2021
2021

Community health worker sustains continuity of essential services despite COVID-19 restrictions and community fears

For every thousand children born in Zambia, 61 will die before their fifth birthday – almost twice the global rate. The leading causes of death include pre-term birth complications, birth asphyxia and trauma, pneumonia, congenital anomalies, diarrhea, and malaria, all of which are treatable with simple and affordable interventions such as immunization, adequate nutrition, and safe water.

However, access to these lifesaving interventions is often limited for various reasons, including low awareness of the importance of vaccinations and long distances from communities to health facilities. This is where community health assistants (CHAs) step in.

CHA Angela Katito leaves Kamaila Health Post to visit her community for outreach services.

CHAs are trained to provide child health services within their communities. This includes growth monitoring, vitamin A supplementation, distribution of ORS and zinc to treat diarrhea, helping families keep up with their children’s immunization schedules, and counseling parents to encourage the use of services at their nearest health center.

Angela Katito is a community health assistant who has been working at Kamaila Health Post in Chibombo district of Central province since May 2019. Angela was part of a Clinton Health Access Initiative (CHAI) program, funded by the United States Agency for International Development (USAID), to increase the capacity of CHAs across the country. The USAID CHA support program ran from March 2019 to June 2021, before being transitioned from USAID support to the Ministry of Health.

Angela Katito conducts growth monitoring in an open-air setting in Katete village.

As part of the program, Angela was one of 600 CHAs that CHAI supported, providing primary healthcare training as well as work supplies, including a bicycle, lab coat, raincoat, work boots, backpack, and health management information systems (HMIS) report booklet.

In March 2020, following Zambia’s first two recorded cases of COVID-19, Angela noticed a sharp decrease in the number of children being brought for vaccinations, nutrition status checks, and growth monitoring at her facility. Angela, who is the only community health assistant in her community, discussed this observation with her supervisor and they created a plan to take under-five health services to the community. This plan allowed mothers to bring children and gather in open-air locations while observing COVID-19 preventative measures such as physical distancing and wearing masks.

Chart following child health attendance in Zambia from Jan-Dec 2020

Number of children reached per month by Kamaila Health Post in 2020

Angela worked with her community’s Neighborhood Health Committee (NHC) members to create action plans that would ensure the delivery of under-five health services continued despite the pandemic.

“When COVID-19 started in Zambia, people in my community became very concerned about catching the virus at my health facility because those with symptoms would come here for medication,” said Angela. “Because of this fear, mothers stopped bringing their children for under-five health services. Since we did not want the children to die, my supervisor and I decided to take under-five services to the community through outreach activities coordinated in collaboration with NHC members. I am happy about the progress we have made so far because our tally sheets show that almost all the children are accessing our services again.”

Angela Katito gives a health talk on nutrition to mothers on an open air space in Katete village.

To track the number of children receiving the outreach health services and their progress, Angela used tally sheets provided by her health facility. Since launching this outreach program in 2020, Kamaila Health Post has reached an average of 324 children every month, providing them with vaccinations, nutrition education, and growth checks. This work is contributing to greater service coverage now and will ultimately reduce under-five mortality in the community – thanks to Angela’s efforts.

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Contributing authors: Timothy Silweya, Senior Program Officer, Community Engagement & Referrals; Nelia Banda, Senior Program Officer, Sexual and Reproductive Health; Miyanda Mail, Program Officer, Peace Health; Emmanuel Katyoka, Associate, M&E for Community Health Assistants, and Naomi Lubala, National CHA Coordinator, Ministry of Health Zambia