responses to a qualitative questionnaire sent to NGOs working in the health sector in Afghanistan as well. After transcribing and analyzing the content, she was able to exhaustively explore the topic by integrating and triangulating multiple perspectives. First, she presented the findings regarding the prerequisites for and determinants of health in Afghanistan by contrasting qualitative and quantitative data. This comprehensive overview illustrated not only the poor conditions and numerous challenges but also the diversity within the country. Second, she described the findings on the Afghan health system, structured along the components of the WHO Health System Framework. This allows for comprehending the well-planned strategies and comparing them to the actual situation. Third, she identified most (NGO-supported) healthcare providers and conducted a gap analysis of existing activities in 13 areas of health. Fourth, the qualitative findings provided insights into the concept of health, common health practices, community-based healthcare approaches, and success factors for working in Afghanistan. Overall, there are various health activities and approaches to health promotion in Afghanistan. The most successful approaches were those that work in the community, with trained female health workers who are trustworthy, committed, and paid, and who provide curative as well as preventive and promotive services. For working successfully in the Afghan setting, trust, collaboration with leaders, community participation, and training are highly recommended. Nonetheless, all activities took place in a context characterized by insecurity, corruption, poverty, low level of education, and cultural constraints. The author proposed the concept of “health care plus and beyond” as an approach applicable to all providers. This concept includes taking care of the immediate health need of the person and, at the same time, empowering them to improve their health. In conclusion, there is a great need for health promotion and health education in Afghanistan, which is worth exploring further. This study could not provide a complete picture, but it does provide a very good first-hand understanding of the numerous influencing factors and facets of community-based health promotion, thus providing numerous starting points for further research and practice.