From dawn to dusk: The tireless journey of rural health workers
FROM the first light of dawn to the fading hues of dusk, Siphephisile Nkomo sets out on her vital mission in Matabeleland South Province.
Traversing the expanse of Zhukwe West in Gwanda District, she is a harbinger of hope and health. With unwavering determination, she navigates the terrain for two hours at a stretch, imparting wisdom through spoken words and printed materials. Her journey is long and arduous, yet her spirit remains indomitable.
On an average day, more than 10 households will benefit from her visit. She seeks out those in need: the sick, the uninformed, and those who find the sparse healthcare centres beyond their reach.
Silikwe Clinic, her nearest medical haven, lies 35km from her residence, underscoring the vital nature of her role as a village health worker.
Resistance is a frequent traveller on her path, rooted deeply in the religious and cultural convictions of her community. Yet, with unwavering patience, Nkomo has triumphed, persuading her neighbours to embrace medical advice, timely pregnancy registrations, and crucial vaccinations for the young, thus fostering healthier lives.
At 53, Nkomo’s journey is fuelled by an unyielding spirit of love, compassion, and dedication. Nightly, she braves the perils of the wild and the threat of criminals, her way lit only by the modest glow of a torch. As Zimbabwe celebrates its exceptional women, the contributions of Nkomo, one of 1 597 village health workers in the region, shine brightly.
These guardians of health prioritise disease prevention and deliver primary care within the rural and peri-urban wards. They stand as the crucial conduit between the community and the formal health system, trained rigorously by the Ministry of Health and Child Care through an eightweek programme blending practical and theoretical knowledge.
Chosen by village elders for the esteem they command, these health workers ensure early testing and treatment for pregnant women, reducing the transmission of viruses to new-borns.
Their expertise spans a gamut of health concerns, from HIV and AIDS to COVID-19, chronic diseases, and family planning, reflecting a deep connection with the community’s lived experiences and needs.
Their service is voluntary, supported intermittently by government allowances and donations. The Health Resilience Fund has notably lightened their load, a collaborative initiative led by the Ministry of Health and Child Care and bolstered by international partners, striving for universal health coverage in Zimbabwe.
MaNkomo’s day begins at the break of dawn, as she prepares her family’s meals before setting out to the far-flung homesteads.
“The few centres we have are 40km away for some, and this discourages health-seeking behaviour, especially from the elderly who are no longer fit to walk such distances,” she explains.
The introduction of life-saving vaccines, such as HPV for girls over ten, underscores the necessity of her visits.
Her efforts extend to pregnant women, whom she diligently reminds to register their pregnancies, seek antenatal care, and ensure skilled attendance at deliveries. This vigilance has been pivotal in preventing maternal and neonatal deaths and protecting infants from vaccine-preventable disabilities.
The HRF has also helped train VHW to teach villagers about infectious diseases and how to prevent the spread of such, Mankomo added, highlighting the fund’s role in enhancing community health education.
“We also have a high number of the elderly suffering from chronic illnesses and through the HRF we can give them medication or mobilise them for medical outreaches being conducted so that they consult doctors from their doorsteps.”
In the rugged terrains of Bulilima, 59-year-old Lungile Nleya from Nzinzima Village speaks of the recent boon - bicycles. These two-wheeled steeds are a godsend for village health workers (VHW) like her, tasked with bridging the healthcare gap in a district devoid of a hospital. The challenging landscape demands that they often dismount and proceed on foot, reaching out to elders burdened with the care of young ones.
“We serve as an extension of the health centres and our role in mobilising villagers to participate in health programmes is critical, albeit challenging. We encounter resistance, particularly from those with staunch religious beliefs, but our perseverance has borne fruit, and acceptance has grown over the years,” she said.
The commitment of VHWs like MaNleya is profound, demanding considerable time spent in the service of their neighbours. Her colleague, 42-year-old Siphosiso Dube from Lulo Village, echoes this sentiment, crediting the HRF for empowering them to conduct door-to-door campaigns.
These initiatives have not only curtailed home deliveries but also bolstered disease control efforts.
“We’ve witnessed a decline in home births. Our campaigns enable us to identify unvaccinated children and maintain pregnancy registers, ensuring timely transfers to waiting shelters for expectant mothers, thus improving birth outcomes,”she said.
Dr Andrew Muza, the acting provincial medical director, underscores the impact of these efforts, noting a significant reduction in deaths.
“In 2023, we recorded only ten deaths, thanks to the HRF and the exemplary work of our VHWs. They’re out in the community, identifying at-risk pregnant women for early referral and follow-up, and ensuring vaccinations for young children are up-todate, despite the challenges of accessing health facilities. The HRF’s support in training our VHWs in essential skills has been invaluable,” he said.