A participatory focus group discussion of maternal and child health concerns and priorities in two districts of kabul, Afghanistan

Health services provision in Afghanistan is limited with one medical facility per 27,000 people, poor rural coverage and heavy dependence on aid. According to the WHO, the lifetime risk of maternal death is 1 in 11 women, 1 in 5 children die before age five and life expectancy is at or below 50 years. Empowerment Health (EH), aims to improve the health of women and children in Afghanistan through locally-driven, community-based care. To understand local needs, concerns and health priorities, EH employed a mixed-methods formative research study. Between March-August 2011, EH partners conducted eight focus groups in two districts of Kabul: Dashte Barchi (N=37) and Murad Khane (N=45). Participants were composed of community leaders, husbands, mother-in-laws, teachers, pregnant women and shopkeepers. Discussion topics included general and health-related community needs, community capacity for community driven health interventions and empowerment, and specific health concerns for women, men and children, and were generated by local partners who subsequently led focus groups. Participants identified weak infrastructure and a polluted environment as main drivers of poor health and limited access to health services. Participants indicated poverty as limiting access to curative and preventative health conditions and that they lacked opportunities for economic development and income generation. Participants suggested increased health education and outreach services--through community health workers--cleaner neighborhoods and economic opportunities would improve the population's health and determinants of health. These findings will be used to inform strategies and activities in maternal and child health as EH moves forward in program planning, implementation and evaluation.