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CHWs, traditional leaders foster community participation in health

Sustained health literacy campaigns by community health workers (CHWs) and traditional leaders in Matabeleland South province has significantly improved health outcomes and enhanced health seeking behavior among communities in the province.


Most of the communities are now knowledgeable about their health rights and entitlements to the extent that they now demand transparency and accountability of health resources from service providers.

The CHWs who include village health workers, health literacy facilitators (HLFs) and health centre committees (HCCs) have also played a significant role in raising awareness on the importance of community participation in health.

Apart from raising health awareness and mobilizing communities together with the CHWs, traditional leaders help to ensure that locally agreed health policies such as no home deliveries are adhered to.

The imprints of the CHWs’ efforts are visible at such rural health centres as Mbizingwe and Esibomvu in Umzingwane district as well as at Raafs and Mdutsheni clinics in Bubi district both in Matabeleland South province.

With coordination from members of the HCCs, the communities have repainted the clinics’ buildings, built waiting mothers’ home (WMHs) and toilets as well helped improved the rapport between health workers and the community in general.

A structure of the Ministry of Health and Child Care (MoHCC) established in the early 1980s, HCCs assist communities to identify their priority health problems, plan how to raise their own resources, organize and manage community contributions and tap available resources for community development.

The committees are composed of representatives of communities nominated or elected by their various social institutions such as the youth, women, civil society, police, health services, education, agriculture and specific groups representing vulnerable communities. The local councilor is an ex-officio member of the committee.

They work closely with the traditional leadership such as chiefs, village heads, and other community leaders in mobilizing communities to attend meetings as well as convincing people to seek health services such as treatment, HIV testing and Maternal Neonatal and Child Health (MNCH) services at clinics.

At all the clinics the Strengthening Community Feedback Mechanisms for Improved Health Service Delivery project, the committees have spearheaded the construction of WHMs in an effort to reduce the high maternal and child mortality.

The project is being implemented by the Community Working Group on Health (CWGH) in partnership with the Ministry of Health and Child Care in Matabeleland North and South provinces in an effort to increase the uptake of quality MNCH services in the region by raising community’s awareness about their health entitlements.

The project is a consolidation of another CWGH project, the Strengthening Community Participation in Health (SCPH) programme that ended in July this year.

Before the construction of the homes, institutional deliveries were very low as pregnant mothers preferred to give birth a home because of the long distances to the clinics.

Mothers would deliver in wheelbarrows or donkey-driven scotcharts on their way to the clinic, some 30 kilometres away.

Institutional deliveries have risen from an average five per month to between 15 and 20 deliveries following use of a WMH where pregnant mothers get free food rations bought using Results Based Financing (RBF) funds.

Councillor Jethro Moyo, an ex-officio member of the HCC at Mbizingwe clinic, said the committee played a huge role in raising awareness on the importance of delivering at the health centre. It also helped improving the once tense relations between communities and health workers a move that encourages people to freely seek medical services whenever they need them.

(HLFs have played a big role in encouraging pregnant women to go for ANC visits, this has greatly improved even the number of institutional deliveries as people are now aware of the dangers of delivering at home,” noted Moyo. “Long back, mothers and babies would die soon after deliveries and no one knew because these deliveries were not even reported.”

The CHWs use different strategies in raising awareness on health issues including door to door visits to educate communities on the Patients’ Charter.

HLFs and community monitors disseminate information and gather feedback on community views on access to services and this has assisted in coming up with proper plans for the facilities as their plans are guided by community needs.

The use of suggestion boxes by communities as a feedback mechanism has proven very popular and has assisted in improving the once frosty relations between the health workers and community.

“Before a suggestion box was put up, it was difficult for people share their grievances; hence that’s why there were perpetual conflicts between the staff and patients,” says Thusi village head, Willis Dube, who is also an HCC member at Esibomvu clinic in Umzingwane district.

The involvement of community leaders has seen an increasing number of men participating in health issues. It is now common to see men now accompanying their pregnant wives to clinics for pregnancy registration or other ANC visits.

“I always accompany my wife here (clinic) because I want to hear for myself the health status of my child,” said Themba Moyo as he arrived with his wife Thembelihle Moyo at Raafs Clinic for MNCH services. “I also need to constantly get checked for any diseases including HIV.”

The community participation in health drive in Matabeleland region has however been affected by the current hunger challenges as people prefer to work at food-for-work programmes that doing voluntary work at clinics. Hunger has also forced mostly men to seek the so-called greener pastures in countries such as Botswana and South Africa, a scenario that is attributed to the current high HIV infection rates in the region as spouses are not always together.

The National Aids Council (NAC) says Bulawayo and Matabeleland provinces have the highest HIV prevalence rate of 21,78% and 18,57% respectively, rates which are above the national average of 14,92%.

However, CHWs are optimistic that the current sustained health literacy campaigns that involve traditional leasers could help drastically reduced HIV infection rates in the region as communities would be aware of the importance of practicing safe sex and seeking treatment early.

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