A lifeline in crisis and after: Village Health Workers fight cholera outbreak and foster resilience

Gatshe – Rosemary Janyure, who lost a close relative to cholera, hugged Village Health Worker (VHW) Lenia Matekenya like a long-lost friend, even though they had only met a few days prior. 

Janyure was devastated when her daughter-in-law succumbed to cholera in November 2024. "I was the one taking care of her before she died. I feared I would be next," she admitted outside her home in Nyamhunga village, Kariba district's Ward 2—the outbreak's epicentre.

However, Matekenya, a seasoned VHW, stepped in with life-saving care and critical information that gave Janyure hope.

Beyond emotional support, Matekenya provided essential water treatment and sanitation supplies, educated Janyure about cholera prevention and symptoms, and continued to conduct follow-up visits to ensure the family maintained safe practices.

"I wouldn't be alive without her," said Janyure, who lives with her seven-year-old son.

In early February, the Ministry of Health and Child Care in early February declared the outbreak—first reported in November—contained after a rapid multi-sectoral response that included improving sanitation, hygiene practices, and access to safe water. Various government agencies, UNICEF, and partners such as Welthungerhilfe worked together to reach to about a million people, 520 females and 480 males, in Kariba, Chitungwiza, Bulawayo and the capital city, Harare, with funding from the European Civil Protection and Humanitarian Aid Operations (ECHO).

The response included setting up an emergency Cholera Treatment Centre and distributing critical supplies such as water treatment tablets, water guards, soap, tapped buckets, and jerry cans. Borehole rehabilitation, school toilet construction, technical training, and awareness materials have strengthened the community and helped it better prepare and respond to waterborne diseases such as cholera and typhoid.

VHWs: The foot soldiers of emergency response

However, authorities emphasise that these efforts would be far less effective without the dedication of VHWs, who played a crucial role in bridging the gap between communities and health services.

When cholera struck, Gatshe Gatshe Clinic had only two nurses. Four additional nurses were deployed from the district hospital, but the bulk of community work fell on an army of volunteer VHWs.

“They distributed supplies, taught hygiene practices, and raised awareness,” explained Portia Chindewere, the clinic’s nurse-in-charge. “When the first cases emerged, we panicked because we were so few and this area is vast. But the VHWs jumped into action. They are the critical link between the clinic and the community.”

Today, the clinic's tent, once filled with cholera patients, stands empty—a testament to the success of the intervention.

Early detection, prompt treatment

The clinic relies on 14 VHWs, each serving dozens of households spread across the rural landscape. Often, these workers were the first responders, detecting cases early and ensuring affected individuals received prompt treatment.

The Ministry of Health and Child Care describes VHW, primarily women, as the backbone of Zimbabwe’s public health system, particularly in the wake of high staff attrition. Chosen by their own communities, VHWs enjoy unshaken trust and influence among local people, making them crucial drivers of health awareness and service uptake.

In Gatshe Gatshe, Matekenya often had to persuade religious hardliners, who resisted modern medicine, to seek proper treatment.

“Some rely on holy water or untested home remedies,” she said. “Convincing them is tough, but I succeeded in many cases. Sometimes, I even accompanied them to the clinic.”

From emergency response to long-term prevention

Though the outbreak has been contained, Matekenya knows her work is far from over.

“People follow hygiene rules strictly when there’s an outbreak, but they relax once the danger seems gone,” she noted. “That’s why we are doubling our efforts to prevent cholera from returning.”

During a recent visit to Janyure’s home, Matekenya inspected the yard for hygiene and reinforced safe water practices. She asked how often Janyure was treating her water and took notes. She used a handheld comparator to conduct a free residual chlorine test on the family’s stored drinking water.

“All is good, the yard is clean, and the water is safe. Keep it up, don’t stop,” she encouraged Janyure before heading to the next household.