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Village Health Workers engage community influencers to drive demand for health services

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BY FARAI MUTSAKA

Umguza, Zimbabwe – In a tiny office at Mbembesi rural health facility in Matabeleland North’s Umguza district, Thembinkosi Sibanda, a midwife, took stock of the numbers in the facility’s birth register. A contented smile followed. Seven deliveries from the hospital’s maternity wing for the month. Only a single home delivery.

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These are numbers she would hardly have imagined two years ago.

“We would usually record one or two deliveries here but most pregnant women would deliver in unsafe conditions at home,” said Sibanda, whose facility, surrounded by hard-to-reach rural and resettlement areas, now records between eight and ten births a month.

“It’s a turnaround,” she marveled, and, as if speaking to herself, added, “Job well done.”

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Yet, Sibanda refused to take responsibility for the change.

“They are the real heroes, the credit goes to them,” she said, pointing to a group of Village Health Workers (VHWs), local traditional and religious leaders and young people sitting in a shed for an advocacy meeting.

Village Health Workers have forged a transformative partnership with community influencers to increase demand for, and access to primary healthcare services as well as engender improved water, sanitation and hygiene practices.

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As part of interventions to strengthen primary health care services such as immunization, HIV services, non-communicable disease screening and treatment and health education, over 400 VHWs in 11 districts across several provinces recently underwent refresher training on how to intensify demand for services management and treatment of minor ailments at household level.

One of the results of those sessions, conducted by the Ministry of Health and Child Care in partnership with UNICEF and with funding from Gavi, the Vaccine Alliance, with funds from the Government of France., is the increased active participation of influential, authoritative, and trusted members of the community in amplifying the work of VHWs.

Authorities held community advocacy meetings with 1,500 key influencers who are trusted members of the community and included VHWs, interfaith and traditional leaders as well as young people such as peer educators to boost demand for COVID-19 vaccination, HPV vaccination, Vitamin A Supplementation and other vaccines amid successive outbreaks of measles, polio and cholera.

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The meetings, done at ward and village level in all the 11 districts involved in the project, also discussed issues like demand for neonatal and postnatal care, HIV testing and treatment, COVID-19 self-testing, adolescent health services and how to intensify awareness campaigns.
This kind of strengthening of primary health care support has contributed to increased referrals for vaccine hesitant groups and other children facing multiple deprivations. The Village Health Workers embarked on a journey to update their integrated Village Registers to record and account for every child in their respective communities and geo coding using ODK on their smartphones. Out of the 3,879 zero children identified in 2023 in Umguza District, 3,685 – representing 95 per cent – were successfully followed up and vaccinated. Out of the 9,165 zero dose children identified in 2022 in the urban areas of Harare, Bulawayo, and Chitungwiza, 8,706, representing 95 per cent, were successfully tracked and vaccinated. The Village Health Workers also recorded 24,424 under immunised children, with the majority referred or accompanied for vaccination.

Health authorities say they are roping in community influencers into some of their regular programmes to sustain the successes.

“Nowadays we also invite the influencers to the monthly meetings that we ordinarily have with Village Health Workers. They have become dependable partners for Village Health Workers in mobilisation and awareness campaigns,” said Sibanda, the midwife at Mbembesi health facility.

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Faith leaders have become key pillars in intensifying awareness and uptake of vaccines and other modern medicines among denominations whose doctrines undermine health seeking behaviours.

Traditional leaders such as village heads in the highly patriarchal community are now treating Village Health Workers, who are mostly female, as part of their inner circle.

Sheila Ncube is one of the 19 Village Health Workers providing a link between Mbembesi hospital and people in hard-to-reach communities that are part of the facility’s catchment population of over 8,000 people scattered across the vast district.

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With settlements opening up in the area, she needs her village head to point her to new inhabitants, who often lack basic water, sanitation and hygiene infrastructure and are also unfamiliar with health services offered in the area.

“The village head is the one who carries the word when I want people to gather for awareness sessions at a central point or when I am mobilising for campaigns such as vaccination. He is the one who helps me identify pregnant women in the village, he is my eyes and ears,” said the 70 year-old.

One of the village heads at the advocacy meeting, Lucky Sibanda, thinks the compliments belong to the Village Health Workers, whom he describes as his mentors. Sibanda said he was previously indifferent to the services of Village Health Workers – until COVID-19 struck.

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“They saved my community,” he said, referring to Village Health Workers. “They educated people on prevention and treatment and many people ended up overcoming their fear of vaccines.”

When his local Village Health Worker approached him for help to mobilise for measles, polio, cholera vaccines following the outbreaks, Sibanda gladly obliged.

“The Village Health Worker is now my chief whip. She is always by my side when I hold functions. I have made it a rule that no gathering proceeds before she speaks about health,” said Sibanda. He reckons he is also turning into a campaigner, thanks to his increased interactions with VHWs and health workers.

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Ongoing mentorship and coaching that has reached 2,200 health workers and Village Health Workers on issues such as integrated service delivery, data collection, consolidation, analysis and reporting also cascades to community members such as traditional leaders, turning them into cadres.

“She teaches me whatever she would have learned from the workshops she attends. She has equipped me with information so much that nothing escapes me anymore, HIV treatment defaulters, sanitation and hygiene red flags, underweight children and pregnant mothers. I alert her as soon as I notice something amiss,” he said.

Heavy with pregnancy, 28-year-old Polite Ndlovu is one of those grateful for the intervention after being nudged by her village head and Village Health Worker to register her pregnancy at the hospital.

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“I planned to go but I was procrastinating but they warned me and other pregnant women in the village about the dangers,” she said.

“I went to the hospital the following day,” added Ndlovu on the grounds of Mbembesi hospital, where she had gone for a routine check-up.

SOURCE: UNICEF

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Leaders commit to creating pathways for transformative education, skills development for children

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BY SIRAK GEBREHIWOT

Victoria Falls – A historic gathering of seven Southern African leaders, international representatives, over 7000 children and youth took place at Baobab Primary School in the resort town of Victoria Falls to commemorate regional World Children’s Day.

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The event, attended by dignitaries from across the southern Africa region, emphasized universal dedication to the rights and welfare of children, guided by the UN Convention on the Rights of the Child.

His Excellency President Emmerson Mnangagwa of Zimbabwe extending warm welcome to delegates, underlined the unity and shared goals of the Southern African Development Community (SADC). “Today is a powerful reminder of our collective duty to protect the rights of all children,” he affirmed.

President Mnangagwa’s speech underscored the importance of providing children with quality education and resilience against climate change, all while fostering their sense of identity and pride in their African heritage.

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The President expressed gratitude to regional counterparts, particularly President Duma Boko of Botswana, for participating in Zimbabwe’s festivities. In a gesture of regional solidarity, he acknowledged, “Though we hail from different nations, we share a common vision for a vibrant, educated, and united Africa.”

Mr. Edward Kallon, the UN Resident and Humanitarian Coordinator for Zimbabwe, echoed the President’s sentiments. He stressed the significance of this event as a platform to emphasize children’s rights, aligning with the Sustainable Development Goals.

“The UN2.0 and its quintet of change—embracing innovation, technology, and inclusivity—guides the United Nations renewed mission towards a brighter future for all children,” Mr. Kallon stated.

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He underscored the UN’s reinvigorated strategy, UN 2.0, aiming for transformational change with children at its core. Kallon called on all stakeholders to remain accountable to the children’s Call to Action, reinforcing the imperative to incorporate young voices in policymaking processes and national development programmes.

Education: A Pillar for Progress

UNICEF Regional Director, Ms. Etleva Kadilli, focused on the transformative power of education. She recognized strides made in various SADC countries that have prioritized digital learning, inclusive education, and curriculum reform. “These advancements illustrate that when governments and educators listen to children and act, significant progress can be achieved,” Ms. Kadilli underlined.
Kadilli acknowledged the persistent challenges facing sub-Saharan Africa, where educational disparities remain stark. She encouraged children present, stating, “Your voices are vital. When you speak, you not only shape your future but ours as well.”

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Collective Regional Pledge

His Excellency President Duma Boko of Botswana accepted the honor of hosting the next World Children’s Day commemoration. He pledged his administration’s dedication to addressing the needs and aspirations voiced by the children and youth. “We stand ready to work with you, empowering our children to lead with wisdom and courage,” President Boko assured.

Senior officials from Zambia, Namibia, Mozambique, Malawi, and South Africa echoed these commitments. They affirmed their governments’ resolve to enhance children’s access to quality education, healthcare, and social protection, reinforcing their rights as a priority.

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Empowering Through Culture and Heritage

The celebration also spotlighted the role of arts, culture, and heritage in building inclusive societies. President Mnangagwa stressed the importance of embracing cultural identity and utilizing natural resources to foster development and unity. “Let us, together, promote our unique cultural products and enhance our children’s understanding of their heritage,” President ED Mnangagwa encouraged.

Combating Emerging Threats

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Addressing contemporary challenges such as climate change and drugs and substance abuse, President Mnangagwa reaffirmed Zimbabwe’s commitment to combating these issues through strategic initiatives like the Presidential Borehole Drilling Scheme and the establishment of Child-Friendly Courts. “Our measures ensure that all children, particularly the vulnerable, have their rights upheld and their futures secured,” he stressed.

A Call to Action and Hope

Ms. Etona Ekole, UNICEF Representative for Zimbabwe said, “This World Children Day, I am incredibly proud to see children from Botswana, Namibia, Malawi, Mozambique, South Africa, Zambia, and Zimbabwe raising their voices for change. Their Call-for-Action is a testament to the power of listening to children and investing in their future.

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The event underscored a unified call to invest in children as Southern Africa’s future leaders. With collaborative resolve, the leaders and stakeholders committed to translating discussions into concrete actions, guided by the insights and demands of the children and youth.

Facilitating a call to action from children and youth representatives across seven countries, Ms. Sithabile Mtigo, Speaker of the Junior Parliament of Zimbabwe, highlighted the critical role of young advocates throughout Africa. She declared, “We are the leaders of both the present and the future for Africa.”

The Regional World Children’s Day served as a reminder of the shared journey towards a future where every child’s rights and potential are realized, and every opportunity leveraged.

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The commitment made in Victoria Falls to “Educate and Skill the African Child for Posterity” is not only a theme but a driving mission as the African continent marches towards a brighter, more inclusive tomorrow.

SOURCE: Sirak Gebrehiwot is UN Partnerships and Development Finance Advisor at the UN Resident Coordinator’s Office in Zimbabwe

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Botswana’s president concedes defeat in election, ending ruling party’s 58 years in power

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BY STAFF REPORTER

Botswana’s President Mokgweetsi Masisi conceded defeat in the general election Friday, in a seismic moment of change for the county that ended the ruling party’s 58 years in power.

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Masisi’s concession came before final results were announced, with his Botswana Democratic Party trailing in fourth place in the parliamentary elections.

The main opposition Umbrella for Democratic Change held a strong lead in the partial results, making its candidate, Duma Boko, the favorite to become president of a southern African country that is one of the world’s biggest producers of mined diamonds.

Masisi said he had called Boko to inform him he was conceding defeat.

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“I concede the election,” Masisi said in an early-morning press conference two days after the election. “I am proud of our democratic processes. Although I wanted a second term, I will respectfully step aside and participate in a smooth transition process.”

“I look forward to attending the coming inauguration and cheering on my successor. He will enjoy my support.”

Masisi’s BDP dominated politics in Botswana for nearly six decades, since independence from Britain in 1966. The nation of just 2.5 million people will now be governed by another party for the first time in its democratic history.

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SOURCE:AP

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Zambia offers health care to Zimbabweans — but for how long?

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Illustration Credit: Wynona Mutisi for Global Press Journal

BY GAMUCHIRAI MASIYIWA

Summary: Zambia is as generous with patients from neighboring Zimbabwe as it is with its own citizens. That could mean problems for both countries.

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This story was originally published by Global Press Journal.

MASHONALAND WEST, ZIMBABWE — When Dube was diagnosed with gallstones in 2013, the public hospital in Zimbabwe recommended surgery costing close to 4,000 United States dollars. She couldn’t afford that.

 

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A friend suggested she go to Zambia, about 150 kilometers (94 miles) to the north. There, the friend said, treatment would be cheaper.

 

Over the past decade, Dube has gone to Zambia multiple times for medical treatment. Her most recent trip was in June. Treatment is cheaper there, she says, but the level of care is also far better than what she would get at home. Dube asked that Global Press Journal use her totem name, a symbolic representation of ancestral lineage, out of concern about Zimbabwe’s Patriotic Bill, which discourages criticism of the government.

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In the 1980s, Zimbabwe had one of the best health care systems in sub-Saharan Africa. But over the years, this glory has faded. An ongoing economic crisis spanning over two decades has left the health care system scrambling to meet the needs of its population. Skilled health care workers have left in droves, drawn to opportunities abroad. More than 4,000 health care workers left Zimbabwe in 2021 and 2022 alone, according to government statistics. By late 2022, Zimbabwe had about 1,700 doctors and about 17,200 nurses to serve a population of 15 million people.

 

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Just as health care workers are leaving the country, so are patients.

 

Over the past decade, Zimbabweans have spent more than 4 billion US dollars on cross-border medical migration. Annually, more than 200,000 Zimbabweans spend around 400 million US dollars on specialized medical treatment abroad. India, China, Singapore and South Africa are the main destinations.

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But an increasingly popular choice is neighboring Zambia. In April alone, the International Organization for Migration surveyed over 260 people migrating from Zimbabwe to Zambia. When asked why they were traveling, 42% stated that it was to access better services — health being the top priority.

 

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Precise data is hard to come by, but anecdotal evidence from sources who spoke to Global Press Journal, including border officials, points to a growing trend, raising questions about Zambia’s ability to manage the influx, and the future of health care in Zimbabwe.

 

The choice of Zambia

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Zambia and Zimbabwe allocated nearly the same amount of money to their health sectors in 2024, even though Zambia is home to 4 million more people. With that budget, it’s an unlikely alternative to the Zimbabwean healthcare system. And in Africa, it’s South Africa and Kenya that are top destinations for medical tourism.

 

But the border with Zambia isn’t far for many Zimbabweans, making the cost of travel low and the process of crossing the border usually straightforward. A person needs either a passport or a pass issued at the border for just 1 US dollar, says Morgen Moyo, assistant regional immigration officer at the Chirunduborder post.

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Even without documentation, immigration officials will at times let those seeking health care pass through. “Zambians prioritize life,” Moyo says.

 

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It’s not only about convenience. Zambia offers free primary health services, including basic treatment, preventative care, vaccinations and maternal health care services, according to the 2022-2026 Zambia National Health Strategic Plan.

 

While these free services are not available to foreigners long-term, they can access them in emergencies within the first 24 to 48 hours in the country, says Dr. Kennedy Lishimpi, permanent secretary of administration for the Zambian Ministry of Health. Foreigners are expected to pay for Zambian health care after that timeframe.

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In practice, though, Zambian health workers rarely charge foreigners, according to a 2019 study paid for by the US Agency for International Development, known as USAID.

 

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“You wouldn’t want to see somebody from Zimbabwe, for instance, getting to Zambia and not accessing a service and then they end up dying. That is not good. Similarly, we expect that our sister countries do the same to our citizens when they are there,” Lishimpi says.

 

Dr. Mwanza, a Zambian doctor who chose to use only his last name for fear of retribution, says availability of surgical and specialist services in Zambia drives medical migration. In Zimbabwe, these services are rarely available outside of the large provincial and central hospitals. In 2019, for example, about 10% of district hospitals could provide basic surgeries, compared to 83% of provincial and central hospitals, according to a Zimbabwe health ministry assessment.

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When Mary Chipfuvamiti’s son broke his arm in June, she says she chose a hospital in Zambia — about 93 kilometers (nearly 58 miles) from her home — over local options. She suspected the local hospital’s X-ray machine wouldn’t be working, and they would likely refer her to a private facility where an X-ray would cost her 40 US dollars.

 

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“I only had 30 dollars on me,” she says. In Zambia, the total cost came to about 12.50 US dollars.

 

A case for Zimbabwe

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Things haven’t always been like this in Zimbabwe. Before the country’s economy took a downturn, it offered free health services in the 1980s to low-income earners. About 90% of the population fell in that bracket.

 

In the early 1990s, the government introduced user fees in public health facilities as part of the austerity measures imposed on the government by the International Monetary Fund to reduce government expenditures. Currently, free health services are offered only to pregnant and lactating mothers, children under age 5 and adults over 60.

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The economic crisis continues to strain what remains of the health care system. Hospitals struggle with obsolete infrastructure. Shortages of medicines and supplies in public health facilities are the norm.

 

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And although Zimbabwe and Zambia have similar health budgets, Zimbabwe’s treasury sometimes delays funds disbursement, says Norman Matara, secretary general for the Zimbabwe Association of Doctors for Human Rights.

 

That was the case in 2021, when the health ministry by September had used just 46% of its budget allocation for the fiscal year due to late disbursement of funds, according to a 2024 situational report by the Zimbabwe Coalition on Debt and Development, a nongovernmental organization that advocates for socioeconomic justice.

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“There is a mismatch between the money that is put on the budget and what is being received by the health institutions,” Matara says. Reasons include hyperinflation and currency rate fluctuations, he adds.

 

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Comparing health services across countries is unfair, says Donald Mujiri, a Zimbabwe health ministry spokesperson. “Each country has its set standards and pricing.”

 

He doesn’t think this migration of patients reflects poorly on Zimbabwe’s health care system. “We have all the services in the country, and they are adequate to serve the people,” he says, adding that people are free to seek health care where they want.

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Mujiri did not address questions regarding the late disbursement of funds.

 

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The cost of the journey

These journeys to Zambia come with challenges.

 

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Dube recalled her trips along the bumpy Harare-ChirunduHighway that connects the two countries, when every bump caused piercing pain.

 

In 2019, six years after her initial treatment in Zambia, she began experiencing severe pain. She went to a hospital in Harare for treatment, but a few months later the pain resurfaced. By that time, there was a health care strike at home, forcing her back to Zambia for treatment. Then in 2023, Zambian doctors discovered metal clips from her earlier surgery in Zimbabwe were piercing her liver. She returned to Zambia in January this year for corrective surgery, and again in June.

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Health care experts warn that such journeys can be especially risky for patients who undergo surgery. If a surgery is performed in Zambia and there is no proper follow-up, there can be complications if doctors in Zimbabwe are unaware of previous procedures or tests, says Mukanya, a health expert working in a Zimbabwean hospital who chose to use his totem, fearing that speaking to the media would cost him his job.

 

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In the case of misdiagnosis or malpractice in a foreign country, it’s difficult to get recourse. “In most cases you are powerless because you don’t know the [reporting] process and approaching a lawyer may require money,” he says.

 

Medical migration also comes at a cost to Zambia. The influx of patients complicates health planning, leading to shortages of essential medications and making it difficult to allocate resources effectively, according to USAID. The agency’s report recommends the Zambian government create a fee-for-service system to discourage foreigners from seeking free health care, but doctors in Zambia don’t seem to agree.

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“Most health care providers interviewed stated that they would continue to provide services free of charge should a foreign patient be unable to pay,” according to the USAID report.

 

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Lishimpi, the Zambia health ministry official, had no comment on the report’s concerns.

 

Dube, who is recuperating at home, is uncertain about the solutions. But she thinks the Zimbabwean government needs to prioritize fixing her country’s health care system. “I don’t know how best we can help our hospitals, but if there was any other way, I think they should consider the health sector more than anything else because we are talking of human life,” she says.

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Gamuchirai Masiyiwa is a Global Press Journal reporter based in Harare, Zimbabwe.

 

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Global Press is an award-winning international news publication with more than 40 independent news bureaus across Africa, Asia and Latin America.

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