Community health workers: Essential for health, under- valued by planners

CHWs continue up to today to augment the work being done by the mainstream health sector, raising awareness, giving health advice, monitoring growth of children under five years, mobilizing communities during out-reach programmes and for immunization including as trusted sources of information for community literacy on Covid-19.

Community health workers reflect on their work

Mrs. Kaseke a CHW in Mwanza Ward (Goromonzi District in Zimbabwe) echoes these sentiments. One of her roles as a CHW is to mobilize food for chronically ill and home based patients in her area. She also runs community based growth monitoring clinics on Saturdays. “I have a scale that was allocated to me by the clinic when I started as a CHW. Women from my area bring their babies at my homestead. I weigh the babies and record their weight on cards, as it is done at the clinic. I then use the weight records to check if the child is growing well; otherwise I refer the child to the clinic for further assessment”.

CHWs see an important role for themselves in bridging the gap between the community and the health services, as explained by another Village Health Worker from Mangwe District in Zimbabwe, Mrs. Portia Moyo:

CHWs and Community Based Distributors were instrumental in implementing the successful Zimbabwe Family Planning Programme, as they helped raise awareness on family planning methods such as condoms and combined oral contraceptives (commonly known as “The Pill”), as well as the advantages of child spacing.

Low morale or lack of support?

Despite these vital functions, the numbers of CHWs and the role played by CHWs has diminished over the past two decades in Zimbabwe. Whilst communities cite low morale due to lack of incentives as the major setback, the CHWs and other health staff point to lack of incentives and supporting resources and protective equipment as a major barrier to their performance.

In their early years, Community Health Workers benefited from incentives from the National Health Budget such as uniforms, bicycles and allowances, which were meant to enhance their work and motivate them. Bicycles were both a token of appreciation, and a tool to enable these volunteers to take their services to a wider population. The allowances they received helped them to buy basic necessities such as soap, so that they could look presentable whilst they carried out their duties. These incentives are now a thing of the past as there is no provision in our current national health budget to support CHWs hence the overreliance on external donors. There is urgent need to invest in Community Health Workers, increasing domestic health financing and move away from the current heavy reliance on external donors as it is not sustainable and poses a security threat in the event that donors decide to pull out for whatever reason.

Highlighting the plight of Community Health Workers, Mrs. Moyo said:

There is urgent need to invest in Community Health Workers, increasing domestic health financing and move away from the current heavy reliance on external donors as it is not sustainable and poses a security threat in the event that donors decide to pull out for whatever reason.

Whilst communities cite low morale due to lack of incentives as the major setback, the CHWs and other health staff point to lack of incentives and supporting resources and protective equipment as a major barrier to their performance.

We as civil society demand more support for CHWs

Revitalizing CHW roles have been proposed as one measure to deal with the gap in health worker numbers in the face of the brain drain of health workers from rural to urban areas and from developing to developed nations. CHWs do not replace the requirement for adequate trained staff at primary and district levels of health systems, but they are a key cadre in the health system-fully aware of the health needs and aspirations of their communities. This makes them an invaluable asset in advancing community-orientated health delivery, and they should be supported.

The Community Working Group on Health (CWGH) has thus urged government to work with other stakeholders to create a plan to fully fund the CHW programme and support their work and to ensure that adequate resources are allocated in the budget for CHWs are accessible and reach these community level cadres for their work. However, this is not just a matter for government.

As civil society we see that the presence of VHWs in our communities is essential in our quest for equity in health and accessibility of health services, so that we too will be part of this support, including documenting the roles and impacts of CHWs our community to engage government and other stakeholders to value and resource these roles in the spirit of health for all.

The CWGH has thus urged government to work with other stakeholders to create a plan to fully fund the CHW programme and support their work and to ensure that adequate resources are allocated in the budget for CHWs are accessible and reach these community level cadres for their work.