Village Health Workers reaching the last mile on two wheels
UNICEF’s work through ZIRP has evolved to include COVID-19 responses and mitigating challenges faced by grassroots community-based health personnel such as Muyambo.
Having trudged dozens of kilometres in rugged terrain to reach beneficiaries in Zimbabwe’s remote Chipinge district Miranda Muyambo, a Village Health Worker (VHW) describes her bicycle as the ‘perfect gift’, amid the extra demands on her role through the outbreak of COVID-19.
Limited access to health services for communities living further away from health facilities means village health workers such as Muyambo need to create connections between these vulnerable populations and health providers to help improve access and coverage of basic health services. Further, pregnant women, malaria patients, children needing Vitamin A and growth measurements all depend on her when they cannot make it to a hospital or clinic.
“The terrain is rough here and some people live in places that are difficult to reach but I have to reach them, so I walked. It was tough,” she said. Her trips involved bush paths and rugged dirt roads up and down the valleys and mountains where homesteads are perched.
Then in April 2020, the gift came. Bicycles for 400 VHWs were procured by UNICEF through the World Bank supported Zimbabwe Idai Recovery Project (ZIRP).
ZIRP is a 4-year programme established after Cyclone Idai ravaged parts of the Eastern provinces of Manicaland, Mashonaland East and Masvingo provinces in early 2019.
UNICEF’s work through ZIRP has evolved to include COVID-19 responses and mitigating challenges faced by grassroots community-based health personnel such as Muyambo. Reaching the 186 households in her Dimire village close to the Mozambican border is now much easier since receiving the bicycle, she said.
“Right now, I am constantly moving around the village teaching people about COVID-19 and also monitoring their compliance to the guidelines recommended by the Ministry of Health and Child Care. It would have been almost impossible for me to do effective door to door campaigns on foot, the village is too big,” said Muyambo, taking the bicycle onto her verandah to shield it from the pounding rains.
The support under the ZIRP increased the number of VHWs that received bicycles this year to 2,400 complementing 2,000 that were procured by the Health Development Fund (HDF) donors in 31 rural districts across the country for improved access to marginalised areas and health facilities. More importantly, they are now able to get to people in hard to reach places, ensuring that no one is left behind in the fight against COVID-19 and other diseases such as malaria which are historically prevalent in the area. The HDF is supported by the EU, UK Aid, Sweden, Irish Aid and Gavi.
Before, Muyambo would walk 4 kilometres to Mt. Selinda Hospital to collect commodities such as malaria testing kits, medical supplies and information material. To visit the households in the village, Moyana said she sometimes walked longer distances.
“As volunteers we are expected to work 24 hours a week and the rest of the week is personal time. Without a bicycle it was difficult to reach all targeted households per week. Now I can cover at least 20 households in a single day and still find some personal time, before I would reach only 6 households. Where I walked for more than an hour to the hospital to collect commodities, submit reports or attend training I now just need 15 minutes,” she said.
Without dedicated and empowered VHWs such as Muyambo, the fight against COVID-19 and other diseases would be lost, said Tsitsi Nyanhete, the Ministry of Health and Child Care district Health Promotion Officer for Chipinge district.
“When COVID- 19 started, many people were unable to go to health facilities to access treatment and other health services, so village health workers played a key role to collect the list of people that were sick, the type of ailments and where people had known chronic conditions. VHWs would go to the clinic and collect medication on their behalf. For ailments within their mandate of work, VHWs continued working in communities, screening children for malnutrition, treating children for diarrhoea, counselling of pregnant and lactating women, distribution of family planning pills and the like,” said Nyanhete.
To date, at the end of January 2021, VHWs in Chipinge district reached more than 200,000 children under five with integrated services, screened nearly 35,000, treated nearly 12,000 for malaria, and identified over 2,000 pregnant women for early ante-natal care (ANC) bookings at 14 weeks.
“Pregnant women are unable to access health facilities during the lockdown, VHWs became instrumental in keeping records of pregnant women, checking for any danger signs and facilitating referral to the nearest health facility,” said Nyanhete.
“Where urgent transportation was required, we would work with the community leaders and Health Centre Committees to arrange for transportation. In some instances, the bicycle became instrumental as a mode of transport to ferry pregnant women or sick children to the health facility”.
“Increased access is also instrumental in the COVID-19 awareness programmes. We may talk about prevention methods, but it is the VHWs who carry those messages to the people. Village Health Workers travel long distances, very far from health facilities so these bicycles help them reach people who otherwise would be very difficult to reach,” she said.