Peer supervisors boost trust in Village Health Workers

In Zimbabwe’s Chimanimani district, a village health worker peer supervisor provides regular support to peers , develops their skills, and guides them in their roles so they can effectively meet the needs of the mothers and children.

Farai Mutsaka
Village Health Workers
UNICEFZimbabwe/2022/Timothy Manyange
21 February 2022

Chimanimani, Zimbabwe - It is early morning and Village Health Worker, Masiiwa Sikangata neatly arranges her medicine cabinet comprising basic commodities including  Oral Rehydration Salts, Zinc, gloves, digital thermometers, a malaria kit, facemasks, pills, MUAC tape, scale and a thermo scanner for COVID -19 screening in her home’s backyard in Zimbabwe’s Chimanimani district. She then sits, on her newly built cement bench to talk to a visiting domestic violence survivor who has found a safe space there.

Meanwhile, a mother and feverish child is among patients – mainly pregnant women, and new mothers – who stream in to her yard turning it into an improvised diagnostic and treatment point. Later, the 66-year-old prepares for her next task: going out to provide supportive supervision, on job mentoring and data quality audits to fellow Village Health Workers (VHWs).

“I take my time to plan on the topics to cover before I go out,” she said, referring to her work as a peer supervisor. She peruses through a book on danger warning signs for pregnant women.  “I train the VHWs on the basics, how they should approach people at their homestead to establish rapport, how to handle pregnant women, I tell them that what is not written is not done, so I ensure that they keep proper records of all the work they do and ensure that they complete the VHW data tools correctly.”

Village Health Workers
UNICEFZimbabwe/2022/Timothy Manyange

Then the idea of the backyard bench hit her. From the money she had saved from her ZIRP allowances, Sikangata bought two bags of cement for $20 and paid a builder to construct a bench on the periphery of her yard.

“To avoid too much talk and to ensure safety I decided to set up this bench. I no longer must consult people inside my home especially when it is raining or cold, given the COVID-19 challenges and the need to maintain physical distance. My clients are very much comfortable with this arrangement and they feel safe . My daughter later called and said ‘Mom, I heard you have a bench outside, that’s good you should continue’,” she said. “I can now do the work I love till I die. It wouldn’t have been possible without ZIRP support.”

The commitment shown by Sikangata highlights the tenacity of the people chosen to be peer supervisors, as well as the VHWs they supervise.

In Gudyanga area in the same district, Christopher Chikwindi is also a VHW peer supervisor supported by a local nurse, Violet Paivha, a nurse at Gudyanga clinic. These are health facility teams who were also trained by UNICEF to strengthen community based supportive supervision and integrate VHWs as part of the primary health care teams.

A peer supervisor typically visits “two or three” VHWs a month, observes them at work and using a checklist, notes their competencies and provides feedback. Areas that need improvement are then discussed at monthly meetings resulting in communities developing more trust in VHWs, said Paivha, who now has extra time to attend to her nursing duties and monitoring that help in disease intelligence.      

“In a village with 30 children for example we may get one or two being referred to the clinic, the rest are attended to by VHWs in the community. Before the peer supervision programme, community members did not quite trust the VHWs competencies so they would still come directly to the hospital. With the ongoing technical support from UNICEF, the intervention has moved from strength to strength mostly evidenced by the increasing number of children and mothers identified and followed up by VHWs ,” she said.

Pregnant women
UNICEFZimbabwe/2022/Timothy Manyange

UNICEF through ZIRP has supported the Ministry of Health and Child Care to support nine cyclone affected districts to ensure accelerated revitalization of basic health service provision. This support has been complemented by the Health Development Fund (HDF), with funding from the EU, UK Aid, Sweden, Irish Aid and  Gavi to scale up the implementation of high impact Maternal Newborn and Child Health (RMNCH-A) and Nutrition interventions  to improve equitable access and quality of health care across Zimbabwe, with special emphasis on women, newborns, children and adolescents.