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FEATURE-Tanzania's army of community health workers face mistrust as they roll out services

by Kizito Makoye | @kizmakoye | Thomson Reuters Foundation
Friday, 26 August 2016 01:00 GMT

Villagers are wary when approached by a stranger dressed in trousers and a shirt, rather than crisp white coats favoured by doctors all over the world

By Kizito Makoye

DAR ES SALAAM, Aug 26 (Thomson Reuters Foundation) - One of the biggest tests of Justine Michael's job as a community health worker is not the distances he must travel along remote dirt roads to visit patients in Tanzania's Mkuranga district, but rather the suspicion he often encounters.

Many villagers are wary when they are approached by a stranger dressed in trousers and a shirt, rather than the crisp white coats favoured by doctors all over the world, he said.

"Some people don't trust the services we provide. When I visit a family, the people are sometimes very hostile or say, 'what do these hospital sweepers (cleaners) want?'," Michael said.

"We want them to change this mindset and know we are trained to do this work," he added.

Michael is one of more than 5,000 community health workers the Tanzanian government has deployed to provide essential life-saving services in rural areas where 70 percent of the country's population of 49 million live.

The initiative was introduced a year ago to address gaps in healthcare in the East African country where there are only 0.1 doctors and 2.4 nurses and midwives for every 10,000 people, according to 2014 data from the World Health Organization.

In Tanzania, healthcare is considered a luxury especially in remote, rural parts where, according to the World Bank, only 9 percent of the nation's doctors are based.

"Our plan is to have at least two community health workers in each village," said Otilia Gowelle, director of human resources and development at the ministry of health, referring to the government's five-year plan.


In Bagamoyo district housing one of the most important trading ports along the East African coast during the slave trade, community health workers make regular visits to Fatma Abdul as she progresses through her third pregnancy.

Using simple messages with pictures, they stress the importance of breastfeeding for the first six months and offer advice on how to keep babies warm or identify signs of illness.

But the health workers have done more than provide antenatal care, they have also brought hope to the HIV-positive mother of two.

"I got a lot of courage when they told me being HIV-positive is not a death sentence," Abdul said, sitting outside her mother's thatch-roofed house not far Bagamoyo town where houses with doors of intricately carved wood line the dusty streets.

Shame over her status stopped Abdul from attending appointments at the local hospital, but she soon started receiving home visits from community health workers instead.

"They taught me how to stay healthy and protect my baby from being infected with HIV," said the heavily pregnant 35-year-old.

"When I give birth I might feed my baby with infant formula to avoid passing the infection," she added.


Eireen Darlington says the community health workers she trains at a nursing and midwifery school in Tanzania's commercial capital Dar es Salaam, are taught to promote nutrition, basic hygiene, family planning and immunisation.

They are also trained to tackle domestic violence and alcohol abuse, provide counselling and care for HIV/AIDS patients and give special attention to expectant mothers.

"They detect and handle risky pregnancies as well as assisting women during labour and child birth," Darlington said.

According to the World Health Organization, only 47 percent of births in Tanzania are attended by a skilled health worker of any kind - a reality that contributes to high maternal mortality rates.

"While Tanzania has reduced child mortality, mothers and new born are still at high risk of untimely death," said Keith Hansen, World Bank Vice President for Human Development, at the launch of a report on service delivery data in Tanzania in May.

Tanzania's maternal mortality rate was 432 deaths per 100,000 live births in 2014, an improvement on 790 deaths per 100,000 live births in 2008.

But the rate still falls short of northern neighbours Kenya, which had a maternal mortality rate of 495 deaths per 100,000 live births and Uganda, which had 438 deaths per 100,000 live births in 2014, World Bank data showed.

Although the use of community health workers is widely seen as an effective way of addressing Tanzania's shortage of health professionals, critics of the scheme say health workers do not always provide quality services.

"For community health workers to be able make an effective contribution, they must be carefully selected, adequately trained and continuously supported," said Anastacia Kileo, a public health expert at KCMC medical training centre.

She also worries that the government does not have the budget to pay a larger health workforce.

"If we cannot even pay our doctors decently, where will the money to pay this army of community health workers come from?" she said.

(Editing by Katie Nguyen. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights and climate change. Visit http://news.trust.org to see more stories)

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