Tribal or village councils, known as shuras, have long played an important role in Afghan society. Traditionally comprised of respected male elders, shuras are responsible for resolving conflicts, deciding community issues, and taking action to meet community needs. Today, the shura tradition has become a vehicle through which Afghan women are assuming leadership roles to improve the health of their communities.

To forge strong relationships between local health facilities and the communities they serve, REACH has established both men's and women's shura-e-sehi, or community health committees, at both the health facility and health post levels. Their members mobilize support for local health facilities, promote the use of the Basic Package of Health Services (BPHS), and at the health post level, personally reinforce the health messages delivered by Community Health Workers (CHW).

Members of women's health shuras are selected by their own community on the basis of their knowledge, acceptance by their neighbours and ability to cooperate with others. REACH NGO grantees operating Basic Health Centers, Comprehensive Health Centers, or District Hospitals provide male and female shura members with leadership training and verse them in the health messages they'll share with the people in their communities.

Both men's and women's health shuras convene regularly, often CHWs in attendance, and meet monthly with NGO and health facility staff to report their activities and design action plans focused on identified needs. By sharing data on local use of BPHS services, NGO and health facility staff help the shura set goals and plan strategic activities, such as promoting child immunizations, reinforcing CHW messages on birth spacing or increasing the number of women receiving antenatal care. Using simple charts and graphs that illustrate changes in the use of health facility services, staff motivate shura members, apprising them of the positive difference they're making or alerting them to the need for greater effort.

In some communities, men and women serve on a shura-e-sehi together. In communities which observe purdah—the seclusion of women—male and female shuras meet separately. In either cases, men and women coordinate their activities and work together to achieve action plan goals. For example, men's and women's health shuras may meet in the same room separated only by a curtain, allowing mutual consultation; meet in adjacent rooms, with a respected older woman acting as a go-between to keep each group informed on ideas being discussed and decisions being made; or share meeting minutes. Often, members of a women's shura are married or related to members of the men's shura, allowing a free and steady exchange of information.

Women's shuras improve the use of health services by raising awareness about health issues, sharing what they've learned with other women in the community and supporting the advice of CHWs on maternal and newborn health, birth spacing, vaccination of children, home hygiene, and care of pregnant women. They work closely with female CHWs and the CHW supervisor to identify, address and solve problems. For example, when CHWs have patients reluctant to seek needed help at the clinic, a shura member visits to reinforce the referral.

Armed with correct information on family planning methods, members of the women's shura are able to counter misconceptions with facts, visiting households to talk to other women personally and taking advantage of opportunities such as weddings and funerals to convey health messages. In some communities, a shura member and a CHW pair as a team to target 10 to 15 people for specific health messages.

CHWs greatly value the help of the shuras. As one CHW put it, "Without the shura, our work does not go forward." In discussions with female shura members, CHWs and CHW supervisors in a number of REACH provinces, Mihi Sato, head of the REACH gender unit, has gathered plentiful testimony on the contribution women's shuras are making to forward progress in health education and the use of health services by Afghan women and their children:

• "People have become more knowledgeable. Previously, people did not breastfeed newborn babies for three days. Now CHWs and the female shura encourage mothers to nurse their babies right away because the first milk provides protection from disease."
• "Shura members support the CHWs when they have difficulties. If mothers-in-law won't accept their sons' and daughters-in law's use of family planning methods, shura members go to talk to them."
• "A pregnant woman in our village would not take a CHW's advice that she should have a Tetanus Toxoid (TT) vaccination. She was afraid. A shura member went to the woman to explain the benefits of TT vaccine and successfully convinced her to be vaccinated."
• "Changes have occurred since the female shura was organized. There is better hygiene in the community, more use of family planning, increased vaccination, and acceptance of CHWs and antenatal care. And people are now visiting the clinic instead of using 'homemade medicine.' "

Since the establishment of a women's shura-e-sehi attached to the Guzar Basic Health Center in Kabul province, the number of families practicing family planning/birth spacing has risen from 20 to 80, and the number of women choosing to deliver at the clinic has grown from five in five months to five every month.

Women's shuras are not only strengthening the vital link between communities and their local health facilities and health providers but also empowering Afghan women, developing their leadership abilities and positioning them to take a proactive role in improving the health and well-being of the people with whom they live.

In the words of one female shura member, "Women's rights have come alive. In our villages, women have more [health] problems than men. Men do not know them. Where there are more problems for women, women's voices should be the loudest." Added another, "Without women's participation, community discussion does not take place."

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