I travelled miles down bumpy dirt tracks in rural Zambia last week in order to meet four Community Health Assistants (CHAs), who are recent graduates from a batch of over 300 health workers trained by the Government of the Republic of Zambia, with funding from DFID through the Clinton Health Access Initiative.
This cadre of health worker is a new addition to the health workforce in Zambia, and a strategically important part of its efforts to overcome critical shortages of doctors, nurses and other health personnel. Zambia’s Community Health Assistant training programme (described here) aims to give people in remote rural areas of the country access to a trained health worker who can promote health, advise communities on disease prevention, and provide a basic range of curative services for common, but potentially life threatening, illnesses such as malaria, pneumonia and diarrhoea.
I travelled with Dr. Meena Gandhi, a DFID health adviser in Zambia, Dr Yeko Worku and Katy Bradford Vosburg of the Clinton Health Access Initiative, and a small team from the Ministry of Health to visit the CHAs. (Meena, Yeko and Katy are pictured below with the Deputy Director of Environmental Health from the Ministry of Health).
The first stop on our visit was at Siavonga District, not far from the Kariba Dam. It was extremely hot, over 40 degrees, which highlighted one of the challenges the Community Health Assistants will face as they move from house to house delivering health messages and providing basic services.
From the district headquarters we travelled to Namoomba village (pictured above) and their health post and met with two of the Community Health Assistants (pictured right). A quick look at the patient register highlighted diarrhoea as a significant problem locally. The CHAs had established that the community’s water source was directly from the Zambezi River (pictured below) rather than from protected wells, and that more than 50% of households still lacked even a basic latrine.
With World Toilet Day having been on 19th November, it is only right that I should highlight a key part of the Community Health Assistant’s job is to review water, sanitation and hygiene practices in the communities they serve. A significant element of the first few months of the CHAs jobs has been to map those houses which have a pit latrine and to promote sanitation and hygiene practices and new latrine construction. There were already some signs of progress, with latrine pits under construction since the CHAs took up their posts.
I have posted a picture of the Zambezi River, at the point where it runs by the side of the village, and from where the villagers draw their drinking water, do their washing and bath (despite Hippos).
A key challenge in assessing the impact of the CHA will be the documentation of the services they provide and a demonstration, over time, that these services are helping to reduce the disease burden. For now though, one of the key indicators of success for the programme has been the fact that the communities from which the health assistants were recruited, and to which they have returned, have welcomed their trained health workers back with high expectations for the potential benefits that they might bring over the coming months and years as they become the ‘front line’ of health care provision for these rural communities.
In my next post I will introduce two more health assistants – to highlight some of the challenges that they face.