Provision of Primary Healthcare in
Derust “A”village in Chipinge district

Derust “A” village is located in the Chipinge district of Manicaland province in Zimbabwe.  The Chipinge district is in the eastern part of Zimbabwe, located twenty-two kilometres from Chipinge town. The village consists of sixty-six households. There is a resident village health worker named Veriah Mawanga who gives primary healthcare. Veriah Mawanga works under Junction Gate Clinic. She was trained as a primary healthcare worker in June 2020. Community Health Workers often work on a voluntary basis and are agents of social change within the primary health care realm (Lewin et al, 2010; Werner and Bower, 1982). She focuses on disease prevention and provision of community care at the village level, where she serves as a key link between the community and the formal health system. Her duties in the village include giving health education, changing the community attitude to health and giving simple medical care, water and sanitation, encouraging pregnant mothers to book early for prenatal care, child healthcare and referrals to the clinic. Shortage of health professionals is a problem globally; a total of four million health professionals are needed to have all positions filled (Global Health Workforce Alliance and WHO, 2011). The problem is, however, more pronounced in developing countries, with Sub-Saharan Africa having only 3% of the global health providers. Staff shortages have weakened the health systems of these countries resulting in high morbidity and mortality; and this has contributed to failure by these countries to achieve targets set for health-related Millennium Development Goals.

According to the WHO, primary healthcare is a whole-of-society approach to health that aims at ensuring the highest possible level of health and well-being and their equitable distribution by focusing on people’s needs and as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation, and palliative care, and as close as feasible to people’s everyday environment (WHO, 2006). It is the first contact one has with the health providers when they have a health problem. Primary healthcare is a term used to describe a range of healthcare providers who work in the community. Two years after the Alma Ata Declaration in 1978, the government adopted the Primary Health Care (PHC) approach, directing resources towards disadvantaged areas and active participation of communities in transforming their health, but skills migration, low investment and limited resources have deterred this ambition. The maternal mortality ratio remains high at 651 deaths per 100,000 live births; the under-5 child mortality rate is 69 deaths per 1,000 live births, and 27% of children under 5 are stunted (Ray & Masuka, 2017). Human immunodeficiency virus prevalence rose from 15%, and 60% of villages have access to a village health worker while households contribute 25% through out-of-pocket expenditure. Government funding for health constitutes 8.7%

Interview

Interviewees:  Veriah Mawanga (village health worker)

Q: How long have you been working as a village health worker?

It is now four years. I started working as a village health worker in 2019 as a para-professional and I was then further  trained in June 2020.

Q: What is the purpose of village health work?

My duties include giving health education, for example, practising hygiene, preventing diseases, and advising on what to do when one is ill. It is to ensure the highest possible level of health and well-being of people in the village by giving the first contact when people have health problems and to give health education.

Q: What are your duties in the village as a health worker?

I also give simple medical care to those having diarrhoea or malaria and then refer them to the clinic. I encourage the community to drink safe water and to build health infrastructures. l also encourage pregnant mothers for early bookings, child healthcare and referrals to the clinic. l take them their medication after they visit the clinic. I also visit people living with HIV, albinos, orphans, poor people, and the elderly, giving the same services and encouraging them that they are part of the community.

Q: How do you carry those duties?

I organise community meetings and sometimes I put up posters for campaign awareness and also distribute health educational pamphlets. I think I’m playing an important role because I see positive changes from the villagers. The community is now practising hygiene, I see fewer cases of diarrhoea, Blair toilets are being built by some families, and everyone now feels that they are part of the community. The elderly, albinos, orphans and the poor were being isolated from others but now everyone is part of the community. Through door-to-door visits and community meetings, no one is left out. People are now opening up about their HIV status. In the community, we no longer have home delivery, and children under five years are being taken to the clinic if l refer them.

Q: How did Covid 19 affect the work of village health?

At first the work was affected since everyone feared for his or her life. But later after being educated to use technology, the work progressed. l formed a WhatsApp group for the community, so that l can spread health awareness. l also texted to those without smartphones so that no one was left out. l also give health services for those who need my attention.

Q: What are the challenges you face as a village health worker?

Some families do not go to the clinic because of their faith, yet they become ill, and sometimes communicable diseases spread to the community, resulting in loss of life. Sometimes, l am given little medicine from the clinic, even though the people who need my attention are many. After referral, some do not go to the clinic, and some do not take their medication well, which leads to death.

Q: What are  the challenges faced by the village?

We have only one spring in the village, and it is far from some of the villagers which has led to some families not practising hygiene. We have little health infrastructure in the village. A larger number of the households do not have Blair toilets because of poverty.

Q: What is the most important thing a person should know or understand when volunteering to be a village health worker?

One should have people’s health at heart. At the same time one should be patient enough to work with the community. Again, one should not have corruption and here I am saying this in terms of the medicine, some ended up selling it and giving it to their relatives only. So in short, one should have people’s well-being at heart. One should be passionate and be a good example.

Reflections

We were paired with two young researchers in Penang, Malaysia from the Universiti Sains Malaysia. They researched and interviewed a representative from the Sentul Free Clinic of HOPE Worldwide, which provides holistic healthcare to treat illnesses while empowering the community with knowledge and resources to improve their health and overall well-being. Compared with Derust ‘A’ Village, the two community services operate similarly. In Derust ‘A’ Village, Veriah Mawanga individually volunteers to carry out Primary Healthcare services. The same applies to the HOPE Worldwide team: they volunteered. These communities don’t operate on their own, but they operate on behalf of the clinics that are the public organisation. The services offered are the same. They are both engaged in medical assistance and health awareness campaigns. They equip individuals with knowledge and resources, and they educate their communities by mobilising them. However, there is one difference in the HOPE Worldwide organisation, and that is there is food security for the disadvantaged. Again, it is a non-profit organisation, whereas in Derust, it’s an individual who is working together with the clinic.

References

Lewins, et al (2010). Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Retrieved from: 10.1002/14651858.CD004015.pub3. Cochrane Library.

Ray, S. &  Masuka, N. (2017). Facilitators and barriers to effective primary health care in Zimbabwe. African Journal of Primary Health Care & Family Medicine 9(1). DOI:10.4102/phcfm.v9i1.1639

Werner, D. & Bower, B. (1982). Helping health workers learn Hesperian Foundation.

WHO (2006) Taking stock: Health worker shortages and the response to AIDS. Geneva: WHO.

WHO (2006a). The World Health Report 2006- Working together for health. The World Health Report. New Delhi: WHO.

Researchers

Hi everyone. My name is Nancy Mharira. I am married, and am a mother of three. I am also a third-year student in  Education at Great Zimbabwe University in Zimbabwe. I am staying in Chipinge, which is my birthplace. During my leisure time, I like singing gospel songs. I also like to join volunteer activities as I love to engage with and help people.

 

Greetings  to you all! I am Mercy Zuvarimwe, a fourth-year student at Great Zimbabwe University. Studying for a Bachelors in Early Childhood Development, I see myself volunteering to assist those in need.