Pedalling vaccines in rural Zim

on September 14, 2024 in Health and Wellbeing, News, Women and Maternal Health

Community health worker Maria Matuka didn’t grow up riding a bicycle – but now she considers it indispensable to her life-saving job.

Maria Matuka’s job as a community health workers is made easier by a bicycle built for the rugged roads in Chiredzi, Zimbabwe

MARIA Matuka arrives at Chizvirizviri Clinic, in Chiredzi, south-east Zimbabwe, to collect the medical supplies she will distribute in the village.

Looking physically fit, the 46-year-old mother of four has cycled more than five kilometres from her home to get to this health facility – her nearest clinic, and the only one for a long way in this sparsely populated area.

The roads are rugged and the terrain is rough, making it difficult to access even in an off-road car. 

While cycling is a popular leisure-time physical activity in some parts of the world, in this remote part of Zimbabwe, it is not only a crucial form of transportation, but a lifesaver.

“If you reduce the distance to a few kilometres, the mothers will bring their children [for vaccination].”

– Simbarashe James Tafirenyika, president of the Zimbabwe Municipalities Nurses and Allied Workers Union

Sitting tall on a black saddle, Matuka visits households to talk to mothers about getting their babies vaccinated against risky infectious diseases like tetanus, measles and poliomyelitis.

“It takes some minutes to move from one household to another, encouraging mothers to bring their babies to a centre in the village for vaccination,” Matuka tells VaccinesWork.

“It was difficult when I became a village health worker without a bicycle. It was draining. I felt cramp pains and numbness after walking long distances.”

Matuka is one of the 45,923 community health workers in Zimbabwe provided with bicycles at no cost since 2009 by World Bicycle Relief (WBR), a charity based in the United States.

Maria Matuka, a vaillage health worker, reports every month at Chizvirizviri clinic

Getting closer

Zimbabwe’s Expanded Programme on Immunisation (ZEPI) has been making routine vaccines available for free to children since 1982, initially to beat back illnesses including  measles, polio, tetanus, tuberculosis and diphtheria.

Over the years, the programme has grown to protect against other diseases, such as Hepatitis B.

Matuka became a community health worker in January 2021 and got her bicycle in December of the same year. It was her first time owning and riding a bike, and it took her a few days to learn, with lessons from her neighbour’s children.

But challenges, including logistical hurdles, mean there’s still further to go on coverage.

Matuka says some rural communities live long distances away from a health facility, a factor which has a negative effect on health-seeking behaviours.

“This is why we have a baby clinic every month,” she says, referring to an outreach campaign in which mobile clinics manned by nurses bring vaccines closer to children not only in rural areas, but urban areas too.

This initiative, and the bicycles, help health workers like Matuka take health services to the people.

“If you reduce the distance to a few kilometres, the mothers will bring their children [for vaccination],” says Simbarashe James Tafirenyika, president of the Zimbabwe Municipalities Nurses and Allied Workers Union, a labour union that represents nurses employed by local authorities.

A bridge between the health system and the community

The Health Ministry also rolls out vaccination campaigns for children against diseases like measles and polio, when the need arises.

For instance, in 2022 and 2023, Zimbabwe undertook nation-wide supplementary immunisation activities with bivalent oral polio vaccine following the detection of wild poliovirus 1 in neighbouring Mozambique and Malawi in 2022.

Village health workers like Matuka play a critical role in interventions like these through mobilisation of mothers in rural areas, who can often fall beyond the reach of professional health workers.

“Currently, the village health workers move around communities conscientising mothers and disseminating information to them,” Tafirenyika says.

“Some people in the rural areas have no access to radios and television, which often broadcast information on vaccines. It is village health workers who disseminate information about national immunisation programmes.”

Matuka became a community health worker in January 2021 and got her bicycle in December of the same year.

It was her first time owning and riding a bike, and it took her a few days to learn, with lessons from her neighbour’s children.

“I grew up in Zaka and our culture and tradition did not allow women to ride bicycles,” says Mutuka, recalling her memories from her rural home in Masvingo province.

She not only educates mothers about vaccination, but also passes on other knowledge and skills.

“I mobilise mothers to come for monthly baby weighing. I also educate them about breastfeeding as well as monitoring the health of their babies using the mid-upper arm circumference (MUAC) tapes,” she says, referring to a measurement that is used to quickly determine if a child is acutely malnourished.

“I also test people for malaria and recommend them to visit the clinic for further diagnosis. I also collect from the clinic and distribute medication to people living with human immunodeficiency virus (HIV) and tuberculosis (TB).”

Matuka, who reports every month at Chizvirizviri Clinic, distributes pamphlets on different health issues like malaria and cholera prevention to people in the villages.

Tafirenyika says she plays a crucial role in educating people in remote areas.

“Some people do not know the importance of these vaccines which are given to children. The pamphlets can help some people who can read to know the importance of those vaccines and how they help in curbing and preventing highly infectious diseases like polio,” he says.

Sean Granville-Ross, Executive Director of Programs at World Bicycle Relief, says village health workers are essential in delivering health care services to rural communities, where access to health care facilities can be limited due to distance.

“These health workers provide vital services such as vaccine mobilisation, maternal and child health care, nutritional education and basic medical care. However, without reliable transportation, their ability to reach patients is severely restricted,” Granville-Ross tells VaccinesWork.

“A Buffalo Bicycle allows them to cover much more ground – reaching up to 88% more patients, quadrupling the frequency of patient visits and allowing health workers to spend more time with patients. This significantly enhances their ability to ensure that mothers in rural areas are informed and motivated to vaccinate their children, helping to improve health outcomes across the community.”

One of the shops where village health workers get parts to service their bicycles in Chiredzi town

Calls to increase remuneration for village health workers

Village health workers are registered with the local clinic and the Ministry of Health and Child Care.

Some are given allowances from various development partners they work with, but experts and labour unions say more needs to be done to remunerate – and incentivise – these essential health workers across the country.

Itai Rusike, the executive director for Community Working Group on Health (CWGH), says village health workers should be supported with allowances from the national budget to enhance their work and motivate them, instead of the current situation where they rely on external partners for their tools of the trade.

“At the present there is no standardisation of payment of allowances. Some are paid their allowances on time, with others not being paid on time,” Rusike tells VaccinesWork.

Matuka’s bicycle is regularly serviced at a low cost at a workshop near Chizvirizviri clinic by a mechanic trained by the American charity.

Plans are underway to expand the programme to additional districts to scale efforts to improve health care access and support national vaccination initiatives in rural communities throughout Zimbabwe, says Granville-Ross.

Matuka says she wishes the bicycle could be modified to have a luggage carrier to ferry medical supplies and educational materials.

“Currently, I carry a heavy bag with the supplies on my back, which is painful,” she says.

SOURCE:: Gavi Vaccines Work via link https://www.gavi.org/vaccineswork/pedalling-vaccines-rural-zimbabwe

Reaching out to remote communities in Zim on two wheels

on September 14, 2024 in Health and Wellbeing, News, Women and Maternal Health

Sanele Mutsiwa with daughter Faith at Kezi Rural Hospital

SANELE Mutsiwa, 25, smiles at her two-year-old daughter Faith at Kezi Clinic in Matobo district, Zimbabwe, where she has gone to get her child vaccinated.

She holds a baby card, while Faith sits on her lap.

Sanele says she owes this happy moment to her local village health worker, who supported her during pregnancy and after birth.

It was village health worker Duduzile Ndlovu who conducted Sanele’s pregnancy test, encouraged her to make the 3km journey to the hospital to make a booking, and continued to monitor the mother and baby after birth.

“Duduzile has been with us all the way,” Sanele says.

“She makes sure I know about the nutritional needs of my child, informs me about disease outbreaks and immunisation campaigns and pushes all of us in the community to adopt safe water, sanitation and hygiene practices.”

Sanele lives in Matabeleland South province, a poor rural region of western Zimbabwe, where it is difficult for young mothers to reach a health facility and have their babies vaccinated.

But now they can rely on village health workers who come and reach out to them, where they live.

In the arid landscapes of Mangwe and Matobo districts, the sight of a village health worker in her distinctive smock uniform and brown hat, pedaling down dusty paths on a blue bicycle with a China Aid logo, has become a beacon of hope.

For 60-year-old Ottilia Ncube, a village health worker in Mangwe with its scattered villages and homes, this simple mode of transport has revolutionised her ability to bridge the gap and deliver vital healthcare services to her community.

Ottilia’s bicycle is more than just a means of transport — it’s a lifeline.

“Home visits were a nightmare before I got this bicycle. I would walk, but there were areas I simply couldn’t reach,” she says.

“The bicycle is an answer to my prayers.”

Otilla Ncube with her bicycle, distributed by the Ministry of Health and Child Care, with support from UNICEF and China

On a typical day, Otilla packs her maternal and neonatal care equipment and sets off on her bicycle to visit households in the community.

Under a grass-thatched gazebo, she sets up her equipment.

Ncube’s role extends beyond health checkups.

She is also a crucial link in promoting safe water, sanitation and hygiene practices.

During her home visits, she inspects homes and ensures that families are following proper hygiene practices, such as treating and storing drinking water safely.

She also teaches mothers and their children how to properly wash their hands.

“At community level, the village health workers have been trained to identify danger signs in mothers and their newborns and make referrals to the health facility,” explains UNICEF Zimbabwe health specialist Meggie Gidiba.

Reducing child deaths

This crucial support is part of a broader initiative by the Ministry of Health and Child Care, in partnership with UNICEF and funded by the Government of China.

Between 2018 and 2020, 600 bicycles were distributed to village health workers across Matabeleland South and Mashonaland Central provinces.

The goal was to improve access to maternal, newborn, and child health services in these hard-to-reach areas and to enhance the quality and use of these services.

Along with the bicycles, village health workers received kits equipped with essential tools such as respiratory timers, mid-upper arm circumference (MUAC) measuring tapes, weighing scales, thermometers, and medical supplies.

These tools are vital for monitoring the health of pregnant women, newborns and children under five, and for ensuring timely interventions.

The programme is making a crucial contribution to Zimbabwe’s efforts to meet UN Sustainable Development Goal (SDG) 3, which aims to reduce neonatal mortality in all countries to at least 12 per 1,000 live births by 2030.

Zimbabwe still has a significant way to go to reach the Goal. In 2019, neonatal mortality rate stood at 32 deaths per 1,000 live births.

The numbers had not significantly changed since 2010.

Against this background, however, the UNICEF and China’s support to village health workers is paving the way for important progress.

According to the district nursing officer for Mangwe, Ncebile Ngwenya, the programme has already gone a long way in improving access to health care in remote areas.

“We now have good linkages with our communities. We are leaving no one behind,” she says.

Otilla and Juliet Ncube conduct a routine check of Daphne and her daughter Priscilla in a grass thatched gazebo

Community outreach

Another village health worker to receive UNICEF training is Duduzile Ndlovu from Matobo district – the one who visited Sanelle when she was pregnant.

Duduzile was among 3,500 village health workers who received a refresher training in 2021,  as part of the China-funded initiative.

This focused on community-based surveillance and home management for mothers, newborns, and children under five.

Midwives and doctors also received on-the-job mentoring and capacity building in basic emergency obstetric and newborn care.

Duduzile says she is now better equipped to engage people in her community, including those previously resistant to modern medicine.

“The training really upgraded my skills. I understood that it is important to avoid home deliveries at all costs,” she emphasises.

Before, the local clinic registered several home deliveries each month, a risky practice that often leads to complications.

“We used to record about four home deliveries a month, but we have been recording none since the training,” says Hazel Moyo, a primary care nurse at Kezi Clinic.

According to Hazel, diarrhoeal diseases are now also managed better.

“Sometimes parents would bring children when it was too late to save the child’s life,” she continues.

“The village health workers didn’t know much about diarrhoea, but they can now identify cases and administer oral rehydration salts.”

Medical supplies, funded by China, at Embakwe District Clinic in Mangwe District

Support from China

Zimbabwe is one of 22 countries so far across Africa and Asia to receive funding from the Government of China, through CIDCA, for UNICEF programmes for children.

Zhou Ding, China’s ambassador to Zimbabwe, highlights the achievements of the programme.

“Cumulatively, 1,74 million people were reached, including pregnant women, children and families,” he says.

Over 57,000 pregnant women were referred to health facilities, and 447,138 children under five received growth monitoring services.

Additionally, village health workers treated 5,216 children with diarrhoea using oral rehydration salts and zinc in their communities, a significant achievement in preventing child mortality.

“I learned that immunisation helps to ensure a child’s health, and if I don’t come my child could have health problems,” mother Masleen Mabikire explains while her daughter, six-month-old Melina receives a vaccination drop.

The girl looks happily at her mother, her mid-upper-arm circumference standing at healthy 13.5 centimeters, which indicates an appropriate nutritional status.

In Beijing, UNICEF China Chief of Public Partnerships Sae-Ryo Kim stresses that “China has made remarkable progress on children’s issues in the last four decades. It can now support other countries in their development. That’s why UNICEF and the Government of China are working together to support children in more than 20 countries around the world, including Zimbabwe.”

For children like Faith and Melina, this support from UNICEF and China means that they can now look forward to a brighter and healthier future.

SOURCE:: Unicef via link https://www.unicef.org/zimbabwe/stories/reaching-out-remote-communities-zimbabwe-two-wheels