Impact of Rural Health Motivators

The Shewula community area in the Lubombo region of Eswatini is incredibly beautiful and remote. Residents rely heavily on family and community support as there is limited access to general public services and it is many hours of travel to the nearest health facility.

Nomvula Madvolo (38) was born and raised in Shewula, and this is where she is raising her four children aged between 12 years and 19 months. Raising a family in this isolated area is not easy and daily challenges are compounded by poverty and limited nutrition. Her youngest girl, Thandiswa, was diagnosed with malnutrition and stunted development at around 12 months of age, further adding to Nomvula’s struggle to build a life for her family.

Mothers such as Nomvula rely heavily on the Rural Health Motivators (RHM), who are community health workers under the Ministry of Health. UNICEF and other partners such as World Vision contribute technical and funding support to the RHM programme towards implementation of various specific activities or interventions. In this instance, UNICEF provided funding support through World Vision for training of the RHMs in the Lubombo region on a variety of issues such as: Infant and Young Child Feeding (IYFC), hygiene and sanitation, importance of immunization, early childhood stimulation and community based growth monitoring including early identification of malnutrition through screening. Such training of RHMs has helped in bridging the gap between this remote Shewula community and access to healthcare.

Once a month, Nomvula brings her youngest child to the Neighbourhood Care Point (NCP) where RHMs screen the development of all children in the area and give health education talks on health, good nutrition, early childhood development and hygiene practices. “I can’t afford transport to any of the hospitals or clinics, so having the RHMs come to our area once a month is the only time I can have my child  checked,” says Nomvula, “the RHM’s are also very helpful to give us advice on the best food to grow and feed our children to help them grow properly.”

During the monthly screenings, the RHM’s monitor children in four different age groups:

• 0-5 months
• 6-11 months
• 12-24 months
• 25-59 months

According to Phumzile Sifundza, the lead RHM in the area, “We screen the children according to weight, height, mid upper arm circumference (MUAC), and checking for edema (swelling of feet). Doing these tests gives us an opportunity to identify children that are at risk of malnutrition and those that are thriving. If we find severe cases, we refer them to the nearest health facility for appropriate management. However, the reality is that most mothers can’t afford to take their children there, even with a referral slip in their hands. That is why our work is so important – we need to ensure these children stay healthy and don’t get to the point where they require treatment.”

Little Thandiswa, however, did reach a point of underdevelopment where the RHMs insisted she be taken to hospital at the age of 12 months. “She was so weak,” says Nomvula, “and I knew she wasn’t growing the same way my other children had. I think it had a lot to do with a very stressful pregnancy and a lot of financial struggles that I went through after she was born. I just couldn’t give her everything that she needed.”

While the numbers of malnourished children in the region seem to be declining, it is difficult to get consistent data and RHMs can only make observations based on what they see in the communities. “I know the RHM programme is making a difference, because I see the same mothers and children every month and I see the improvements,” says Phumzile.

The RHMs also conduct regular house visits, especially with families where children have been identified as at risk of malnutrition or disease. “Every month the RHM comes to my house,” says Nomvula, “and she assesses Thandiswa’s development. She teaches me what I must do to help stimulate her and help her grow and looks at what we are eating. She is very helpful with suggestions of what I can feed my child and where I can get or even grow certain foods.”

Over the past few months Thandiswa has made notable progress. She is not yet at the same developmental level as the average 19-month-old, but she is stronger, more responsive and happier according to Nomvula.

The RHM programme plays a crucial role in areas such as Shewula and for individuals like Nomvula and Thandiswa. They are the residents’ only link to any kind of regular healthcare and mothers rely on their RHMs for support and advice to help their children thrive.

“The RHM’s have been a very big help with my child and I am extremely grateful for all I have learned from them. It is comforting to know I have their support and I can ask them anything if I am worried about my child. They always help me the best they can, and I am confident that Thandiswa will continue to grow stronger and develop as she is meant to,” says Nomvula.

In addition to the funding support for RHM training, UNICEF supported procurement of anthropometric equipment such as weighing scales, height boards and MUAC tapes. The RHMs play a critical role during emergencies as they conduct screening of children for malnutrition, identification of vulnerable children and making necessary referrals for appropriate management.