Future Generations Approach Reduces Under-Five Child Mortality in Afghanistan by 46 Percent

In remote Afghan valleys, a women’s empowerment project reduced under-five child mortality by 46 percent in two years. From 2005-2006, for each village a Community Health Worker (CHW) was trained using five new interventions of community-based child health care. Unexpectedly the outside funding was diverted, but the CHWs continued the program themselves.

The specially trained CHWs organized Women’s Action Groups that covered all village households; their continuing work was supervised by a mullah employed by Future Generations. Two years later, reports came back that women were continuing their volunteer service. To document the impact, in late 2008, Future Generations sent an independent evaluation team from Johns Hopkins to these villages to investigate results.

The challenge was how to document change with no prior baseline survey. Using a new version of Retrospective Pregnancy History Surveys, an approach pioneered by Dr. Stan Becker at Johns Hopkins, it was possible to interview all 870 women in Rostam and Syadara valleys in Bamyan Province who had children during the previous ten years and create a baseline for what the health status had been prior to the intervention.

Careful data analysis, including rechecking of the data three times, showed that child mortality had declined, and, the declines had held during the two-year absence of formal outside assistance, demonstrating a method that allows women themselves to achieve the impact. 

This data points toward a more sustainable, low-cost, and culturally-appropriate approach to improving the care of children in their homes. A final report is under development and will be made available on www.future.org.

Now, an adaptation of this approach is being piloted in three districts in Arunachal Pradesh, India (see Program Briefs, India).