4 April 2018
As in many other countries in Africa, Tanzania, a nation of over 55 million people, is not immune to the crisis in health services brought about by a shortage of skilled health workers, with only 5.2 clinical health workers per 10 000 people, a ratio critically below that recommended by the World Health Organization (WHO). In order to tackle this challenge, in 2016 THET, in collaboration with the Mkapa Foundation, launched a programme to train Community Health Workers (CHWs) in the Lake Victoria region.
Whilst malaria and HIV are still among the most persistent threats to the health of the local population, the biggest challenge identified by the CHWs is maternal health. In the Mwanza region, being a woman – and being a mother – still means being exposed to life-threatening conditions that are easily treatable, and preventable, elsewhere in the world.
Here are the accounts of three female CHWs (and one man!) who are bringing real change to the communities they serve.
Grace, Community Health Worker, Kwimba,Tanzania
“When I saw the situation in my village, I was touched by the cases of so many mothers who lost their babies or even their lives because of lack to access to care. As a woman myself I thought it was my duty to do something for them. I know that when it comes to maternal and child health, women are more trusted within the community, people find it easier to speak to us than to men. In the villages, we go door to door to sensitise both men and women who are expecting a baby. In general it is the village leader who helps us identify the families to reach out to. Sometimes traditional beliefs get in the way. For example, once I met this mum whose baby was really sick. I urged her to go to the health center, but initially she refused, as she didn’t believe they could assist. “I have help here” – she told me, referring to traditional medicine. I insisted and explained that her baby needed professional help, so she finally decided to go. The baby is fine now. Overall I think the training [organised by THET and Mkapa, ndr] provided me with the right skills, when visiting the community I always felt comfortable enough to identify the situations when I can provide support directly and the ones when it is best for the patients to see a doctor or a nurse. Obviously the health worker shortage is a real issue. “
Dina, CHW student, Kwimba, Tanzania
“This job for me is a real call. I decided to become a CHW in the hope to go back to my village and bring real change to my people. There are many issues that need to be tackled, but for me one of the most pressing ones is gender-based violence. It is not well addressed. The victims are now well reached, but the message is not well communicated. If I can change that, if I can become a champion for the women in rural areas, to give them voice, to advocate for them, then I’ll consider my job done.”
Ruth, Community Health Worker, Kwimba, Tanzania
“I decided to become a CHW to support my community. The people we serve are facing a number of health issues, from severe diarrhoea and malnutrition to HIV. It is to pregnant women, though, that I feel that I can provide greater help. I want to advocate for them to make sure they have access to the care they need. I remember a few cases dear to me: one woman who has a three-week old baby and one who was seven-months pregnant. They both hadn’t seen a doctor so I referred them to the clinic. The first took my advice and went to the health centre. The other one, in spite of wanting to go, never had a chance to do so, unfortunately, as her husband wouldn’t allow her. As you can see, there are health issues, but it is even more complicated than that as many barriers to access are actually cultural. This is why it is so important for me to sensitise the whole community, men included. What we are doing is important and my ambition is to continue down this path and one day maybe become a CHW Coordinator.”
Rashid, Community Health Workers, Geita, Tanzania
“Growing up in my village, I saw so many cases of pregnant women experiencing issues. Many of them lost their babies simply because they weren’t able to walk long distances to reach the closest health facility. When I heard about the CHW programme, I thought: This is it! This is how I’m going to help those women in my community!
Later on, because of the things I’ve seen in my own village, during my six weeks practicing in the community, I was very keen to make sure pregnant women understood the importance of delivering at the health centre. The most rewarding moment for me was when I went back to the centre and, a few months later, I met those same women. I was so proud that they followed my advice. One of them even came up to me and said: I remember you, you shared with me your education and now here I am. I’d like to believe that I made the entrance in life of those babies a little bit easier.
Another big achievement is linked to patient attendance. The presence of CHWs as us has considerably reduced waiting time and we have now more patients coming to the clinic. For some of them, transports are an issue as it is often very expensive; spend the night is not an option, as they need to work. With the reduction of waiting times, patients feel more encouraged to come to centre as they know it won’t take as long as it did before.”
Research on Child Poverty in Tanzania Project:
In 2017 we started working with the Overseas Development Institute (ODI) to deliver this project, funded by UNICEF, which is being implemented in Dar es Salaam, Mwanza, Zanzibar and Mtwara.