In February 2020, we organized a four week training course on Impact Evaluation for four selected members of the Shuhada Organization.

The training covered the following topics

• Theoretical and conceptual background of knowledge and impact evaluation
• Preparation: Manage, define and frame impact evaluation projects
• Concretize: Study design and measuring techniques
• Analyze, visualize, and present data
• Discuss and report findings
• Desigining an impact evaluation study
• (Implementing the impact evaluation in Afghanistan)

Moreover, we aimed at establishing a Center for Research and Evaluation at Shuhada Organization (CERSO).

Health Literacy in Ghazni, Afghanistan
Background: Studies worldwide show that health status is related to the health literacy of individuals. Practitioners in Afghanistan emphasize that health literacy among Afghans is very low and there is a great need for health education. The situation in Afghanistan is difficult to assess due to the lack of valid data and the fact that health research is mostly limited to the larger cities, while more remote regions are difficult to access and rarely researched.

METHODOLOGY: With high effort and in close cooperation with our external research partners from Afghanistan, a first quantitative study on the health literacy of individuals in Ghazni, Afghanistan was conducted using a globally used instrument, the HLS-EU-Q16. Quality of life, as well as numerous contextual factors and health practices, were also included.

Based on two multi-strategy randomized sampling methods, we generated two differentiated samples: on the one hand, we interviewed male household heads in the villages, and on the other, female patients or their female companions in a hospital in Ghazni. Two male and two female trained interviewers orally conducted a total of 824 interviews with individuals from four districts in Ghazni province. 502 men and 322 women participated in the study.

RESULTS: Health literacy levels measured with the HLS-EU-Q16 are comparatively low in Afghanistan, even by international standards. Behavioral indicators showed, for example, that it is common for women to wait up to two days after childbirth before breastfeeding their infant with breast milk and prefer feeding with oil first.

We identified weak to moderate correlations between the level of health literacy and determinants as well as behaviors.

Surprisingly, contrary to the widely documented association of educational level and health literacy, we could not empirically confirm this with our data from the male sample.

CONCLUSION: This study provided data on health literacy in a rural region in Afghanistan for the first time. The results highlight that in these districts in Afghanistan, the need for health-related information is high, and better health literacy is relevant to improve health-promoting behaviors. Environmental and income-related factors play a major role.

It is recommended to increase the education on health-promoting behaviors and to reflect anew on how the behavior can be learned successfully - independent of the educational standard. Initial approaches through health education in the hospital waiting room are to be recommended and expanded.

Publications can be found here

Harsch, S; Bittlingmayer, UH (2021): Determinanten von wahrgenommener Lebensqualität sowie der Zusammenhang von Lebensqualität und Dimensionen von Gesundheit und Gesundheitskompetenz von Menschen in Zentralafghanistan. In Martin Staats (Ed.): Lebensqualität. Ein Metathema. Weinheim, München: Beltz Juventa, pp 578-588.

Harsch, S; Jawid, A; Jawid, ME; Saboga-Nunes, L; Bittlingmayer, UH.; Sahrai, D; Sørensen, K (2021): Health Literacy and Health Behavior Among Women in Ghazni, Afghanistan. In: Frontiers in Public Health 9, S. 629334. DOI: 10.3389/fpubh.2021.629334.

Harsch, S; Jawid, A; Jawid, ME; Sahrai, D; Bittlingmayer, UH (2020): The Relationship of Health Literacy, Wellbeing and Religious Beliefs in Neglected and Unequal Contexts – Results of a Unique Study in Central Afghanistan. In Health Promotion Journal of Australia 32, S. 80–87. DOI: 10.1002/hpja.419.

Harsch, S; Jawid, A; Jawid, ME; Saboga-Nunes, L; Bittlingmayer, UH.; Sahrai, D; Sørensen, K (2020): Health without formal Education? Health Literacy, Quality of Life and Health behavior among Male Household Leaders in Four Districts of the Ghazni Province, Afghanistan. In Luis Saboga-Nunes, Uwe H. Bittlingmayer, Okan Orkan, Diana Sahrai (Eds.): New Approaches to Health Literacy. Linking Different Perspectives. Wiesbaden: Springer, pp. 261-287.

The University of Education Freiburg and the Gawharshad University (formerly Gawharshad Institutes of Higher Education), Kabul, Afghanistan, have had close contact and joint research projects (e.g., a study on health literacy in Afghanistan) since 2015. In order to improve the cooperation in further education, teaching, and research, eight lecturers of the Gawharshad University visited Freiburg under the title ‘Developing Teaching Methods Internationally’.

In June 2018, eight lecturers of the Gawharshad University travelled to Germany. Numerous encounters and guided tours allowed them to gain an insight into the structure, the administration, the offers and the designs of a variety of offered study programs. The program was planned and realized by Uwe H. Bittlingmayer, Johannes Lebfromm and Thomas Fuhr in close cooperation with a project by students of Adult Education, and it was financed, among others, by the Verfasste Studierendenschaft [Student Government] of the University of Education Freiburg. One main focus was the exchange about teaching and learning strategies and possible areas of cooperation.

The visit of the Afghan lecturers allowed the students to gain insights into the country and its educational institutions beyond mass media reports.

Furthermore, a writing center is going to be built at the Gawharshad University in the near future.

Further meetings are planned.

You can find a report on the lecturers’ visit and an overview of the program ‘Developing Teaching Methods Internationally’ from the magazine of the University of Education Freiburg here.

Health Promotion in Afghanistan

Background: Health is a very complex topic influenced by multiple aspects and the state of health cannot be attributed to one-dimensional relationships. But especially in a country like Afghanistan, where maternal and child mortality is very high and communicable diseases are very common, it is helpful to try to understand the health aspects, in general, more precisely and to identify possible starting points for improving health, such as health literacy. Within the framework of a small study (Master's thesis), we have examined the current health situation and the framework conditions using quantitative data, analyzed health-related interventions and the design of health-promoting interventions and care through qualitative interviews with local experts, as well as developed an overall view of health-relevant factors for the promotion of health in Afghanistan. The research was guided by the question: How is health promotion taking shape in Afghanistan and which approaches have shown promise and for what reasons?

Methodology: This mixed-methods study included a literature review (of research literature as well as grey literature from stakeholders in Afghanistan), 29 interviews were conducted, and feedback from 22 organizations on their health-related engagement in Afghanistan was analyzed.

Results: Data on health in Afghanistan as well as the availability of health-related interventions is very limited as well as dependent on the specific situation in each region (e.g. with regard to the security situation, medical/health care or availability of material resources, etc.). Countless actors (mainly NGOs) are involved and have developed programs in many areas. In view of the overall situation, it is of utmost importance that these are local offers, carried out by trustworthy persons, in the long term with good quality. Gender- and religion-sensitive offers are still relevant, as well as addressing the decision-makers in the family (e.g., the head of the household or the mother-in-law) and passing on health-related information from person to person.

Conclusion: In the past 15 years, a large number of interventions have been developed and implemented, but many have not been continued due to financial, political, or personal situations, and the generally project-based design has led to significant limitations in the sustainable implementation of interventions. From our point of view, it is crucial to continue existing, proven offers, to start with the health care system, to train local, trustworthy persons, and to pursue further ways - such as setting-related strategies, e.g. school health promotion.

The findings of this project were presented at the 

DAVO Conference 2016 in Tübingen

and can be found in the master thesis

Harsch, S (2017): Health and Health Promotion in Developing Countries. A Case-Study on community-based Health Promotion Approaches in Afghanistan. Freiburg: University of Education Freiburg (Master Thesis).

Highly Motivated, Transnational, Heterogeneous, and Barely Interconnected: An Explorative Online Survey among German Organizations

Motivation/Background: It is undisputed that the situation in Afghanistan is characterized not only by local developments but also by the trans-state and transnational engagement of a wide range of actors, both at the political and military level, but also through the involvement of non-governmental organizations, private individuals and family members. Often overlooked, but of great relevance, is the engagement of people from Afghanistan who have emigrated abroad and who support their families and communities in various ways, for example financially and through projects. While the engagement between the states of Germany and Afghanistan has been documented several times, there is hardly any knowledge about the numerous engagement of non-governmental organizations.

Method: In order to fundamentally capture and describe this engagement, we conducted an online survey among 150 actors regarding their organizational form, their engagement, their stated motivation, and future perspectives.

Results: We identified more than 200 organizations that reported supporting activities in Afghanistan online. However, a considerable number were found to be active in Afghanistan for only a short period of time or could not be contacted. Succinctly summarized, engagement can be described as motivated, transnationally situated, heterogeneous, and poorly networked.

Of the organizations participating in this survey, most are registered as registered associations or non-governmental organizations with varying membership sizes (mostly under 26) and significantly varying numbers of staff (0-2000). The composition of the founding members reflects a high level of commitment on the part of Afghan exiles. Overall, all regions are supported by people from Germany, but the commitment accumulates in larger cities and most organizations have a strong focus on one region and few but diverse projects. The most common form of support is financial contributions, training, and technical advice, as well as coordination and donations in kind. The most frequently cited motivating reason is to contribute to the reconstruction and to support people in need.

Engagement sector: the main target group of engagement is women and children and the sectors where high engagement was shown are education and health.

The organizations get involved in the areas of improving the education system, equipment, and facilities. The focus here is on practical assistance such as the construction of classrooms and the provision of teaching materials, but also on improving school management, transport for teachers/students, financial support for students, and improving the school curriculum. In-service training for teaching staff is given just as much attention.

With regard to current and future developments, the organizations indicated that they would continue their involvement despite the deteriorating security situation and impairments due to corruption, hopelessness, poor governance, and worsening economic situation because they had good contacts on the ground and were able to record visible successes.

When asked about the areas in which Germany could be involved in Afghanistan in the future, they primarily emphasized the importance of vocational and school education as well as the strengthening of civil society, but at the same time placed great value on the supply of water and also involved in the security sector.

Discussion/Conclusion:

The engagement in Afghanistan of people living in Germany is driven by humanitarian reasons, continues to be high, and covers many areas with a focus on particularly 'vulnerable' groups such as women and children. Whether and how these 'empowered' target groups can shape their future, however, depends heavily on the political, geographical, and security-related framework conditions. Therefore, it is highly relevant that supporting individuals and improving contextual factors go hand in hand.

Publications:

Harsch, S; Bittlingmayer, UH (2019): Highly Motivated, Transnational, Heterogeneous, and Barely Interconnected: An Explorative Online Survey among German Organizations. In: Bittlingmayer, Uwe H. et al. (eds): Education and Development in Afghanistan. Challenges and Prospects, Bielefeld: transcript, pp.79-101.