January 23, 2015 by Mercy Chikhosi Nyirongo
Abiti Saulos, 23, is pregnant with her second child. She is in her first trimester and she has been visited by a community health volunteer in Mbalame village, Traditional Authority Mkukula in Dowa district.
Abiti has a youthful face and a darkish complexion. Her hair is well kept, and she wears a green blouse. She adjusts her chitenje, a traditional Malawian cloth, that is wrapped above her protruding belly. Her chitenje extends below her knees, a symbol of respect and honor for a rural woman.
15 volunteer community health workers operate at the frontline of healthcare provision in 27 villages and their responsibilities are steadily growing. Bridging the gap between community members and Dzaleka Health Center, these community soldiers in southern Dowa are demonstrating the very real potential for household-level care.
Armed with cards for educating, and following several intensive training sessions, Mbalame’s community health workers interact regularly with their allocated households. Often knowing their neighbors since childhood, they can easily access the intimate details of family life. “Their reach is far greater than the formal health system could ever have,” said Mrs Sanje, the nurse In-charge of Dzaleka Health Center.
The volunteers act as channels for information to the community on family planning, voluntary counselling and testing for HIV/AIDS, nutrition, malaria and monitoring bed net usage among other duties.
“We bring services directly to the community,” explained Richard Fakisoni, a community health worker. They also recommend supplementary feeding for children suffering from moderate or severe malnutrition, identified through a simple measurement of the circumference of the mid-upper arm.
“It’s a tough job – you have to be dedicated and you might be called out at any time,” said Fakisoni. But the results are deeply satisfying for the volunteers. The rapid decline in the number of home deliveries reflects their influence within the community, where they counsel expectant mothers on the importance of delivering in a clinic or hospital.
At 32 weeks, Abiti will join these other expectant women at Dzaleka Health Center maternal waiting shelter, a facility within the health center to await her labour. This facilitates emergency Obstetric care assisted by a skilled birth attendant.
Abiti has to bring her own mat as the facility has none and has to get prepared to sleep on the floor. According to the Sister In-Charge, during busy months, the facility can accommodate up to 50 women.
The health center has an average of 120 deliveries per months and mothers stay in the postnatal ward for 24 hours if there are no complications after delivery. This is to create space as the ward has only 9 beds. They also get a bed net each before discharge.
During pregnancy, any woman can develop serious, life-threatening complications that require medical care. Because there is no reliable way to predict which women will develop these complications, it is essential that all pregnant women have access to high quality obstetric care throughout their pregnancies, but especially during and immediately after childbirth when most emergency complications arise. Therefore, the community health workers are important as they serve as counselors, helping expectant mothers in Mbalame overcome the barriers that prevent them from seeking vital healthcare. The barriers to care include transportation, lack of awareness, fear, and healthcare costs. These community health workers are knowledgeable about local needs and sensitivities, and thus are in a position to gain their clients’ trust and to refer them to the health center to receive proper care.
The community health workers have a real impact, both in terms of disease prevention and promoting good practices. They are in close contact with the household unit, which is where many of the most important decisions regarding health are being taken. Their work is indeed vital.