Bagamoyo, Tanzania – For almost a decade, Salma Chuma has been spending three to four hours every day, with little or no payment, visiting households in her coastal village of Kisoga. During these visits, she educates women and families on issues ranging from personal hygiene and reproductive health to immunization and communicable diseases.
“I teach and motivate families on the importance of keeping their surroundings clean. What to do to avoid epidemic diseases such as measles, cholera [and to improve] maternal and newborn health and family planning,” says Chuma, 46. “Because of my efforts, more pregnant women in Kisoga are now delivering at the health facility and there are more families today on family planning, making decisions together on spacing and the number children they should have.”
Chuma and her community health worker colleagues play a key role in scaling up health care and bringing essential services close to where people live—in remote areas and places where skilled health providers have yet to set foot.
According to the World Health Organization, community health workers have the potential to be part of the solution in addressing the human resources for health crisis that is looming in countries like Tanzania, especially in places that are regarded as hard to reach. Only a third of the health worker positions in Tanzania are filled by skilled health providers, with the majority in urban areas, although 75 percent of the population lives in rural areas. Deployment of skilled, motivated and equipped community health workers can go a long way toward resolving the human resources gap and lack of access to health services.
Chuma and fellow community health worker Selemani Kondo were among 80 participants at a recent meeting organized by the Ministry of Health and Social Welfare to discuss community health initiatives. Also present were government officials and representatives from UN agencies, nongovernmental organizations, universities, research institutions and civil societies.
“This meeting is historical in that it is the first of its kind ever in Tanzania as it has brought together various partners and stakeholders who have vast experience in providing community-based health services,” said Dr. Geoffrey Kiangi, Assistant Director for Health Promotion and Education Services at the Ministry of Health, when he gave opening remarks on behalf of the Chief Medical Officer.
The goal of the meeting was to develop “a community health workers approach that will be holistic, sustainable and responsive to the needs of communities.”
Tanzania has a long history of community health work initiatives, dating to the 1970s. Dr. Peter Mbuji, the Acting Director of Preventive Services at the health ministry, recalled the contribution of “barefoot doctors” and village health workers during the period of socialism, and later when primary health care was introduced after the Alma Ata Declaration of 1978.
During two days of discussions, participants agreed on one issue after another—from defining who is a community health worker and that worker’s tasks, to identifying the components of a basic training package to build capacity of workers, compensation, accreditation and the government’s role in moving the community health agenda forward.
For Chuma and Kondo, their hope was that the meeting would get beyond the rhetoric—and ensure that community health workers are formally recognized; their remuneration is improved; affordable, simple and sustainable means of transportation are provided; and the availability of kits and supplies to facilitate their work is assured.
During the meeting, the Mothers and Infants, Safe, Healthy, Alive (MAISHA) Program—funded by the U.S. Agency for International Development (USAID) and led by Jhpiego, an affiliate of Johns Hopkins University—shared progress and experience on its innovative, integrated community maternal, newborn and child health initiative involving community health workers in Morogoro, Iringa, Lindi and Mtwara regions.
“Jhpiego, through the MAISHA Program, has been working with the Ministry of Health to develop national guidelines on integrated maternal, newborn and child health care in the community,” said Dr. Chrisostom Lipingu, Technical Advisor at Jhpiego. “In the community, we have started in Morogoro region, where we have built the capacity of 25 trainers so far. These will in turn build the capacity of community health workers who will be linked with 68 health facilities covering more than 120 villages in five districts.”
By year’s end, the MAISHA Program plans to have built the capacity of 60 additional trainers, 144 community health supervisors and more than 576 community health workers in the four regions, said Dr. Lipingu. The program will also equip community health workers with bicycles, backpacks and resource tools to help them provide basic maternal, newborn and child health care in the community during home visits. These same workers will also provide health education and counseling messages on antenatal care, the importance of giving birth in a health facility, danger signs in pregnancy, care of the mother and newborn, and services for HIV/AIDS counseling and testing and family planning.
As part of its efforts to improve community health, the MAISHA Program has rolled out a mobile phone application, in partnership with D-tree International, a non-profit organization committed to improving quality of health care through mobile technology. The mobile phone application is helping providers at health facilities and community health workers to do a proper and thorough screening for danger signs and pregnancy-related complications. Currently being pretested in two facilities in Morogoro, the mobile phone app will soon be scaled up to other regions and communities. The user-friendly technology also allows health care providers to interpret lab results.
“The premier meeting has been very successful in setting the direction and future of community health work in the country. I am struck by the level of preparedness and willingness among partners to devote resources and time to improve on how we deliver community health in the country,” said Dr. Dunstan Bishanga, Chief of Party for the MAISHA Program.
The community health meeting was soon followed by the launch of the Ministry of Health and Social Welfare’s National Guidelines on Integrated Community Maternal, Newborn and Child Health and other materials to be used by community health workers. This was a major step in improving services and ensuring quality care at the grassroots level. The guidelines were developed with technical assistance from Jhpiego through the MAISHA Program.
“The journey to revitalize community health in Tanzania has just begun, and there will be no going back,” said Dr. Kiangi in his closing remarks. “As the midfielder, the Ministry of Health is committed to making sure the deliberations and action points from this meeting are realized. We will work to bring on board all players so that they can operate in harmony to make sure community health is back on stage, allowing communities and community health workers to plan and implement health interventions that address their priority needs.”
With such initiatives and commitment from the Ministry of Health and partners like Jhpiego, the hopes of Chuma and Kondo to get beyond the rhetoric—and make community health workers a recognized part of the health system—are closer to being realized.