MELUSE KAPATAMOYO, Lusaka
TO FOLLOW your passion and get paid for what you love to do is the ultimate dream for many people. In situations where it has been impossible to have both, many have abandoned their dreams and changed careers in preference for a pay cheque.
However, there are special kinds of people who risk it all to live out their passion, even without pay to sustain their livelihoods. One of these special groups of people are the community health workers, commonly referred to as CHWs who honour service to their communities above their own needs.
In a continent faced with a shortage of doctors, nurses and other essential health care workers, international health organisations like Amref Health Africa, describe CHWs as the bridge between communities and their health and social systems.
But what inspires CHWs to give so much of their time, without any remuneration, and at the risk of providing a financially stable life for their families?
My curiosity took me to Luanshya’s Twashuka township on the Copperbelt Province where I caught up with Patson Daka, a community health worker, who I found conducting a sensitisation meeting in the area with other volunteers.
After interrupting him for the interview, my first question was perhaps an obvious one, how could he work so passionately for zero pay?
“I do it so that other people do not have to feel the pain of losing a child like my wife and I did. We were victims of what can happen if you do not have the right information. I have five children now, but we lost several through miscarriages,” Mr Daka explained.
“It was a desperate time for us and we went as far as consulting native doctors. Nothing helped. That was until we met a community health worker who advised us to seek medical treatment at a nearby clinic.
“Tests revealed that we had syphilis. We were treated and conceived not long after. I decided then to become a volunteer in order to help others. So you can say I fell into it by mistake.”
At age 45, and now 15 years later, Mr Daka, who is also a member of the Safe Motherhood Action Groups (SMAGS), works passionately to ensure that pregnant women deliver healthy babies.
His responsibilities also include encouraging men to get informed and involved in the healthcare of their families. He believes that with the correct knowledge and working together, couples are able to identify problems more quickly and prevent loss of life.
Regrettably, with few volunteers against a growing population of more than 10,000 in Twashukwa township, ensuring that health programmes run smoothly and community members receive adequate healthcare services, may not be an easy task in the near future.
“For example, we have children as young as 14 falling pregnant, so not only are there few CHWs to cater to the girls, [but] some of them are too young to even understand the importance of antenatal and the need to have their children vaccinated,” he lamented.
“It is our responsibility as CHWs to visit these girls often to make sure they get the message. Unfortunately, there are few of us and many of them.”
Even with such dedication and commitment, he confesses that his work has financially taken a toll on his family. Like many other volunteers, his day starts as early as 07:00 hours, leaving very little time for him to work on the farm which is his family’s main source of livelihood.
It is therefore not a surprise that he does not shoot down the idea of remuneration for CHWs as being advocated for by some non-governmental organisations like Amref Health Africa.
Mr Daka agrees that remuneration of some sort would help alleviate some of the financial obligations that he and other volunteers have towards their families. In his view, it is these obligations that have hindered many more from volunteering.
According to Amref Health Africa, CHWs drop out of the programme for lack of remuneration, with attrition levels being at 77 percent. The organisation is seeking to have CHW’s recognised as part of the health workforce and be adequately remunerated, financially and morally.
Nevertheless, with or without pay, Mr Daka insists that the knowledge he has gained through volunteer work is worth the free man hours he offers.
With a glow in his eyes and a smile on his face, he adds, “I will never know the exact number but I know that I have helped save many lives. On a daily basis, I use the knowledge I have gained over the years to help others and my family. I now understand the importance of vaccines and how they work to protect children.”
While passion may not be what is lacking for the few available CHWs, aging ‘workers’ like Rhonda Chikombe Mulenga, who has been a volunteer for 48 years, may soon be forced into ‘retirement.’
Although evidently still energetic, and insisting she has no intention of withdrawing her services at age 65, Mrs Mulenga is looking forward to a time when more young people will come on board to volunteer.
But being someone who has spent most of her life as a volunteer, she understands why not many people are rushing to join. She feels that while a lot has been done by various organisations in addressing challenges they face such as providing bicycles and rain coats for CHWs, a lot more still needs to be done.
“This type of work calls for a lot of commitment and sacrifice. More support towards CHWs would be appreciated, especially for young people who are just starting out in life and those that have worked tirelessly over the years in various communities,” she says.
Apart from the shortage of volunteers, she says other factors hindering the success of health care programmes in most parts of the country include shortage of healthcare personnel, long distance to health care centres and lack of mothers’ shelters.
Noting the challenges and looking forward to seeing improvements made in the health sector, Mrs Mulenga says despite the difficult conditions, she and other volunteers have recorded positives over the years. Also a member of SMAGS, her specialty is growth monitoring of under-five children.
“Before we took this knowledge to the community, a lot of mothers lost their lives while trying to deliver at home,” she says. “That is no longer the case. In addition, unlike before, most parents now understand the importance of immunisation. We are now seeing fewer children getting sick.”
Perhaps it is because of such impressive results that even tragedies that have occurred in Mrs Mulenga’s life have not quenched her desire for volunteer work. A few years ago, her son, his wife and four of their children were killed in a car accident.
“I would have quit then, because I still had to nurse two of my surviving grandchildren in hospital for three months but I didn’t,” she says. “I thought about people who need me. As a Christian, volunteer work is my way of serving the Lord. The way I see it, my reward is in heaven.”
With so many areas of involvement, civil society organisations such as the Zambia Civil Society Immunisation Platform (ZCSIP) describe CHW’s as strategic stakeholders in their organisation due to their direct link with the community.
According to the Platforms board chairperson Alex Mutale, the role of CHW’s is to take information from the organisation and then go out to sensitise communities about health matters. In addition, CHWs also help health staff at health facilities especially in the area of data compilation.
“CHWs have brought great relief to the community and to health staff as well. In some health facilities, you may find only one trained health staff and the rest are CHWs,” Mr Mutale explains. “These are people who bridge the gap in cases of staff shortages in hard to reach areas.”
The main objective of the platform is to increase the uptake in immunisation in the eight districts and also to prevent children from dying of preventable diseases. The platform consists of 62 civil society organisations (CSO’s) working in 26 districts and with over 50 volunteers.
“As you can see, CHWs have helped the platform so much even though they do so with a lot of challenges, with the most common being lack of sustainable financial support,” he says. “CHW’s work as volunteers, so they are not entitled to monthly salaries, a situation demotivates many.”
However, while the situation may seem hopeless, not all hope is lost.
Some organisations like the Churches Health Association of Zambia (CHAZ) are recognising and appreciating the role that CHWs play. The organisation is complementing the efforts of the government through the Ministry of Health by implementing the Health System Strengthening (HSS) Project, supported by the Gavi Vaccines Alliance.
CHAZ’s role on this project is communication for immunisation at community level, working with CHW’s through CSO’s in defaulter tracing, outreach activities and community mobilisation for immunisation, explained Friday Nkhoma, CHAZ senior programme officer.
The CHWs through the CSOs are appreciated with bicycles for transport, and lunch allowance, but above all, the Ministry of Health and its partners are implementing Results Based Financing (RBF) which includes the payments for performance even for CHWs. This will help in alleviating poverty and CHWs will be engaged in livelihood activities like savings and agriculture.
“The community health workers play a pivotal role in service delivery to the community, for example in child health service, these CHWs work with us to educate community on the importance of vaccinating children, they conduct growth monitoring, defaulter tracing, weighing of children during under five clinic etc,” Mr Nkhoma says.
“Their work is not remunerated but so much is done by them, it is for this reason that the RBF model has included them to atleast give an incentive.”
CHAZ has been implementing RBF and livelihood activities in different districts and health facilities and this strategy has helped in alleviating poverty amongst community members.
MELUSE KAPATAMOYO, Lusaka