Expanding Access to Integrated Health Services
MSH acknowledges the range of barriers that women and girls face in accessing health services and designs contextually appropriate solutions to expand access and availability. In addition to improving the quality of services to eliminate discriminatory practices, we have worked to ensure that services are available at locations and times that enable women and girls are able to safely access them. Examples of challenges we have worked to solve include: constraints around travelling long distances to facilities, requirements for women and girls to see female health workers, and constraints related to women’s time. Responsive strategies that we have employed to address these challenges include: expanding community health worker initiatives and supporting mobile clinics, introducing incentive programs to increase the number of women health providers available, and building capacity for integrated services enabling patients to address multiple needs with a single visit.
In Afghanistan, MSH has worked with the Ministry of Public Health to strengthen health services in a gender-equitable manner. Over the past 10 years, MSH has supported and trained over 23,000 community health workers to provide reproductive, maternal, and neonatal health services for women and youth at the village level, where facility access is limited. Half of these community health workers are women, responding to cultural norms that dictate that women seek services from female healthcare providers. Furthermore, MSH garnered support from local governments and communities to provide contributions to enable women health workers to provide services. For example, in villages without a local female health worker, resources supported construction of housing near facilities to attract a female health worker from an adjacent village who could work in the community without leaving her family or traveling long distances (with associated security and cultural concerns). Through this work, MSH contributed to:
- an increase in access to basic health services for over two-thirds of the population;
- an increase in use of modern contraception from 5% to over 40%;
- the provision of antenatal care to 60% of pregnant women;
- a reduction in maternal mortality from 1,600/100,000 to 500/100,000; and
- a reduction in under-5 mortality of nearly two-thirds.