At the service of health

Tanzania Amida Nachucha tells her story with shining eyes. Almost seven years ago, she and her husband could not believe that their boy Rajabu, born two months prematurely, had a chance of survival. In their society, a premature birth means a great risk of losing the child. There is a widespread belief that a premature birth brings bad luck to the whole family. Amida and her husband Abbas were deeply saddened and prepared for the worst. After a few days at the health center, they received a visit from Manfred Pius Lyoga, a community health worker. "Manfred showed me how to hold my baby directly against my upper body - skin to skin. This is to help the little one survive." Amida reports. Unfortunately, at the time, there was no kangaroo mother care station like there is today and built by SolidarMed. Manfred was able to help the baby in other ways as well. "He encouraged both of us that our boy would survive and showed us exactly how to handle him - including breastfeeding, for example." Amida, her husband and everyone else in the village could hardly believe that Rajabu, who was once born much too early, was developing splendidly. Without the community health worker, the little boy might not have survived and would hardly be a happy schoolboy now.

Although great strides have been made in providing health care to the population of some countries, like Tanzania, within the last few decades, it remains inadequate for pregnant women and newborns. The number of miscarriages
as well as maternal and infant mortality remain high. SolidarMed is therefore committed to strengthening primary health care with a focus on these vulnerable groups. Activities in the village play a major role in this.

Link to the health system

Community health workers like Manfred are members of the community who are equipped with elementary, basic knowledge and with materials and tools to carry out activities in the village. Since they usually come directly from their community and are also elected by it, they enjoy a high level of acceptance and bring with them the necessary cultural awareness. They represent the important link of the often very remote villages to the health system. At the same time, they promote disease prevention by raising people's awareness of various health issues. They often break down prejudices about conventional medicine among the people and can thus, for example, consolidate acceptance of pregnancy checks or the correct care of premature babies. Particularly in view of the massive shortage of health workers in Africa and the very uneven geographical distribution, village health advisors have become indispensable pillars for better health care.

Mozambique
In the rural and remote district of Namuno in Mozambique, traditional birth attendants also enjoy great respect. They too are selected directly from the village community. Their task is to accompany pregnant women from their village to the regular check-ups and to the birth. This is often time-consuming work that is not compensated by the health authorities. And yet Maria Mussa (38) has been performing this important task for more than ten years. In the rainy season, it is particularly difficult to reach the nearest health center in Namuno. A river lies insurmountably in between. Therefore, she has to transport the pregnant women on her bicycle to the more remote Ncumpe. She has also accompanied women with serious complications to the hospital in Montepuez, three hours away, on several occasions so as not to leave them alone during this difficult time when the family could not be present. Maria is a great role model for other traditional birth attendants. In a meeting organized by the district health authorities together with SolidarMed, she received an award in 2020 for her important work. She accompanied 77 women during the birth of their babies throughout the year and provided medical care in this important moment.

Strengthening mental health

Zimbabwe Violet Machokoto began her journey as a village health worker in 2015, one of the few to gain the trust of the community in her area, and participated in a six-week training for community health workers. To promote mental health care and reduce the burden on health facilities, SolidarMed has been supporting the introduction of the so-called Friendship Bench initiative in Zaka district, Masvingo province, since 2019. This involves training community health workers to counsel individuals on the most common mental health disorders. Violet was selected to receive this additional training. Therefore, she counsels people with mental health problems because there are no other mental health services available. In this work, she has had some very encouraging and heartwarming moments where she has been able to significantly support people in their lives. As for example with Sarudzai *, an elderly woman who had lost her daughter-in-law and was left alone with six grandchildren. The children's father was unable to care for them. Therefore, the whole burden was on the grandmother's shoulders. Violet Machokoto listened to Sarudzai and together they discussed all the problems to find solutions for them. Violet was able to encourage the grandmother to join a horticultural cooperative. In this way, she was able to raise the necessary funds for the children's food, education and health care. The enormous psychological burden was lessened and Sarudzai is happier.

Realizing potential

But it's not just the lives of the village community that can improve as a result of the work of community health workers; they themselves can also personally experience a positive transformation. "I am now able to plan and implement projects, which I could not do before. I also now possess great self-confidence. I have learned to speak in front of a larger audience and to be able to bring positive things to the community," says Violet Machokoto. The stories from Tanzania, Mozambique and Zimbabwe show how important the work of community health workers is. They fill the gaps in health care in a variety of areas and contribute to the well-being of their communities. Although village health workers have been used in many different countries around the world for over 50 years, their potential is still not fully realized. SolidarMed will continue to promote this potential in several partner countries. Further training, support in methods of data collection or assistance in coordination are fixed cornerstones in this context. In this way, these important links between village communities and the health system continue to contribute to improved health care and enable children like the boy Rajabu to lead a healthy life.

* Name changed by the editors.