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 Many villagers are wary when they are approached by a stranger
dressed in trousers and a shirt, rather than the crisp white coats
favored 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.
COURAGE
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.
MATERNAL MORTALITY
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 immunization.
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They are also trained to tackle domestic violence and alcohol abuse,
provide counseling 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 labor 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 neighbors 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 center.
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)
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