After more than two decades of war, life is not easy in any part of Afghanistan. For the 80% of the population living in rural areas, many in remote villages reached through rugged, mountainous terrain, it is particularly hard. A USAID/REACH grant of over $2 million is helping Care of Afghan Families (CAF), an Afghan non-governmental organization (NGO), to improve the quality of life and health of Afghan families in such regions.

When CAF received the REACH grant in October 2003, it had two main objectives for its work in three districts of Takhar province, located in northern Afghanistan: To increase access to quality Afghan health services through implementation of community based health care and (2) to train, support, supervise, and supply 120 Community Health Workers (CHWs).

A little less than one year later, CAF has gone a long way toward achieving these goals, REACH is proud of the role it has played in helping realize its vision of Afghan families living in a healthy environment, rebuilding their own lives and that of their country.

Creating a healthy environment means fighting disease and its causes, such as poverty, hunger, unawareness, and injustice. Using REACH funds, CAF is now providing Primary Care Health Services in Afghanistan to the most vulnerable members of the family—women and children.

CAF has established, staffed and equipped six new Basic Health Centers and five Comprehensive Health Centers in three districts of Takhar province: Ghoza Ghor, Yangiqalah, and Darqad. Altogether, these facilities can provide the Basic Package of Health Services to a population of 284,760 people.

So that families can be self reliant, CAF is educating them and providing programs that will increase their abilities to take care of themselves. In the past year, to promote ownership of the programs, five district health committees and 66 village councils have been established.

Since July 2004, CAF has also been partnering with Merlin, another USAID/REACH grant recipient, to build community support for educating community midwives and to link the Afghan community midwife education system to similar initiatives by others in the health sector in the province. Some 890,000 people live in the area that stands to benefit from this program, and it is greatly needed. A 2003 survey in Takhar province found that in 99% of cases, an unskilled, untrained friend or family member had attended the birth of a woman's most recent child.

Orientation sessions have been held to heighten community awareness of the midwifery education program and to introduce the candidates from that location. Says REACH Grant Officer Nigor Mouzafarova, "Reception has been remarkable! Village elders, mullahs, and other leaders in the area, not all of whom CAF might have expected to come forward, have voiced strong support. They know that trained midwives can save the lives of their own and others' wives, sisters, and daughters."

CAF faces several challenges that come along with being a new NGO with limited activities and experience. As do many NGOs in rural Afghanistan, CAF suffers from a lack of female staff (especially health workers), and those women who are working in the clinics must deal with rural living conditions and the socio-cultural issues that go with the territory, including security.

And though it's gratifying when communities embrace Community Health Worker and midwifery training programs, people may also have high expectations that cannot all be met, at least initially. CHWs are critical to delivering health care services to areas which have long been without them—but CHWs are volunteers tasked with educating communities in ways to maintain and improve their health where few are literate and most are poor. REACH is providing technical assistance for CHW training programs so that CAF and the CHWs it prepares can meet this challenge. The NGO has trained 59 Community Health Workers so far.

CAF is making a difference in Takhar province. Its strengths include the good coordination it has with provincial authorities and stakeholders; the remarkable involvement of the community in improving the quality of the programs; and, not least, the steadfast support given it by USAID/REACH.

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