Zimbabwe’s Village Health Worker Programme dates back to the 1980s, when the country adopted Primary Health Care (PHC) as its chosen approach to health services delivery. In 1981, the government initiated the training of and support of VHWs. To date, the programme has led to notable achievements in health outcomes and impact. Examples of these achievements include increased access to family planning, decreasing rates of new HIV infection, and decreasing HIV/AIDS-related mortality.
We had the privilege to speak to five VHWs and their manager, a District Nursing Officer, to understand their role, their achievements and areas of improvement.
- Ms. Justina Mashoko, VHW trained in 2010
- Ms. Mary Wamachi, VHW trained in 2010
- Mr. Mpeuka Bondo, VHW trained in 2015
- Ms. Zviyedzo Mutize, VHW trained in 2015
- Ms. Patricia Kamundaranga, VHW trained in 2015
- Mrs. Assah Mufandaedza, District Nursing Officer in Mazowe District from 2013
What do you enjoy most about your role?
Ms. Mashoko: I enjoy educating my community. Many VHWs are not well-educated, but we are well trained and supported.
Ms. Wamachi: I enjoy going to the community and helping them. Through my interactions with my community, I am able to manage stress. Though I am a volunteer, I love my job. I have a lot of relatives and friends, who have supported me in becoming a VHW. I appreciate that VHWs are treated for free at the health facility. We have healthy communities.
Mr. Bondo: I enjoy meeting people and learning from them. On a typical day, I meet people and provide counselling to them. People come to me with questions that may even be sensitive in nature. This makes me feel like I’m trusted and doing a great job in the community. I learn from the community as I help them. I was initially very skeptical about serving women in the community, but so far, the women are comfortable around me. I would encourage men to join the programme as well.
People come to me with questions that may even be sensitive in nature.Mr. Mpeuka Bondo, Village Health Worker
Ms. Mutize: I appreciate the people who developed the programme to support the community. This programme was an eye opener for me. I would previously be hesitant to interact with specific communities but this has since changed as I serve all without discrimination.
Ms. Kamundaranga: I am happy to say that I was the first VHW in my community. Through my work, people in the community I live in know the importance of going to health facilities for treatment when they are ill. I work with patients who suffer from different ailments, and willingly help them. They freely associate with me because I am open. I’m also happy with the support and encouragement I receive from higher health system levels.
Mrs. Mufandaedza: My strength is in VHWs. They are available in places I can’t be, taking care of people on behalf of government and the communities themselves. I play an advocacy role for the recruitment and training of more VHWs, and provision of allowances, refresher courses and equipment.
What are some of the activities you perform, in your role?
Ms. Mashoko: I educate my community on how to prevent diseases by observing hygiene. We sometime go to visit members of religious sects that shun modern medicine and educate them on the importance of receiving medical interventions such as immunization and treatment for ailments.
Ms. Mutize: I am involved in many health programmes such as immunization. I work with many people such as: the disabled, vulnerable children, orphans, the elderly. I educate the community on hospital delivery and early ANC bookings hence reducing home deliveries. I distribute LINS (bed nets) and also share the importance of Vitamin A for children under 5. I encourage women to go for cervical cancer screening, men to go for voluntary male circumcision and all to go HIV and TB screening. Nowadays, we don’t have bed-ridden people in the community as they are referred early to the health facility.
Mrs. Mufanaedza: I share the criteria for VHW selection with communities: a married woman – as a girl will marry and leave the community- able to read and write, can maintain confidentiality, trusted and chosen by the community. When VHWs go for training, DNOs meet the trainees, welcome them and give them an overview of the programme. We make sure their living conditions during training are good and address complaints. We also distribute the VHW handbooks to the VHW trainers. Once training is complete, we ensure VHW needs are met in terms of stationery and IEC material.
What are some areas where additional support is required?
Ms. Wamachi: We sometimes have to cover a long distance to reach households. Access to bicycles would help. Phones and airtime would also help improve our reach to do active search of all those who are ill and refer them. Additionally, shortage of equipment is a major challenge. VHWs need commodities such as paracetamol to treat minor ailments, so that communities don’t have to go to the facilities. We should all have adult and children scales, height boards, MUAC tapes, first aid kits and gloves.
VHWs need commodities such as paracetamol to treat minor ailments,Ms. Mary Wamachi, Village Health Worker
so that communities don’t have to go to the facilities.
Mrs. Mufandaedza: VHWs need resources such as the standard uniforms, including shoes, hats, and rain coats, as well as bicycles, phones and airtime to track defaulters in EPI, HIV treatment, registers and VHW kits. They all need to receive a regular allowance. The bicycles need to be regularly serviced and bicycles replaced on an annual basis.
What would you want the world to know about Zimbabwe’s VHW programme?
Ms. Mashoko: VHWs are able to reach the last mile, which other formal health workers would not be able to.
Ms. Wamachi: While many VHWs not educated, with some having only reached Grade 7, they are still important as they are the eyes of the health system, see, document take those that are not well to the health facility.
Mr. Bondo: VHWs take people from the community to the clinic. When there were no heath workers in the community, there were many defaulters but they have since changed. They are important and others can learn from that.
Ms. Mutize: VHWs have love and care for the entire community. Even those that are not ill receive health information on HIV and put on ARVs if necessary. Now people don’t die from HIV anymore but from diabetes and cancer.
Ms. Kamundaranga. VHWs want to be respected and recognized by people by the formal health system. While we may not be educated, and our job is not high profile, we are in in the community and help those in the community.
Mr. Bondo: Nurses and health facilities educate them and provide support.