Village health workers in primary healthcare

It is midmorning in Gurure Village, Nyazura in Manicaland.

THERE is a slight breeze on this otherwise hot summer day.

Ms Munetsi Hungwe (31), a community health worker in the village, sits with a young mother under a tree.

Gently, she asks her some questions: “How are your children today?” “Is your daughter breastfeeding?” “Are you getting enough to eat?”

Hungwe playfully coaxes the 10-month-old baby to put out her arm to have it measured.

The results are excellent — in the “green” on the tape measure. No signs of acute malnutrition.

This household is fortunate on this day.

The children are healthy, the baby is feeding well, and the young mother is on time with her antenatal visits.

Ms Hungwe often faces an urgent condition — an under-nourished child or a pregnant woman who has not yet gone for an antenatal visit. The health worker is always ready.

On her bicycle, she carries a backpack laden with oral rehydration solution, flip charts and a handbook.

Her mobile phone has become the new “virtual stethoscope”, it is always at hand to call the ambulance or clinic, or to text the nurse-in-charge at Rukweza Clinic, a local treatment centre just a few kilometres from her village.

The phone provides a link between Ms Hungwe and the entire health system, including an expert automated system that informs her about vaccinations, test results, and dates for repeat antenatal visits, among others.

Ms Hungwe is a proud and capable member of the new generation of community health workers who are increasingly on the frontlines of disease control in rural areas.

“I received my training at a local clinic in 2004. We were taught a lot of things. These included the need to educate the community about hygienic habits, such as building toilets, cleaning houses and yards and weighing children, among other lessons,” she said.

With HIV/Aids still the leading cause of death among women of reproductive age globally and the main cause of child mortality in countries with high HIV prevalence, like Zimbabwe, her strength and resilience is helping to fight stigma and eliminating mother-to-child transmission of HIV.

She is in charge of a village with almost 400 people. More have been relying on her for health information.

Ms Hungwe hopes her efforts will lessen the spread of communicable diseases.

The health sector continues to suffer from brain drain. A huge chunk of Zimbabwean nurses and doctors continue to trek to countries where the conditions of service are better. Therefore, despite investing in training medical personnel, Zimbabwe is left with a chronic shortage of doctors and nurses.

To cushion the country against this, community health workers are stepping up to the task.

They come from within their rural communities and are typically young people with around eight to twelve years of schooling.

When properly trained and supported as part of an organised local primary health system, community health workers are saving lives.

They are warmly embraced by their communities and bring trust, cultural knowledge and sensitivity to topics such as childbirth, contraceptives, and family planning.

They reach out to the vulnerable individuals — the poor, elderly and the disabled.

Village health workers play an essential role in the primary healthcare system. They are contributing towards the fight against HIV/Aids and other diseases.

Since the first cases of cholera were recorded early this month, Ms Hungwe has been educating everyone in her village about the disease.

Fortunately, no cases of cholera have been recorded in her area.

Ms Hungwe said every now and then, they receive training as well as uniforms and health kits from non-governmental organisations and the Government.

“The bicycle I was given provides a low-cost and sustainable mode of transport that allows me to travel up to 20 kilometres a day to reach the remote rural families,” she said.

Ms Hungwe said there is need for more training to enable village health workers to attend to more complex situations.

A UNAids document published in 2017, which is titled “Two million African Community health workers”, reports that a substantial body of evidence demonstrates that community health workers increase uptake of health services, reduce health inequalities, provide a high quality of services and improve overall health outcomes.

Part of the document reads: “Community health worker programmes also represent good jobs, bolster national and local economies and increase productivity by improving health and well-being.

“Investments in community health workers will also enable Africa to turn the projected near-doubling in the youth population through 2050 from a potentially perilous ‘youth bulge’ into a dynamic ‘demographic dividend’ that drives economic growth and improves living standards.”

Indeed, investments in community health workers present an ideal opportunity to tackle the most vexing problems in Africa — health and the perilously high levels of unemployment among young people.