Guljan lives in a modest mud-brick house in Bibimehro, on the outskirts of Kabul city. Jobless and a widow, she is raising four young children.

Karima, also a widow, lives in Kabul in a one-room, cellar-level apartment in a Soviet-built, multifamily apartment complex called Qasaba. Nearly 15,000 people are crowded into the 12 apartment buildings, and sanitation is poor. Karima and her seven children share a single toilet, shower, and kitchen with 20 other families.

Parwin, an illiterate mother of three, also lives in Qasaba; more fortunate than Karima, her family has a three-room apartment.

Guljan, Karima, and Parwin are Kabul residents who have recently begun the second phase of a three-phase Afghan Community Health Worker (CHW) training program. Though only three of the 4,414 CHWs being trained and supported by USAID through REACH NGO grantees, they are prime examples of the dedication Afghan women display toward the community health worker model of health service delivery.

Not only do CHWs participate in the program on a volunteer basis, receiving no remuneration, they must also designate a room in their homes to serve as a health post, where they can provide basic health education to community members and receive ill women and children. Meeting this requirement isn't always easy.

Knowing that Guljan had no room to use as a health post and no money to add the space needed, the elders in Bibimehro gathered community funds to build an extra room onto her small home. At the Qasaba apartment complex, Karima uses her single room as both her living quarters and health post, while Parwin uses one room as living room and health post combined.

The health post is a focal point for women in Guljan, Karima, and Parwin's communities, as it is in others. Women congregate at the health post to learn from the CHW how to prevent diarrheal diseases and how to make and administer oral rehydration salts (ORS), important skills in a country where only 13% of the population has access to improved drinking water sources and diarrheal disease takes thousands of lives each year. Women rely on CHWs to learn about good hygiene practices; the symptoms of malaria; and, most importantly, the measures they can take to ensure a healthy pregnancy and a safe delivery—invaluable information in Afghanistan, whose 1,600 maternal deaths for every 100,000 live births is one of the highest maternal mortality ratios in the world.

Because only 21% of Afghan women are literate, the REACH program provides CHWs with brightly colored pictorial materials, including flipcharts and posters, to use in educating women on good health practices. CHW trainers also use pictures and visual examples as primary educational tools for teaching non- or semiliterate CHW trainees, such as Parwin. In addition, literate women in the CHW program may assist their classmates with written materials.

CHWs are on the front lines of Afghan health service delivery. Each day, Guljan sees three to four sick women in her newly constructed health post. Guljan, Karima, and Parwin refer those who are ill to the nearest Basic Health Center, where they can see a doctor, receive medication or, if necessary, be admitted for the night. Women referred to a Basic Health Center by a CHW receive priority care, a strategy that boosts the CHW's status within her community and promotes her sense of ownership of her work—positives sorely needed after years of female oppression.

Through REACH, USAID has granted more than $58 million to Afghan and international NGOs to support community-based health care throughout the 14 USAID priority provinces including the training of CHWs. Guljan, Karima, and Parwin are being trained by Care of Afghan Families (CAF), an Afghan NGO recipient of a 3.5 million USAID-funded grant to increase access to quality health services through implementation of community-based health care, and to train, support, supervise, and supply CHWs.

CAF's vision is to help create a healthy environment in which Afghan families can rebuild their lives and their country. Empowered by their newly acquired knowledge, Guljan, Karima, and Parwin are dedicated to bringing quality health care and health education to their communities. They are very glad for the REACH program and CAF support for the CHW initiative, and the three womens' families and communities have embraced their participation in it. Says Parwin's oldest son: "My mother is strong and cares about what happens to people; she is perfect to help others with their health problems. I am very happy she is in this program."

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