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Zimbabwe's voluntary foot-soldiers against TB and HIV

Some 15,000 women health cadres across Zimbabwe have completed training in community health care (CHC) and have been equipped with health information to ensure that there is a sustained war on HIV and TB, reports Newsday.

Shorai Nyamadzawo was passing by a homestead in her village in Kagande in Guruve, when she heard cries coming behind a hut. She looked across the surrounding area searching for the source of the cries only to see a woman who was visibly in discomfort. “I am going to die!” the woman cried for help, “Take me to the clinic.” Newsday reports that for Nyamadzawo, this was a tough call. What will the sick woman’s relatives say if she was to take her to the clinic? What if she died in her hands? “No, I won’t take you to the clinic in this state,” she told her. “I will take you to my home and when I get the transport, we will then go to the clinic.” Nyamadzawo then led the woman to her home, bathed her, prepared food for her before laying her on a cosy mat to rest.

The report says the ailing woman was later taken to Guruve District Hospital, where she was diagnosed to tuberculosis (TB) and initiated on TB treatment, setting her on a journey of recovery from the debilitating effects of the deadly bacterial disease.

Nyamadzawo is a 2007 graduate from Runyaro Health Centre in Guruve, in the northern part of Zimbabwe, and since then she has been trudging within her rural community rendering her volunteer work. The report says she is among the 15,000 women health cadres across Zimbabwe, who have completed training in community health care (CHC) and have been equipped with health information to ensure that there is a sustained war on HIV and TB. “Training allowed me to open my home as a healing centre and has strengthened the belief and trust of the community in me,” Nyamadzawo said. “Now, they recognise me as an important person. People with small health ailments seek me out.”

Another community health worker (CHW) from Lennox Mine in Mashava, Enedy Zimuto, concurred that there has been a gradual shift in community attitudes in terms of seeking and accessing health services. “Health seeking attitudes have changed,” Zimuto is quoted in the report as saying. “Communities get knowledge of how to do constant exercises and practice good hygiene. Avoid smoking, drugs and heavy drinking. We also support people we know who are on TB treatment and encourage them to stick to their drug uptake, even if they have side effects or feel better.” “Most importantly, we have been teaching communities to deal with the stigma that has been associated with HIV and TB,” Zimuto said.

The report says women such as Nyamadzawo and Zimuto have received their training through various civic organisations such as Save the Children, Community Working Group on Health, United Nations Programme on HIV/AIDS (UNAIDS), Zimbabwe Network of People Living with HIV. Their initiatives for the mothers and newborns, people living with HIV, TB patients has strengthened Zimbabwe’s health care system by helping communities improve their living environments and the delivery of health care services to millions of mothers and newborns, men and children.

Chief Nyajena from Ngundu area of Masvingo Province says the role of CHW has corrected misinformation and demystified HIV and Aids and TB. “People better understand the health workers whom they live with,” he said. “Communities respect them because they know and respect their culture, so health messages are transmitted well by community workers.”

The report says TB is a huge national health problem in Zimbabwe accounting for over 35,000 cases in 2013, of which 19,832 were men and 15,808 were women. Many families have lost their bread winners, while many others are now child-headed, owing to deaths of parents and relatives through the disease.

The report says community health workers are playing a critical role in caring for people living with HIV and finding presumptive TB cases within their catchment areas. They also help communities get information on testing and diagnosis, the risk factors for both regular and drug resistant TB.

Christopher Zishiri, Zimbabwe country director of the Union against Tuberculosis and Lung Diseases (The Union) says the CHW compliments government efforts and build systems according to their capacity. “Community health care workers have been crucial in making sure that communities understand HIV and TB well, how people get it, signs and symptoms, testing and diagnosis, risk factors in treatment for both regular and drug resistant TB (DR-TB),” Zishiri said. “They make sure communities understand why people living with HIV are more susceptible to TB, as well as helping to find local TB services and establish relationships with service providers, so they know where to refer patients who have symptoms.”

The report says according to Charles Sandy, the deputy director of the HIV/ TB Control Unit in the Ministry of Health and Child Care, the introduction of community-based TB care services including mobile services and involvement of CHWs has upped TB case detection to as high at 72%. “But this need to increase rapidly to 90%,” he noted.

Worldwide, the report says, the World Health Organisation recommends the use of CHW to provide primary health care in countries with weak health systems and high demand for health services.

Zimbabwe’s health system has been weakened by staff shortages through the brain drain. The demand for health services is high, for instance the high HIV prevalence rate which is at 15% and maternal mortality ratio at 651/100 000 according to the Zimbabwe Demographic Health Survey of 2015 has pushed a renewed interest for CHWs involvement. The report says Zimbabwe has made gains in health services by using CHW under the Village Health Worker (VHW) programme.

The country adopted the programme in 1981 and VHWs were selected by the community at ward level, trained for a period of eight weeks, before operating on a part time basis within their communities. The country has trained 7 000 VHW in 1987 with an expectation of reaching a target of 15 000 under that programme.

Zimbabwe is ranked 17th out of the world’s 22 TB burden countries and has a challenge of a high rate of TB and HIV co-infection. TB in the country is driven by the HIV and Aids pandemic – 92% TB patients have HIV, according to World Health Organisation Global Report, of 2014.

The report says although TB is a curable and preventable disease, it is the second leading cause of death from an infectious agent HIV. In 2013, about 9m new cases of TB occurred, with 1.5m deaths worldwide, and most of the cases were from Asia and Africa. Roughly 550,000 of the cases were in children and, with 80,000 deaths in those who were HIV-uninfected. This number might be an underestimate owing to the challenges of establishing the diagnosis of TB in children.

The report says the country’s fight against the TB scourge remains hampered by inadequate funding, with domestic funding continuing to dwindle, hence the need for CHW support to save the country from regressing in its fight against TB.

[link url="https://www.newsday.co.zw/2017/08/foot-soldiers-waging-war-hivtb/"]Newsday report[/link]

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