The village health worker program in Afghanistan.

PIP: The questions of policy and operation encountered during a program for training and placing health workers in villages in Afghanistan are discussed. In the spring of 1976, the Ministry of Public Health and the United States Agency for International Development (USAID) decided to support several experiments in creating an alternative health delivery system. The 1st group of 11 village health workers (VHWs) completed training in May 1977. A total of 137 WHWs were trained. The new pro-Soviet government that took power in Kabul in April 1978 decided to eliminate the VHW program for political rather than technical reasons. Although the program's termination prevented the results of this effort from being observed for very long, many of the issues that arose and their solutions are of interest. It was generally agreed that VHWs would be selected by their villages, but there were several options as to guidelines for selection. The Ministry provided the guidelines for qualification but accepted the final selection decision of the villagers, even if some of the guidelines were violated. A major area of disagreement was the potential effect of a decision to allow VHWs to dispense drugs. The VHW did not receive a salary from the Afghan government but was permitted to sell prepackaged drugs at a small profit. The VHWs were very eager to learn. The VHW curriculum initially emphasized the training of VHWs to perform those skills listed in the manuals. Practical work was given the highest priority.^ieng