Amiry Freshta, Neyazi Narges, Mirzazadeh Ali, Ibrahimi Abdul Ghani, AlAsfoor Deena, Tanoli Jamshed Ali
MPH International, Nuffield Centre for International Health and Development, School of Medicine, University of Leeds, Leeds, UK.
Health System Development Department, World Health Organization, Kabul, Afghanistan.
BMC Health Serv Res. 2025 May 7;25(1):653. doi: 10.1186/s12913-025-12841-3.
Community health workers (CHWs) played a vital role in providing diverse essential health services to their communities during the pandemic. Using CHWs perspective, this study investigates barriers to seeking and delivery of essential health services in the nine Afghan communities during the COVID-19 pandemic.
In this cross-sectional study, 107 primary health care clinics from 9 provinces were selected, in which around 45% of the total country population reside. We used the validated questionnaire "Community Needs, Perceptions and Demand, Community Assessment Tool" which was contextualized by WHO headquarters and the WHO Afghanistan office. Data was exported into Excel, cleaned, and then exported into and analyzed using STATA version 17.
Most CHWs were men (80.9%), from rural areas (87.2%), and volunteers (58.1%). About 66.3% reported that lack of information about available services was a main barrier. Other reported barriers were a lack of transportation to health facilities (47.2%), their home were too far from health facilities (40.9%), and a perceived lack of medicines at facilities (23.6%). More than half of CHWs reported that they received some training on how COVID-19 spreads (67.2%), COVID-19 vaccine (65.4%), and how to use a mask properly while working (56.3%), while 27.2% said that they had not enough mask available to use.
Our research demonstrated that most barriers and concerns related to using critical services during a pandemic may be addressed by providing information about available services, providing transportation to facilities, and providing masks to personnel and individuals. CHWs could play critical role in managing and responding to emergencies and pandemics if the government invest on their capacity and motivation. Revision of training curriculum for CHWs and their job description to include the emergency and pandemic management at community level, and providing them monetary incentives are highly recommended.
在疫情期间，社区卫生工作者（CHW）在为其社区提供各种基本卫生服务方面发挥了至关重要的作用。本研究从社区卫生工作者的角度调查了在新冠疫情期间阿富汗九个社区寻求和提供基本卫生服务的障碍。
在这项横断面研究中，从9个省份选取了107家初级卫生保健诊所，这些省份居住着该国约45%的总人口。我们使用了经过验证的问卷“社区需求、认知与需求、社区评估工具”，该问卷由世界卫生组织总部和世卫组织阿富汗办事处根据具体情况进行了调整。数据被导出到Excel中进行清理，然后导出到STATA 17版本中进行分析。
大多数社区卫生工作者为男性（80.9%），来自农村地区（87.2%），且为志愿者（58.1%）。约66.3%的人报告称，缺乏关于可用服务的信息是主要障碍。其他报告的障碍包括缺乏前往卫生设施的交通工具（47.2%）、他们的家离卫生设施太远（40.9%）以及认为卫生设施缺乏药品（23.6%）。超过一半的社区卫生工作者报告称，他们接受了一些关于新冠病毒传播方式（67.2%）、新冠疫苗（65.4%）以及如何在工作时正确佩戴口罩（56.3%）的培训，而27.2%的人表示他们没有足够的口罩可供使用。
我们的研究表明，通过提供关于可用服务的信息、提供前往卫生设施的交通工具以及为工作人员和个人提供口罩，可以解决与疫情期间使用关键服务相关的大多数障碍和问题。如果政府对社区卫生工作者的能力和积极性进行投资，他们在管理和应对紧急情况及疫情方面可以发挥关键作用。强烈建议修订社区卫生工作者的培训课程及其工作职责描述，以纳入社区层面的应急和疫情管理，并为他们提供金钱激励。
