Learning for Life

Country Profile: Afghanistan

Population

34,400,000

Official Languages

Dari, Pashto

Access to Primary Education – Total Net Intake Rate (NIR)

53% (2000-2006)

Total Youth Literacy Rate (15-24 years)

Total: 34%
Female: 18%
Male: 51%

Adult Literacy Rate (15 years and over, 1995-2005)

Total: 28%
Female: 13%
Male: 43%

Programme Overview

Programme TitleLearning for Life
Implementing OrganizationManagement Sciences for Health (MSH), University of Massachusetts, International Rescue Committee
Language of InstructionDari, Pashto
FundingUSAID
Date of Inception2004 –

Context and Background

Image

The Afghan people’s right to education and the responsibility of the government to improve the socioeconomic well-being of all citizens is upheld by the national constitution. In particular, the constitution guarantees the right to free and quality education for all citizens up to a bachelor’s degree. Article 44 of the constitution underscores the government’s responsibility to provide programmes that address the educational needs of the citizens and in particular, the socially disadvantaged groups such as women and nomads in order to combat illiteracy. In addition, articles 13 and 14 of the constitution outline the government’s responsibility to offer programmes that improve the socioeconomic well-being of the people. However, despite these guarantees, major obstacles restrict access to education for many people in Afghanistan. These obstacles arise from the long-standing and ongoing conflicts, endemic poverty, poor funding of the education sector and (often ultra-conservative) cultural norms and practices. The latter has, in particular, prevented girls and women from accessing education. As a result, an estimated 11 million Afghans are illiterate. Thus, in the period 1995–2004, the total literacy rate for young people (aged 15 to 24) and adults was 34 per cent and 28 per cent, respectively. The situation is particularly dire for girls and women in remote and conflict areas with reports suggesting that only about eight per cent of women in such areas are literate.

Because of illiteracy, women face major socioeconomic challenges including high risks with regard to reproductive health with reports suggesting that the maternal mortality rate in the country is among the highest in the world. In addition, health service providers face difficulties in recruiting women with appropriate qualifications to fill midwifery positions in health facilities located in remote and insecure areas. As a result, health service providers are often forced to recruit illiterate women to serve as community health workers (CHWs, or volunteer health workers). While literacy and numeracy skills are not required for CHW recruitment, experience has shown that CHWs are more effective in their work when they have at least basic literacy and numeracy skills.

As part of an effort to train a new cohort of local health workers and hence to improve the health delivery services for women and their families in rural communities, Management Sciences for Health (MSH), the Centre for International Education at the University of Massachusetts, International Rescue Committee and seven local non-governmental organisations (NGOs) initiated the Learning for Life (LfL) programme. The project was a component of the larger USAID-funded Rural Expansion of Afghanistan’s Community-based Healthcare (REACH) programme. Learning for Life operated from 2004 to 2006 under the REACH programme. Since 2006, CARE, International Rescue Committee, Afghan Health and Development Organisation, and other Afghan NGOs have used the LfL materials in their adult literacy courses.

Learning for Life (LfL) Programme

LfL is a multi-level, health-focused and competency-based adult literacy and learning initiative for women. The programme supports the key priorities of the Ministry of Public Health (MoPH). More broadly, the programme endeavours to empower women by nurturing the development of skills necessary for informed and effective decision making, communication and increased participation in community development activities.

Two programmes were developed under the LfL programme: a nine-month foundations programme and a six-month bridging programme. At the time that LfL operated under the REACH programme, the programme’s primary aim was to create a cadre of women and older girls better prepared for CHW training and qualified for community midwifery training. Women who were interested in becoming health workers, active CHWs, traditional birth attendants, and women from the community simply interested in participating in an educational programme were recruited. In the foundations programme, particular emphasis was placed on the recruitment of active CHWs and traditional birth attendants. The majority of the women who entered the foundations programme were illiterate; however, others who entered the programme had some prior primary education or were home schooled. The bridging programme was designed for women with at least a sixth grade education. Many of the women in the bridging programme were interested in applying for community midwifery training in their provinces.

Under the REACH programme, the programme operated in 12 provinces. These 12 provinces were the relatively peaceful northern provinces of Badakhshan, Faryab, Jawzjan, Takhar, Bamyan, and Baghlan, Kabul province, the western province of Herat, and the Taliban-influenced southern provinces of Paktia, Paktika, Khost, and Ghazni. Classes were open to women age 15 and over in the target communities. Altogether 8,061 women participated in 361 foundations programme classes in 12 provinces, and 536 women participated in 28 bridging programme classes in the six provinces that offered community midwifery training. (The total number of provinces offering community midwifery education has increased since that time.)

Programme Implementation: Approaches and Methods

FOUNDATIONS PROGRAMME

The foundations programme covers four literacy learning themes: language; maths; health; and Islam and social sciences. Hallmarks of the programme design include: multi-level classes; a competency based ‘milestones’ system of learner assessment and progression; active learning methods; and a close affiliation with the health sector. During the design phase, staff reviewed the primary school syllabi up to grade six to ensure that the reading, writing, numeracy, and the science concepts and content areas taught in LfL would be aligned with the competencies taught in the formal education system. Staff worked closely with the CHW Training, Safe Motherhood and the Information, Education and Communication/Behavioural Change and Communication units at REACH. Priority health issues in rural communities, real stories about people’s interactions with the healthcare system, teaching aids commonly used in health education, and appropriate messages for the diverse communities in Afghanistan were incorporated into the programme as a result of these interactions. Foundations classes include such health topics as personal and environmental hygiene, transmission and prevention of infectious diseases, immunisation, nutrition, birth planning, and antenatal and postnatal care. LfL foundations classes were offered 2.5 hours per day, six days per week for a period of nine months.

BRIDGING PROGRAMME

A requirement for entry into the 18-month community midwifery education programme is a ninth grade education. In 2004, there was general concern that community midwifery training programmes would not find applicants with the minimum skills to qualify for the programme. The government relaxed the minimum requirements to a sixth grade education for a limited period of time. In support of this system, the bridging programme was designed for women who completed at least a sixth grade education and were interested in applying for community midwifery education.

In the design phase, staff members reviewed the community midwifery curriculum and teaching/learning materials; interviewed learners, teachers, and programme staff of the community midwifery programmes; worked with REACH’s Safe Motherhood Unit; and interviewed the staff at one hospital. Through this process, staff learned what women needed to know prior to entry to the community midwifery education programme, what could help the women during their training, and what might help them in their work as midwives. LfL staff designed the programme according to the content areas identified in the review: language; mathematics; communication and analytic skills; and the health sciences required for eligibility to the community midwifery education programme. Bridging programme activities supported the development of skills used in midwifery practice, such as reporting, interpersonal skills, and maths. Bridging classes were offered for 2.5 hours per day, six days per week for a period of six months.

Teaching-Learning Approaches

Teaching and learning under the foundations and the bridging programmes emphasise participatory methods including role play and dialogue based on relevant case studies and/or real-life events and situations. LfL classes offered opportunities for women to develop interpersonal communication skills which they could use in negotiation with their families and in their work as CHWs and community midwives. In the foundations programme, facilitators guide the women through a set of activities which are marked by a series of learning milestones. The learning milestones are aligned with the reading, writing, and math competencies of grades one to six in the formal school system and the health education priorities of the MoPH. The programme employs a variety of teaching-learning aids, including posters and flipcharts on reproductive health (birth planning, antenatal and postnatal care), personal hygiene, malaria, and disease control and prevention.

The multi-level approach is incorporated into the design of both the foundations and bridging programmes in recognition of the fact that adults often bring varying levels of reading, writing, and maths skills to educational programmes like the LfL. Learners are grouped according to the different milestones or level of competency that they have reached. Prior to the LfL’s establishment, the multi-level system had never been implemented in Afghanistan in the non-formal education sector. A considerable amount of time was devoted to the training of national, provincial and community level staff in this approach.

In the bridging programme, facilitators used active learning methods to teach the four learning domains. Activities introduced and reinforced the skills and knowledge that midwifery training candidates and midwives require. Communication activities included these content areas: working as a group, listening and communication, speaking with self-confidence, interviewing, reading a table, collecting and understanding data, and observation and facilitation. Language activities covered: punctuation and grammar, reading fluency, basic medical terminology, report writing, reading texts, and reading and following instructions. In maths, the programme focused on building women’s skills in the areas that midwives would have the greatest need, including weight and volume, percentages, division and ratios. Women who applied for community midwifery training often had poor knowledge of anatomy. The health component of the programme covered such areas as the respiratory, digestive, and skeletal systems as well as areas focusing specifically on women’s health.

Programme Impact and Challenges

Impact/Achievements

The LfL programme has been a great success since its inception in 2004. Key indicators of programme impact include:

FOUNDATIONS CLASSES

More than 8,500 women enrolled into the foundations classes, most with very basic or no prior literacy skills. Of these, about 90 per cent successfully passed the examination that was administered to assess learning achievements at the end of the classes (one to six). For example, 7,574 learners participated in the third grade equivalence test and of those 6,804, or 90 per cent passed. A total of 913 learners also took the test for grade six equivalence, of which 91 per cent passed. Successful learners were awarded a certificate of third grade equivalence. These certificates were jointly signed by programme representatives and the Functional Literacy Department of the Ministry of Education. The Functional Literacy Department’s certificate of grade 3 equivalence, the highest level which can be awarded by this department, is officially recognised by the Ministry of Education for entry into formal education.

BRIDGING CLASSES

Over 536 learners participated in bridging classes in six provinces, exceeding the targeted number by 50 per cent. Tests were not administered for bridging learners; ongoing learning achievement assessments were conducted by facilitators. However, without end of class examinations, it is not clear how bridging learners will be able to gain entry into the community midwife training programme.

Challenges

The effective implementation of the programme was undermined by high levels of insecurity and social resistance. This is particularly the case in the southern provinces of Paktia, Paktika and Khost. Kandahar was originally a target province. However, the programme found no international or national non-governmental organisation willing to offer LfL classes, and the programme never started in that province.

The rapid expansion of the programme stretched the scarce resources beyond limits. As a result, the distribution of instructional materials to learning centres was often slow which, in turn, prevented the facilitators from effectively executing their duties. In-service training and support programmes for facilitators, including field supervision and monitoring, was limited due to a lack of human resources. However, as the test results show, even with the limited support, the learners gained health awareness and literacy skills.

Start-up of the programme was delayed. The various layers of implementation

Lessons Learned

Although most project participants were satisfied, staff found that there was still need to empower trainers of facilitators and the facilitators through follow-up training in order improve project effectiveness. The number of support staff per province seemed generally too low to provide adequate quality support to facilitators and classes. Most provinces had three trainers responsible for supporting a minimum of 30 classes, with one province supporting 37 facilitators. The majority of trainers relied on shared vehicles. Many provincial trainers had limited input in designing their support structure. While they might have understood that more support was needed, they did not have the capacity to facilitate it. Similarly, efforts should be made to improve community mobilisation in order to sensitise communities about the goals of the project and thus to reduce the levels of social resistance.

LfL would not have been able to capture the complexities of the health issues faced by women in Afghanistan, nor that of the requirements of the community midwifery training programme without the close coordination with REACH’s CHW Training, Safe Motherhood, the Information, Education and Communication/Behavioural Change and Communication, Gender, and Community Leadership units. At the same time, LfL supported the MoPH by incorporating its priority health education issues into the learner activities. The project, however, did not make sufficient efforts to work with the organisations operating health facilities in the provinces to link the LfL participants with the health system in a systematic way. Two organisations, one that had close ties to a health provider and the other that was responsible for provision of health services in the province, were able to make the appropriate linkages. Others were not. Programme staff learned that a considerable amount of up-front, preparatory work in Kabul was needed to support LfL implementing partners to make the appropriate linkages in the provinces.

Sustainability

Currently, LfL classes are offered by the Afghan Health and Development Organisation through a Rotary International grant. The Partnership for Advancing Community Education in Afghanistan (PACE-A) consortium and other local and international NGOs have used and/or adapted LfL materials for use in their own health education programmes and literacy programmes. PACE-A uses the foundations programme materials up to the third grade equivalency; their classes are offered in areas where illiteracy rates are high. PACE-A learned that men were also interested in the LfL foundations programme and have offered men’s classes as well.

The Centre for International Education at the University of Massachusetts posted the entire set of teaching and learning materials for the foundations and bridging programmes, along with an evaluation report, on its website. These materials have been consistently used by organisations seeking to adapt or prepare literacy and health education activities for their own programmes in Afghanistan.

Sources

Contacts

David R. Evans, Ph.D.
Center for International Education
285 Hills House South
University of Massachusetts/Amherst
Amherst, Massachusetts 01003 USA
Email: cie@educ.umass.edu
Telephone: (413)545-0465 | Fax: (413)545-1263

Anita Anastacio
Chief of Party
Partnership for Advancing Community-Based Education in Afghanistan (PACE-A)
House #8, Taimani, Street 3
Kabul, Afghanistan
Email: anitaanastacio@gmail.com

Management Sciences for Health
784 Memorial Drive, Cambridge, MA 02139 USA
Email: MSH communications@msh.org or lisadeyo@gmail.com
Telephone: (617)250-9500 | Fax: (617) 250-9090

Jane Zimmerman
International Rescue Committee
Hs. 61, Kocha-i-Afghana, District 9
Shash Darak, Kabul Afghanistan
Jane.Zimmerman@theirc.org

MSH LMS Program
#24, Darulaman, Ayub Khan Mena
Karte Seh
Kabul, Afghanistan