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CHAs, Nelly Mwandila and Veronica Pansi in Chibombo
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WITHOUT improvements to the human resources situation in the health sector, the health-related Sustainable Development Goals cannot be achieved.
The problems are multiple, the most serious being staff shortages, particularly, in rural and remote areas.
In many countries, Zambia inclusive, the effects of insufficient capacity development in the health care system are aggravated by migration and a mounting burden of disease.
As a result, poor and vulnerable communities countrywide still face many barriers to health care, including stretched services.
The health of people in poor communities is further compromised by a lack of access to transport, clean water and sanitation and nutrition. This means that they require services that can respond to a complex mix of challenges.
And to address this challenge, the use of community health workers becomes handy.
In Zambia, community health workers are an important resource in the health delivery in rural areas as well as densely populated townships in major cities in the country.
Community health assistants, as they are commonly known in Zambia, fulfil a significant role in improving access to health care for poor communities.
They create a link between the health system and communities. They also have the potential to improve access to sectors other than health, creating avenues to services such as social welfare and housing.
Currently, Zambia has 1,600 trained community health assistants who provide a wide range of care-related services in poor communities, Ministry of Health spokesperson Kennedy Malama says.
Dr Malama says the community health assistants provide a wide range of care- related services, which include conducting health promotion activities and awareness about diseases, and identifying and attending to minor ailments.
“Community health assistants can also refer chronic conditions for treatment to the nearest health centre, conducting defined activities in areas such as treatment and counselling support for TB and HIV, malaria, rehabilitation, hypertension and diabetes, and connecting communities to resources and services,” he says.
Dr Malama says Zambia has two training institutions at Ndola School of Medicine in Ndola and Mwachisompola in Chibombo district where Community health assistants undergo a one year course.
“For Zambia, we made policy decision that we will start training community health assistants and we have trained 1600 of community health assistants so far. These are grade 12s. They are trained for a year after going through practicals. We have two training institutions where they are trained; Mwachisompola and Ndola respectively. And once they graduate, they are certified and put on a pay roll as a salary,” Dr Malama says.
The question of remuneration for community health assistants in Zambia and other low income countries remains contentious.
In most cases, community health assistants get motivation through incentives such as monetary and non-monetary in most cases.
However, there is enough evidence that volunteerism has contributed to demotivating the community health assistants worldwide.
As a result, the World Health Organization (WHO) has consistently recommended an adequate compensation that improves health worker motivation, retention and performance.
Additionally, fair and consistent wages ensure a stable income and livelihood for community health workers.
Although paying workers requires a modest investment of resources, cost should not be a significant barrier if governments and donors prioritise primary care.
In meeting the WHO recommendation, Dr Malama says, “Zambia is already implementing the recommendation and cannot be done overnight, it’s a process. We are looking at ways of scaling up the training of community health assistants and they are supposed to spend 80 percent in the community and 20 percent at the health centre in the community to do health promo, disease prevention and treatment and linking community in terms of referral.”
The success of the efforts has caused not only government agencies, but also nonprofit organizations, faith-based groups and health care providers to create paid positions for community health workers to help reduce, and in some cases, eliminate the persistent disparities in health care and health outcomes in underprivileged communities.
Although research shows how effectively community health workers can contribute to the improvement of health care provision, many of these programmes have failed in the past. This failure comes from the expectation that they act as a single solution to a complex set of problems, including weak health systems.
It also stems from the misconception that community health assistants are a cheap alternative to providing services to underserviced communities.
A community health assistant, Chabu Kalenga of Rufunsa district says from his experience, community health assistants serve as a bridge between the community and the health care, government and social service systems but very little is done to motivate them.
“As community health assistants, we have a lot of work and among them is helping individuals, families, groups and communities develop their capacity and access to resources, including food, quality care and health information,” Mr Kalenga says.
Mr Kalenga says among several other duties, the community health assistants also include helping health care and social service systems become culturally relevant and responsive to their service population.
Despite all the work that community health assistants do, they face a myriad of challenges. These challenges hinder their potential to provide outreach services.
Mr Kalenga says very few community health assistants have received training in line with their work.
“We report for work every day and very little is done to better our work in terms of training and decent remuneration. A lot of us have only received training that involved sectors other than health such as the police and social welfare services. This only helped shape our roles which in turn enabled them to provide broader services beyond health. But a specific training will be ideal for effective health delivery,” Mr Kalenga says.
Limited finances to enable community health assistants to accompany clients to access services such as distant hospitals or registering for a social grant has been a challenge too.
Looking at the significance of the community health assistants, can only be successful if there are several changes in the system that govern them. This includes increasing efforts to formally incorporate them into the health workforce in ways that recognise their unique needs. PUBLISHED IN THE ZAMBIA DAILY MAIL ON MARCH 5, 2017. LINK: https://www.daily-mail.co.zm/human-resource-improvement-key-to-achieving-sdg-on-health/
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