A gender analysis of a national community health workers program: A case study of Afghanistan

ABSTRACT

Gender equity can be a neglected issue in health system reforms. This paper explores the multiple layered gender dynamics of the Afghan Community Health Worker (CHW) Program within broader health system reforms in Afghanistan using a qualitative research design. We interviewed policy makers, health managers, CHWs and community members in 16 sites in 2013 and 2014. We found that gendered societal norms interact and influence the Afghan CHW program in a dynamic way. Gendered social norms around the division of labour tend to privilege women in terms of access to resources at the community level, but it is men who hold leadership positions that ultimately decide how the resources are to be distributed. The Afghan Ministry of Public Health expresses a commitment to gender equity, but policies on gender are restricted to reproductive health, thus constraining a gender-equity approach as focused on maternal and child health. Our explicit gender analysis not only reveals gender inequities in the Afghan CHW Program and the broader health system, it also uncovers how a highly gendered division of health labour provides some opportunities for women’s empowerment that can disrupt patriarchal role constraints and broader gender inequities.

KEYWORDS:

• Gender analysis
• health programs
• Afghanistan

Acknowledgements

First and foremost, we thank all participants in this study, who have shared their stories, experiences, and knowledge with us. We thank the Afghan Ministry of Public Health and all its national and international partners, and the implementing organisations for all their support for this research. We would like to thank the two research assistants Sadaf Fetrat and Elyas Najafizada who have helped with the data collection in rural and remote villages of Afghanistan. This work was carried out with the aid of a grant from International Development Research Centre, Ottawa, Canada. Information on IDRC is available on the web at www.idrc.ca.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Said Ahmad Maisam Najafizada http://orcid.org/0000-0001-9195-5379

Additional information

Funding

This work was supported by International Development Research Centre [award number 107099-99906075-041].