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Cry the neglected village health worker

by Lesotho Times
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Pascalinah Kabi

Maletsie Makoro silently prayed for strength and wisdom soon after fellow Khohlontšo residents nominated her their Village Health Worker (VHW) in May 2014.

This was a God-given opportunity for the now 46-year-old not only to help her community but also put food on the table for her family as the responsibility came with a M900 quarterly incentive.

Soon after her selection, Ms Makoro embarked on a seven-day training programme in her village and when she graduated, began what she had hoped would be a fulfilling journey to a healthy future generation.

Village Health Workers perform a wide range of roles in their communities, among them supervising the treatment of terminally patients, serving as counselors, helping poor patients overcome barriers that prevent them from seeking vital healthcare, act as healthcare educators, keeping a lookout for people who show signs of developing serious conditions to ensure early treatment, and providing treatment to patients in their homes where necessary.

“We were informed through a public gathering that government, through the Ministry of Health, wanted to be closer to the people through the VHW programme and my community nominated me into the programme,” Ms Makoro told the Lesotho Times this week.

“Soon after the training, I went straight into my job with a lot of enthusiasm. My duties include making sure every child under the age of five years in the village is vaccinated, and pregnant women go for antenatal care.”

Ms Makoro says the training she went through helped her convince fellow villagers that she was there to help them lead healthier lives.

“I explain my duties through public gatherings held together with councilors, chiefs and relevant authorities. I then talk nicely to the people individually and since I assumed this role, I have never had any serious problems with my community,” she said.

According to Ms Makoro, the understanding that VHWs have struck with the public has helped them become an integral part of a healthy community-based lifestyle.

“Raising a child has never been easy and it would be a grave mistake for people to forget their children’s vaccinations, for instance. This is where we come in and remind parents and guardians that this should never happen. With such interaction, we have seen communities appreciating what we do and this makes us feel we are contributing to the wellbeing of our people.”

Yet despite finding fulfillment in helping her community, Ms Makoro says failure by the relevant authorities to pay her the promised incentive since she became a VHW has left her frustrated.

“Since I received this nomination to become a VHW way back in May 2014, I only received M700 for the training. That was the only money I have received yet some VHWs I started this programme with, have been getting their M900 quarterly incentives.

“Some are even telling me that the total amount they have received to this date is M5 000 yet I have not received a single cent.

“The old adage that whoever digs the well doesn’t drink from it is true because most of these people who are receiving their incentives as scheduled are not even committed to their jobs,” she said.

Ms Makoro and some VHWs who have not been receiving their incentives have since approached the Prime Minister’s (PM) office for intervention, which she however, said should never have been the case in the first place.

“I am sure the Prime Minister doesn’t want to see Basotho suffering which is why we are pleading with him to intervene in this matter by ensuring we get our incentives just like what is happening with our colleague,” Ms Makoro said.

“We are still carrying out our duties as usual despite the current state of affairs, but we need the Prime Minister to intervene in this matter as we are always told that all will be well whenever we ask about the money. I had so much hope for the future when this nomination came and I still do, but I would be happier if the incentive I was promised was to come because I have responsibilities as a parent and this money was supposed to go a long way in helping me look after my family.”

Asked if he was aware of the workers’ predicament, the PM’s Press Attaché, Motumi Ralejoe said: “It is true that the office has received complaints from various VHWs about their incentives.

“However, there are two development partners, Global Fund and Partners In Health (PIH), as well as the Ministry of Health, who are responsible for the incentives.

“But there is need to have a strong coordinating team to ensure all VHWs get their incentives on time regardless of the office they fall under.

“Following a recent radio programme by the PM’s office on the National Health Leadership Reform, we received so many complaints from VHWs concerning their incentives.

“The first complaint came from Ha Chepeseli, Maputsoe VHWs, and upon taking up this issue, we realised that Ha Chepeseli VHWs fall under the PIH programme. We immediately contacted PIH and they assured us they would resolve this matter.

“After a few days, we received reports from VHWs that they had received their incentives following the PM’s office’s intervention.”

However, Mr Ralejoe said the plight of Khohlontšo VHWs had not been resolved and the PM’s office was yet to approach the relevant agency responsible for the incentives.

“Although we are yet to resolve the Khohlontšo problem, it is worth noting that the plight of VHWs goes beyond their incentives and is the responsibility of the PM’s Leadership Programme to ensure the smooth-running of our healthcare system.

“VHWs are the first line of defense in the fight against diseases, especially HIV and AIDS and tuberculosis (TB) which are devastating the country,” Mr Ralejoe said.

“Every single leader in our country—the PM, health minister, members of parliament, district administrators, councilors and chiefs—must be involved in ensuring the system is so smooth that everyone is accountable for the VHWs’ incentives and other needs.

“The PM’s office has also engaged Pitsong Institute of Implementation Research to ensure maximum involvement of traditional healers, chiefs and the media. This is to make sure every individual understands health issues are not for the ministry alone but that we all need to work together.”

Mr Ralejoe further said Dr Mosisili was calling on every individual to take responsibility for the country’s health as it is through commitment that Lesotho could achieve the 90-90-90 targets.

The targets state that by the year 2020, 90 percent of Basotho should know their HIV status; 90 percent of HIV-infected Basotho are on medication and 90 percent of those on antiretroviral therapy have the viral load suppressed.

“Like I said, VHWs are our first line of defence and it is through strengthening this programme that we can safely achieve these targets. This includes ensuring VHWs get their incentives without fail,” Mr Ralejoe said.

According to the 2014 Village Health Worker Draft Policy Framework, VHW are the cornerstones of Lesotho’s Primary Health Care but over the years, they have “met a series of challenges due to inadequate funding, increased burden of diseases and the absence of a clear policy framework to guide community health.”

“The National Health Policy 2011 argues that Lesotho’s community health work programme is weak, fragmented and not coordinated properly.”

The Policy also asserts the link between the Ministry of Health and VHWs has remained “very informal” despite the huge contribution and role they play in the healthcare system. It adds supportive supervision for community health programmes is inadequate as is financial assistance for VHMs operations.

Bankrolled by Global Fund, the 2014 Village Health Worker Draft Policy Framework was developed by the Ministry of Health and Pitsong Institute of Implementation Research.

Advantages of VHWs

According to US-based NGO Allies for Quality, lay health workers comprised of local community members have certain advantages over other healthcare workers. These advantages are they can more easily communicate with and gain trust from their patients; develop culturally relevant and highly accessible health materials and information; help adapt the healthcare system to better suit their population’s needs; and can be cost-effective extensions of the healthcare system.

With these capacities, Allies for Quality says VHWs “can successfully engage significant numbers of consumers in increasing knowledge and reducing barriers to healthcare quality.”


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