# Barriers to seeking and delivery of essential health services in nine provinces of Afghanistan during the COVID-19 pandemic: community health workers’ perspective

## TL;DR

This study explores barriers to health services in Afghanistan during the pandemic from the perspective of community health workers.

## Contribution

It identifies key barriers and proposes solutions based on CHWs' experiences in nine provinces.

## Key findings

- Lack of information about services was the main barrier reported by CHWs.
- Training on COVID-19 and proper mask use was received by over half of CHWs.
- Improved transportation and access to masks are recommended to address service barriers.

## Abstract

Community health workers (CHWs) played a vital role in providing diverse essential health services to their communities during the pandemic. Using CHWs perspective, this study investigates barriers to seeking and delivery of essential health services in the nine Afghan communities during the COVID-19 pandemic.

In this cross-sectional study, 107 primary health care clinics from 9 provinces were selected, in which around 45% of the total country population reside. We used the validated questionnaire “Community Needs, Perceptions and Demand, Community Assessment Tool” which was contextualized by WHO headquarters and the WHO Afghanistan office. Data was exported into Excel, cleaned, and then exported into and analyzed using STATA version 17.

Most CHWs were men (80.9%), from rural areas (87.2%), and volunteers (58.1%). About 66.3% reported that lack of information about available services was a main barrier. Other reported barriers were a lack of transportation to health facilities (47.2%), their home were too far from health facilities (40.9%), and a perceived lack of medicines at facilities (23.6%). More than half of CHWs reported that they received some training on how COVID-19 spreads (67.2%), COVID-19 vaccine (65.4%), and how to use a mask properly while working (56.3%), while 27.2% said that they had not enough mask available to use.

Our research demonstrated that most barriers and concerns related to using critical services during a pandemic may be addressed by providing information about available services, providing transportation to facilities, and providing masks to personnel and individuals. CHWs could play critical role in managing and responding to emergencies and pandemics if the government invest on their capacity and motivation. Revision of training curriculum for CHWs and their job description to include the emergency and pandemic management at community level, and providing them monetary incentives are highly recommended.