Healthcare at the Doorstep

...  The Essential Role of Community Health Workers in Zambia

Bu Francis Maingaila 

Lusaka, Zambia — (8-10-2024) - Community Health Workers (CHWs) in Zambia play a critical role in bridging the healthcare gap for rural and underserved communities. 

In areas where formal healthcare facilities are limited, CHWs provide essential services, especially in remote regions like Western Province. 

In districts such as Kaoma, CHWs often serve as the first point of contact for pregnant women and young children. 

CHWs deliver antenatal care, assist with safe deliveries, and monitor child development. 

Dr. Kalangwa Kalangwa, a health policy expert, emphasized, "CHWs are critical in early maternal care and child health services because they reach areas that traditional healthcare systems cannot." 

One CHW added, "We educate mothers on maternal health, monitor pregnancies, and identify complications early on," contributing to reduced maternal and infant mortality rates.

CHWs also address malnutrition, which is prevalent in rural areas. In the Northern Province, they run nutrition programs for undernourished children and promote sustainable practices like kitchen gardening.

 Wanga Zulu, a community health expert, explained, "Their work in nutrition education is key to improving food security and child health." 

One CHW noted, "We teach families how to make the most of locally available foods, which has improved children's health."

Given the high prevalence of HIV/AIDS and malaria in Zambia, CHWs promote prevention strategies and conduct rapid diagnostic tests. 

In Southern Province, they distribute mosquito nets during the rainy season and provide HIV-related services in Lusaka’s peri-urban areas. 

Dr. Kalangwa Kalangwa, who also serves as the Ministry of Health Spokesperson, stated, "CHWs are a critical link in fighting HIV and malaria, ensuring patients can access ongoing care."

In areas with limited infrastructure, CHWs provide basic healthcare, including treating minor ailments and assessing urgent cases.

 In Eastern Province, they recognize symptoms of severe dehydration in children with diarrhea, administer oral rehydration solutions, and arrange transport to health facilities when necessary. 

Dr. Kalangwa Kalangwa concluded, "Without CHWs, many in these communities would suffer severe outcomes from treatable conditions." By offering immediate support, CHWs are indispensable to Zambia’s public health system.

Despite their significant contributions, Community Health Workers (CHWs) face numerous challenges that hinder their effectiveness. 

A major issue is inadequate compensation; many work on a volunteer basis or receive minimal pay, often as low as $50 per month, which is insufficient to cover basic living expenses.

 In rural areas like Luapula and Muchinga Provinces, CHWs are often forced to walk long distances to visit patients, but their stipends "do not cover transportation costs, let alone food and housing," according to a local CHW from Luapula. 

This financial strain forces many CHWs to juggle their health work with other jobs, diverting focus from healthcare duties.

The inadequate pay leads to high turnover rates, with many CHWs leaving for better-paying opportunities.

A 2023 Ministry of Health report revealed vacancies at several rural health centers in Eastern Province due to the inability to retain trained personnel. 

One health official noted, “The turnover rate among CHWs in rural areas is alarming, as many leave for other jobs that offer better compensation.” 

This departure disrupts service delivery, particularly in remote areas, and hinders continuity of care.

A 2022 University of Zambia study found that CHWs who are not adequately compensated are less motivated to perform effectively. 

In places like Chongwe District, CHWs often rely on personal funds or community donations to cover travel costs and medical supplies. 

One CHW from the area shared, “I often use my own money to travel and buy supplies because the stipend is not enough. 

It’s hard to stay motivated when you’re struggling to make ends meet.” This financial strain reduces the quality of care and impacts community health outcomes.

In Zambia, the challenges related to training and resources for Community Health Workers (CHWs) are indeed critical and can be seen through practical examples. 

One significant issue is the lack of formal training. Many CHWs are often volunteers or have received minimal training, which affects the quality of care they provide. 

For instance, during the cholera outbreaks in 2017, CHWs were on the front lines, trying to educate communities about sanitation and hygiene. 

However, due to a lack of formal training in disease management and health education techniques, their efforts were not as effective as they could have been. 

"Training programs were not consistent or standardized," said one CHW from Lusaka, "leaving many of us inadequately equipped to handle such public health crises."

Furthermore, during the COVID-19 pandemic, the shortage of personal protective equipment (PPE) highlighted the lack of resources available to CHWs, particularly in rural areas. 

Many CHWs continued their work without sufficient PPE, such as masks, gloves, or gowns, despite being at high risk of contracting the virus. 

"I had to use a cloth mask and gloves that I had to reuse," said a CHW in the Copperbelt region. 

"We didn’t have enough PPE, and the risk was high." 

In some cases, CHWs reported that they had to make do with improvised protective gear or none at all. 

This situation emphasized the dire need for better resource allocation and support for these frontline workers. "We were left exposed, but we continued to serve our communities," added a CHW from Lusaka.

Moreover, the Health Ministry and non-governmental organizations (NGOs) have occasionally responded by providing training and materials, but these resources are often insufficient. 

"In rural areas like Eastern Province, CHWs struggle to access up-to-date training materials," explained a health expert from the region. 

"They might receive basic first aid and maternal health training but lack continuous education on new diseases or treatment methods." 

This limits their ability to provide optimal care, particularly in the face of emerging health threats. A CHW from Eastern Province highlighted, "We are often left in the dark when it comes to understanding new health challenges."

The COVID-19 pandemic further underscored the critical need for improved training and resources.

 While some CHWs were equipped with basic COVID-19 educational materials, many lacked the advanced training necessary to handle the complexities of the virus. 

"We were given pamphlets and a few online sessions, but that wasn’t enough to help us manage COVID-19 cases," said a CHW from Livingstone. 

"We didn’t know how to properly handle suspected cases or manage the spread effectively." 

This gap in training and resources put both CHWs and their communities at risk, as CHWs are often the first point of contact for those seeking medical attention. 

"If we had received better training, perhaps more lives could have been saved," a CHW from Kitwe reflected.

Recognizing the importance of CHWs in achieving universal healthcare, the Zambian government has increased funding for community health programs and improved CHW training. 

For example, the Community Health Assistant (CHA) Program was launched in 2019 to address healthcare shortages in rural areas. However, advocates argue that these measures are insufficient. 

CHWs often face delays in receiving essential supplies and financial support, limiting their effectiveness. 

Many report inadequate training and lack of ongoing professional development, particularly in rural regions.

Community health expert Wanga Zulu highlights, “Supporting CHWs is not just about fairness; it’s about building a healthcare system that works for everyone.”

 CHWs are essential in bridging the gap between health facilities and remote communities, but their impact is hindered by low wages, poor working conditions, and insufficient recognition. 

In 2022, CHWs went on strike over poor remuneration and limited career advancement. 

Some are even forced to use personal funds for transportation and medical supplies.

To build a healthcare system that works for everyone, the government must provide better funding, training, and compensation for CHWs. 

Without these improvements, the potential of CHWs to contribute to universal healthcare will remain unrealized.

Investing in Community Health Workers (CHWs) could significantly improve healthcare access and quality across Zambia.

 As former Minister of Health Dr. Chitalu Chilufya emphasized, “Strengthening the role of CHWs is essential to achieving universal health coverage in Zambia.” 

CHWs are often the first point of contact for healthcare in rural and underserved areas, ensuring access to essential services like immunizations, antenatal care, and treatment for common illnesses. 

For instance, the Zambia Ministry of Health’s Community Health Assistant (CHA) program has successfully placed health assistants in remote communities, bridging the gap between healthcare facilities and the people who need them most.

Enhancing CHWs' training, compensation, and resources would enable them to perform their roles more effectively. 

The Integrated Health Systems Strengthening (IHSS) Project, which trains CHWs in maternal and child health, nutrition, and sanitation, has equipped workers to manage diseases early, reducing the need for costly hospital interventions. 

In maternal health, CHWs have helped reduce maternal deaths by identifying high-risk pregnancies and referring them for proper care—aligning with Dr. Chilufya’s goal of reducing maternal mortality in Zambia434  . 

As he stated, “Community Health Workers are pivotal in reducing maternal and child mortality by providing essential health services right at the doorstep of those who need them most.”

Improved compensation, as advocated by the Zambia Health Workforce Support Program (ZHWSP), would motivate CHWs to remain in their communities and provide consistent care. 

Dr. Chilufya was a strong supporter of improving healthcare workers' welfare, recognizing its direct impact on the quality of care. He once remarked, “A motivated workforce is a productive workforce, and ensuring that our CHWs are adequately supported is key to the success of our healthcare system.”

Investing in CHWs would also reduce preventable diseases and ease pressure on formal healthcare facilities. CHWs have been pivotal in Zambia’s malaria prevention efforts, distributing insecticide-treated nets and educating communities, which has significantly reduced malaria cases.

This community-driven approach has alleviated the strain on hospitals and is a success story frequently highlighted by Dr. Chilufya. “