Village health workers face extinction in troubled Zimbabwe

HARARE - Each of her hands tightly wrapped up in old plastic for protection, Eugenia Mushambi carefully sat her patient - who suffers from AIDS - on the goatskin mat. The delicate task completed, she slowly turned around to speak to us.
"I have been a village health worker for the past 11 years but I can promise you things have never been this desperate," Mushambi said.

Spreading out her plastic-wrapped hands she lamented: "We no do not have gloves to protect us from contracting diseases during our work, we are also no longer getting uniforms and I do not know the last time I received drug supplies for patients."

A village health worker in the rural district of Chimanimani in eastern Zimbabwe, Mushambi, 51, is one of a fast dwindling breed of dedicated community workers, credited with helping make health accessible to even the remotest village but who now face "extinction", thanks to a severe economic crisis gripping the southern African country for the last six years.

The economic crisis, worsened by acute food shortages threatening a quarter of the 12 million Zimbabweans, has spawned shortages of electricity, fuel, essential medical drugs and just about every basic survival commodity because there is no hard cash to pay foreign suppliers.

With President Robert Mugabe's cash-strapped government forced to divert resources to the importation of key commodities and to servicing mounting debts to the International Monetary Fund, other areas and needs not considered immediately critical have suffered.

Among these have been the village heath workers who now have to go with virtually no support from the authorities in Harare. This, ironically at a time village health workers are most required to help combat increasing malnutrition-related diseases because of hunger and not to mention a burgeoning HIV/AIDS crisis that is killing at least 2 000 Zimbabweans every week.

"You know, we even used to get bicycles from the Ministry of Health to use to travel around the villages," Mushambi said, a distinctive yearning for the good old times unmistakable in her voice. And then in a much subdued and drier tone she added: "That was then, nowadays you have to organise your own transport to visit the sick."

The lack of gloves, drugs and other material support aside, Mushambi said the little allowance the government pays health workers was most disappointing even for those like her still wishing to soldier on with their work for the good of their communities.

For example, as of December last year, a village health worker was getting an allowance of Z$15 000 (US15 cents) a month, which is not enough to buy half a loaf of the cheapest quality bread.

"Their (health workers) allowances are too low although their workload has almost doubled because they now double as home-based care givers (for AIDS patients)," said Itai Rusike, the director of health promotion non-governmental organisation, Community Working Group on Health (CWGH), who spoke to ZimOnline in a separate interview.

In the early 80s, there were about 9 000 community health workers across Zimbabwe and they formed the backbone of the country's health outreach programme. Today they are only about 500 village health workers left in the field at a time when, according to Rusike, community health workers are in critical demand to help villagers in remote areas cope with the HIV/AIDS pandemic.

"Most people who fall ill in the cities and towns end up in rural areas and it is these health workers who take care of them," Rusike said. "They now carry the country's health burden," he added.

Health and Child Welfare Minister David Parirenyatwa conceded the community health workers were getting a raw deal from the government. But he said the government had not neglected the village health workers saying their plight in fact reflected wider "challenges" confronting Zimbabwe's public health sector as the country grapples its worst ever economic crisis.

Once the envy of many in the developing world, Zimbabwe's public health sector has virtually collapsed after years of mismanagement and also because there is no hard cash to import medicines and equipment.

Most state hospitals cannot prescribe anything other than simple aspirin while the majority of the best skilled doctors and nurses have fled the country to seek better opportunities abroad. And those that remained behind in government hospitals seem to spend more time either striking for more pay or moonlighting in Zimbabwe's thriving informal business sector to raise cash.

But Parirenyatwa, himself a medical doctor, said his department was doing its best to restore Zimbabwe's public health sector to its former glory As part of the effort to rebuild the state health delivery sector, the government would soon review and improve the conditions of community health workers, who are the principal health outreach agents.

"We have also since revised their allowances and they are now getting Z$1.4 million a month," Parirenyatwa said.

The new allowance might still not be enough to buy much in Zimbabwe's hyperinflationary environment but it is an acknowledgment by the government of the sacrifice that Mushambi and her fellow community health workers are making. Hopefully it will encourage them to keep up the good work.