CHWs: Adapting a health video library for use in Afghanistan

20 May, 2020

Dear HIFA colleagues,

Here's a new paper in Human Resources for Health. Citation, abstract and comment from me below.

CITATION: Adapting a health video library for use in Afghanistan: provider-level acceptability and lessons for strengthening operational feasibility.

Lara Lorenzetti, Jenae Tharaldson, Subarna Pradhan, Sayed Haroon Rastagar, Shafiqullah Hemat, Sharif A. H. Ahmadzai, Lisa S. Dulli, Amy Weissman & Catherine S. Todd

Human Resources for Health, volume 18, Article number: 35 (2020) Cite this article


Background: Community health workers (CHWs) in Afghanistan are a critical care extender for primary health services, including reproductive, maternal, neonatal, and child health (RMNCH) care. However, volunteer CHWs face challenges including an ever-expanding number of tasks and insufficient time to conduct them. We piloted a health video library (HVL) intervention, a tablet-based tool to improve health promotion and counseling by CHWs. We qualitatively assessed provider-level acceptability and operational feasibility.

Methods: CHWs implemented the HVL pilot in three rural districts of Balkh, Herat, and Kandahar provinces. We employed qualitative methods, conducting 47 in-depth interviews (IDIs) with male and female CHWs and six IDIs with community health supervisors. We used semi-structured interview guides to explore provider perceptions of program implementation processes and solicit feedback on how to improve the HVL intervention to inform scale-up. We conducted a thematic analysis.

Results: CHWs reported that the HVL increased time efficiencies, reduced work burden, and enhanced professional credibility within their communities. CHWs felt video content and format were accessible for low literacy clients, but also identified challenges to operational feasibility. Although tablets were considered easy-to-use, certain technical issues required continued support from supervisors and family. Charging tablets was difficult due to inconsistent electricity access. Although some CHWs reported reaching most households in their catchment area for visits with the HVL, others were unable to visit all households due to sizeable populations and gender-related barriers, including women’s limited mobility.

Conclusions: The HVL was acceptable and feasible for integration into existing CHW duties, indicating it may improve RMNCH counseling, contributing to increased care-seeking behaviors in Afghanistan. Short-term challenges with technology and hardware can be addressed through continued training and provision of solar chargers. Longer-term challenges, including tablet costs, community coverage, and gender issues, require further consideration with an emphasis on equitable distribution.

COMMENT: As we continue to work with WHO to support the uptake of the CHW Guideline (October 2018), we would be very interested to learn about different training tools for CHWs. Are you aware, for example, of the use of video for training CHWs in RMNCH in other countries? We heard just today on HIFA from Deborah van Dyke of Global Health Media Project. Medical Aid Films may like to comment also?

Best wishes, Neil

Coordinator, WHO-HIFA Collaboration: Empowering Community Health Workers (CHWs) to accelerate progress towards Universal Health Coverage

HIFA Project on Community Health Workers

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with 20,000 members in 180 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: