A Day in the Life of a Community Health Worker


Shakila is a volunteer Community Health Worker at a health post in Enjil District, Herat Province. Every day, prior to working a typical 24 hour shift at the health post, she leaves her two-year old son, Mohammad Moshfe, with her mother-in-law. “Everyone is welcome here. Enjil is a poor district. It is important that this health post is open on time, is clean, and is organized. Where else can they go? The nearest health center is a two hour walk.” At the rural community health post, Shakila provides essential health services to women like 45 year-old Gulzada, who is visiting her today to discuss her family planning options. Gulzada has nine children. “I have been working in this health post for four years now. We serve around 10 to 15 people every week,” says Shakila.

Shakila provides health services to women like Gulzada, 45 years of age, who is visiting her today to discuss her family planning options.


There are 170 families in her community. Shakila spends a significant part of her time visiting women in the community. She provides counseling and essential medical commodities. Shakila received Community Health Worker training through the USAID-funded Helping Mothers and Children Thrive (HEMAYAT) program. During this training, she learned to always keep her health worker bag packed with a variety of health care information, family planning tools, and most important, essential medicines. Today, Shakila is visiting an eight-month pregnant woman, also named Shakila. She is pregnant with her fourth child. They discuss delivery preparation and Community Health Worker Shakila gives the mother three doses of misoprostol, a medication that prevents excessive bleeding after delivery, also known as postpartum hemorrhage.

Sadly, in Shakila’s community, many women who deliver at home die from excessive bleeding after childbirth. However, if these three pills are taken immediately after birth, deaths can be prevented. “It sounds so simple, three tablets, just after birth. Two years ago, this was the fate of women in my community where they died after childbirth from bleeding. I wish we knew about this at that time.” After the training, Shakila now gives misoprostol to all her clients during her consultation for home delivery, because the nearest health facility is far and often unreachable at the onset of childbirth.

Today Shakila is visiting an eight-month pregnant woman. She is expecting her fourth child. They talked about how to prepare for delivery; then, Shakila gave the pregnant woman three misoprostol tablets.


Semagull, 35, delivered her sixth baby last month. Community Health Worker Shakila visited her today. Semagull shows off the used pack of misoprostol and describes how she took the medicine. Semagull’s parents bring out the baby boy, Mohammad Tafiq. He is healthy and the grandparents are very happy. They thank Community Health Worker Shakila for providing life-saving health information and medical commodities.


“Even though it is a volunteer position, I don’t get tired of walking. These are my neighbors and friends. They take care of me. When my house needed to be repaired, the community members helped me out. They did not take any money,”said Shakila. “I feel very valued here. I feel that I am serving Allah by serving these families.”

She added, “I couldn’t complete my education. I was married off when I was 18. I had my first child the following year. When people call on me as I walk along the street for advice, it’s a sign for me – that I am doing my job properly and living a worthwhile life. No woman should die from childbirth.”

“I want to be a role model for young women. Even without an education, with knowledge and skills, everyone can be a valued member of society.”

CHW Shakila travels through challenging landscapes to provide in-home pregnancy counseling for expectant mothers.


Shakila is a volunteer Community Health Worker. For four years, she helped pregnant women during delivery in the Enjil District in Herat Province. The number of women who die from pregnancy-related complications is high in Enjil, according to the Ministry of Public Health’s 2015 Afghanistan Demographic and Health Survey, the maternal mortality rate is 1291 per 100,000 live births, and the the nearest health facility that can handle such complications is about two hours away on foot; so many women are forced to give birth at home.

Shakila received training from the USAID-funded HEMAYAT program on how to control excessive bleeding following the birth of a baby—also known as postpartum hemorrhage. The training is part of HEMAYAT’s Community-based High Impact Interventions. Before the training, Shakila did not know that postpartum hemorrhage is largely preventable, even if a woman delivers at home.

Since the training, Shakila pays two visits throughout the pregnancy for women in her community; one visit in the earliest stage, and the second at eight months. During the second visit, she counsels the woman on how to prevent excessive bleeding, and gives the woman Misoprostol—a pill used to prevent postpartum bleeding. Shakilla says the postpartum-related complications have reduced in the last year, because of misoprostol. Increased awareness and education provided by the Community Health Worker, fosters proactive behaviors from the expectant mothers and families to seek care at the health post or health facility from a skilled-birth attendant which reduces preventable deaths related to pregnancy complications.

Afghanistan’s 2010 Mortality Survey, conducted by ICF Marco, estimates that 56 percent of pregnancy-related deaths are due to hemorrhage, 59 percent of which occur during delivery and the postpartum period. According to Afghanistan’s 2015 Demographic Health Survey, 59 percent of women in the rural areas give birth at home. Community-based distribution of misoprostol prevents one of the reasons women die during childbirth.

Shakila counsels pregnant women at the health post, households, and now, her husband and family are also aware of the dangers of postpartum bleeding, and know how to prevent it.

Shakila recalls, “I couldn’t complete my education, I was married off when I was 18 years old, my first child when I was 19. When people call me on the street, and ask for advice, I know that I am doing my job properly and living a worthwhile life. No woman should die from childbirth. I want to be a role model for young women. Even without an education, with knowledge and skills, everyone can be a valued member of society.”

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