Community health workers yearn for consideration in government payroll

06Apr 2019
James Kandoya
The Guardian
Community health workers yearn for consideration in government payroll

AMERBEGA Novati is a small-scale farmer in Bwangaluti Village, in Missenyi District, Kagera Region said. She grows banana and other food crops.

Community Health Worker, Leonida Adolf of Bisole village in Muleba District, Kagera region registers in her book the trend of clinic attendance Veronica Eventi child. Photo: Correspondent James Kandoya

Apart from her farming activities, Novati is a community health worker (CHW), wh0 delivers a range of preventive, promotive and curative health services, in particular to underserved populations and in situations of emergency.

A mother of six serves three sub-villages and one of her key responsibilities is to ensure that pregnant mothers and their children attend clinic on regular basis.

Novati started working in that capacity 20 years ago, when the village assembly selected her to serve as the CHW under agreement of paying her little allowances to facilitate her movement.

In 2014, trained by the Jhpiego—an international non-profit health organization affiliated with Johns Hopkins University, through Mother and Child Survival Programme (MCSP), a five year’s programme funded by the U.S. Agency for International development (USAID), to increase coverage and utilization of high-quality reproductive, maternal, newborn and child health intervention at all levels.

The training was on how to offer services to pregnant women and children including keeping all records of new-born children in the village who need to receive vaccination and other essential medication to ensure they grow healthy.

According to Novati, despite the fact that community health workers (CHWs) contributed a lot in delivering healthcare services to the community, the government is yet recognizing them in terms of budget allocation.

She says: “Sometimes we’ve to use money from our own pockets to reach the targeted people. We’re appealing to the government to allocate budget and pay money that can at least motivate us...we are working in difficult environment.”

Presently, community health workers are neither paid nor remunerated across many African countries, including Tanzania.

Novati is not alone, there are many CHWs who are working in the area and Leonida Adolf is one of them.

Adol is a CHW in Bisole village in Muleba District, who serves four villages. Sometimes, Adolf walks up to 10 kilometres a day to reach the targeted community in the district.

In her lifetime, Adolf has successfully managed to convince many women to imbibe a culture of accessing health facilities for Maternal and Child Health (MCH) services.

According to Adolf, it is important for expectant mothers and under five children to regularly attend MCH services.

She, however calls on the government to reconsider giving them employment so that their job can be simple.

“Our contribution is well known by all stakeholders including the government.Therefeore it is a right time our request to be put in place to get fund as motivation,” she says.

At the moment, the CHWs have been working as volunteer, the situation that sometimes discourages them to do their good job.

They are more sensitive to their fellow community members on healthcare related problems including providing needed support to patients and their families.

MCSP’s senior technical adviser at Jhpiego, Dr Maryrose Kahwa describes CHWs as the first link in the primary health system as they are important cadre in the value chain process of improving health services in the country.

He says they contribute to epidemic preparedness and response; deliver vaccinations that have brought the world much closer to being polio-free, among other vaccine-preventable diseases; and provide life-saving integrated community case management diagnosis and treatment for pneumonia, diarrhoea and malaria, which can be deadly for children under the age of five.

 “This is one of the reasons Jhpiego trained them on matters related to healthcare services,” she says, adding that experience shows that community health workers can undertake various tasks.

Dr Kahwa further reveals that several trials had shown substantial reductions in child mortality, particularly through case management of ill children by these types of community interventions.

 “In the five years of the project, the CHW have done marvellous. Their contributions must be highly recognised by other stakeholders including the government in terms of budget allocation,” she Dr Kahwa says, suggesting the need for CHWs to be employed as it is in countries like Ethiopia and Rwanda.

“This will make the project sustainable.”

According to Project Coordinator, John George, about 70bn/- has been spent in facilitating various outreach programmes in the country. The initiative involves the improvement of the quality of health training institutions by empowering nursing and midwifery in the private health institutions.

Funded by USAID, the programme is geared towards improving vaccination coverage, malaria control and cancer prevention in the Lake Zone regions—Mara and Kagera.

He says: “We are proud that in five years of the project, we have reached more than 10 million people in different places. Under the project, at least twenty three advisory policies and guidelines were formulated and are in place.”

The programme also empowered more than 60 percent of health training institutions by building the capacity of the tutors, staffs and supplies of equipments.

He clarifies that the project is aimed at increasing coverage and utilization of high-quality reproductive, maternal, newborn and child health intervention at all levels.

George says since its inception, it has achieved a number of successes including the increase in immunization coverage from below 85 to over 98.5 percent. Through the project good number of nurses and midwives were trained.

“The idea was to build their capacities and assisted the formulation of guidelines and policies

Lack of human resources in health facilities and fund to improve infrastructure in public owned health institutions have been cited as a stumbling blocks thwarting implementation of MCSP.

George cited commitment amongst players in the sector such as district and regional medical officers as key tool towards achieving the goal.

Muleba District Medical Officer, Dr Modestus Lwekahemula reveals that MCSP project has increased immune coverage from between 65-75 to 98.7 percent.

To me this is a success story, that’s why I see community health workers are key in scaling up healthcare system in the district, he says.

Regional Medical Officer (RMO) Dr Marko Mbata also unveils that vaccination coverage increased from 81 to 92 percent, since the project started operating in the region.

Dr Mbata assures the Jhpiego about the programme sustainability, noting that his office had well organised in all cadres.

He also highlights the important need for the government to enrol CHWs in the payment roll.



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