IN Zimbabwe, the ratio of healthcare workers to the population, at 1.23 per 1 000, is very low. Global requirements are that a country should have a minimum of 445 healthcare workers for every 100 000 people. But countries like Zimbabwe fall far short of this standard.
BY PHYLLIS MBANJE
This has resulted in over-reliance on village health workers (VHWs) who are community cadres that work on voluntary basis to assist the Health ministry.
Over the years, these brave women and men have soldiered on and as the health delivery system continues to fall apart, they act as glue holding together the system.
The health village workers were key to Zimbabwe’s successful expansion of primary healthcare in the early 1990s.
They played a central role in closing the gap between public health services and communities at local level, bringing health services to communities, and facilitating community roles in the health delivery system.
However, the COVID-19 pandemic has worsened their plight with many resigning and giving up, citing lack of protective clothing as well as being burdened by the ever-increasing demands stemming from severe hunger afflicting many villages.
Chipo Charichi from Negomo in Mashonaland Central province is passionate about health and ensuring her community in ward 19 has access to proper health services.
For many years, she has walked hundreds of kilometres beyond her ward either educating the community on proper hygiene or visiting patients, mostly suffering from malaria. She has covered many topics as well as many diseases including HIV and Aids.
“This year the malaria cases are too many and per week I get over 35 positive cases,” she said, but that is not her only concern.
“With malaria, we are used to the high numbers but there has been a severe drought in the province.”
She said some of her clients came from faraway places and she has to feed them.
“After they take their medication, they are supposed to rest and I need to feed them first,” she said.
Like Charichi, Judith Mhuka from Mucheri village is in a similar dilemma.
“I love my work and try to alleviate pressure on the staff at Negomo Clinic but we are struggling,” she bemoaned.
She said they lacked even the most basic things like a watch to ensure medication is taken on time.
“When I give out the drugs, I need to know when I will give the next dose but without a watch, it is a challenge,” she said.
Some patients come at night, presenting another challenge since there is no electricity or any other power source.
“I do not have a torch, candles or even a cellphone to give me light and that presents a big problem when attending to patients that fall sick during the night,” she said.
But a bigger threat has now made these cadres’ job a nightmare — COVID-19.
“We received some training and we are able to tell apart symptoms of malaria and COVID-19, but we are so scared because we do not have protective clothing,” said Charichi.
Her fear and desperation is shared by fellow VHWs within the province. COVID-19, unlike malaria and HIV and Aids, is highly infectious.
“We deal with many people who come to our homes. We use what we have been taught, like making sure the patients sanitise their hands first,” she said.
The VHWs used the “tippy-tap” strategy, which is a cheap contraption that conserves water while keeping people healthy. It is now widely used in most communities without running water.
“We occasionally get a piece of soap but it does not last, so we improvise with ashes and whatever we can find for the patients,” said Mhuka.
After the patient is sanitised, they sit a metre apart and the consultation begins. Charichi said the greatest challenge was when conducting a malaria test.
“I have to draw close to the patient and that unnerves me. We do not have gloves, masks or aprons,” she said.
Each day she risks being infected as malaria and COVID-19 have similar symptoms — fever, headache and weak joints.
“We have no choice. Our patients come for help and we offer the best we can,” said Mhuka.
But both women are stressed out and pleaded with stakeholders to step in and provide PPEs.
Compensation is the least of their concerns but they said it would help, especially when they end up feeding the patients.
“I wake up every morning and using resources meant for my family prepare porridge for patients. We do not get any allocation from the headman,” Charichi said.
Community Working Group on Health (CWGH) director Itai Rusike said in a low-resource country such as Zimbabwe, health professionals were a very scarce resource.
“So, to attain universal health coverage we are working with VHWs as they are playing key roles at community level to support the prevention, detection and contact tracing efforts in the COVID-19 crisis,” she said.
VHWs, said Rusike, continued to augment the work being done by the mainstream health sector, raising awareness, giving health advice, monitoring growth of children under five years, mobilising communities during outreach programmes and for immunisation.
“Despite these vital functions, the numbers of VHWs and the role played by VHWs has diminished over the past two decades in Zimbabwe due to lack of incentives, supporting resources and protective equipment,” he said.
On COVID-19, Rusike said that VHWs, are often undersupplied with PPE and because of the ”corona fear” the VHWs are extra worried about their own safety as there is a serious shortage of protective gear such as PPE and masks.
CWGH is currently training VHWs on COVID-19 as trusted sources of information for community literacy and to support case tracing.
To lessen the burden of walking long distances, the organisation has entered into a partnership with the World Bicycle Relief in their bicycle response against COVID-19 emergency.
“This will definitely lessen the burden on some VHWs that were walking long distances to cover their catchment areas due to lack of the adequate tools of the trade,” Rusike said.