Village Health Workers Key to Non-Communicable Disease Care in Zimbabwe

Non-communicable diseases (NCDs) in children and adolescents include chronic respiratory disease, cancer, heart disease, high blood pressure, diabetes and sickle cell disease. Though many are preventable and treatable, these diseases lead to the death of nearly 1 million people under the age of 20 each year globally. UNICEF, in collaboration with public and private sector partners, aims to strengthen health systems and alleviate the burden of NCDs at the local, national and global levels. Village Health Workers play a crucial role in educating their communities about the prevention, detection and treatment of NCDs.

When medical rounds stretch for miles 

At 8 a.m., a woman heads out from her home on foot in northern central Zimbabwe. Traversing rough bush paths and mountainous terrain, the 62-year-old grandmother may walk more than 9 miles that day to deliver essential health care information and services to her neighbors. 

Stella Pedzisai is one of approximately 20,000 volunteer Village Health Workers in who provide health and nutrition services to women and children by visiting homes and community gathering places in rural and remote areas.

Carrying a backpack filled with medical supplies, including malaria testing kits, thermometers, blood pressure monitors and Vitamin A doses, Pedzisai can screen for malnutrition and diseases, administer vaccines, promote safe hygiene practices and offer pregnant women routine check-ups, delivery assistance and breastfeeding support.

Lately, Pedzisai has noted an increase in non-communicable diseases (NCDs) among the children on her rounds. In fact, Village Health Workers are often the first to spot the symptoms and signs of NCDs, refer patients to lifesaving medical care promptly and follow up with families on management at home. 

In Zimbabwe, NCDs account for 55 percent of the public health system burden, a share expected to increase, according to Dr. Justice Mudavanhu, Acting Director for NCDs in the Ministry of Health and Child Care (MoHCC). NCDs account for as high as 39 percent of deaths in Zimbabwe.

Pedzisai’s daily routine includes visiting remote homesteads. “I walk to check on babies and teach parents and caregivers about the signs of NCDs in children, proper diet and the importance of medical care to manage the disease,” she says. She refers severe cases to the nearest health facility and maintains contact with the children and their families. “I follow up multiple times to see whether they indeed went to the clinic and are taking medication,” she explains.

A trusted voice to educate and advocate

Elected by their communities, Village Health Workers have local and cultural knowledge of the households they visit. They are trusted to enter homes to offer health and nutrition services when an unknown medical professional from a distant health facility may be unwelcome or perceived as intimidating. In many areas, religious or cultural norms forbid unrelated men from entering the home. In such circumstances, other women — and the majority of Village Health Care Workers are women —­ are well placed to reach mothers and female caregivers.

The MoHCC and other partners describe Village Health Workers as the backbone of the country’s public health system. Indeed, with typically understaffed, overburdened health facilities miles away on foot, Pedzisai is the go-to person for her community.

“I serve 187 households, but the population usually balloons during the dry season [April to October] when we can have as many as 600 people that need my services,” says Pedzisai, sitting on a bench at Patchway Clinic, a health facility in the Sanyati District. “I am not deterred, I still do the job thoroughly.”

A pathway to economic participation

Village Health Workers in Zimbabwe undergo an eight-week training by the MoHCC to acquire basic health care skills, including vaccine administration and other interventions. Once a month, they travel to a local health facility to collect supplies, report to the supervising nurse-in-charge and receive ongoing education and skills training on topics such as maternal, neonatal and child health, nutrition, safe water, sanitation and hygiene (WASH) practices, and common childhood illnesses.

Investing in training for Village Health Workers strengthens public health systems by building a health workforce that cuts through gender-based discrimination and norms that marginalize women’s employment and economic participation. In Zimbabwe, volunteer Village Health Workers receive a quarterly stipend to pay for family necessities like school fees and food.

Dispensing care that dispels misconceptions about non-communicable diseases

The Mafemera family in Mutoko, a rural area in northeast Zimbabwe, tried many ways to alleviate 12-year-old Isheanesu’s asthma. Family members would scrounge bushes for herbs that had little effect on the boy’s symptoms.

That changed when 57-year-old Village Health Worker Josephine Chinyanga came along.

“I used to trust herbs, but Granny [Chinyanga] told us that the best way to deal with Isheanesu’s condition is by going to the hospital for proper care and medicine,” says Alice Mafemera, her nephew’s caregiver. “The medicines are helping Isheanesu survive better. I am happy that Granny has taken us this far; it has lessened our burden.”

Isheanesu, in his grey school uniform, smiles shyly.

Video: Village Health Workers in Zimbabwe deliver non-communicable disease care 

Chinyanga continues to visit the family at least once a week. “Even when we meet at the community water well, the first thing she wants to know is Isheanesu’s condition,” Maferma adds.  

Chinyanga confirms, “I make sure they are not exposing him to dust, that he wears warm clothes, takes his medicine and doesn’t miss school.”

“Granny is a trusted friend of the village,” Mafemera said, hugging Chinyanga.

Her undying love for all children motivates Chinyanga. “A child only belongs to the mother when they are still in the womb," she says. "Once born, they belong to all of us. It is our collective duty to take care of them as a village. That’s why I spend most of my time visiting families to check on children with chronic diseases.”

Promoting non-communicable disease awareness from the household to the community square

Given the grueling nature of visiting far-flung homesteads, UNICEF and other organizations encourage community-level health systems to integrate Village Health Worker appearances and services into established gatherings and settings.

Folklore, music and art are integral to Zimbabwean culture. Some Village Health Workers have begun to reach their communities through these more creative channels. At community meetings, funerals and even weddings, many rural communities have begun to reserve time for Village Health Workers to speak on health issues and practices. “People internalize the message when they sing along and dance; sometimes we perform drama as well. It is effective,” says Pedzisai.

Successful investment in country-led health programs begins at the community level. When equipped with innovative technology and supported by local health facilities, Village Health Workers play an indispensable role in meeting the primary care needs of their communities and advancing equitable care for children living with NCDs in Zimbabwe.

This vital work is made possible by support from the U.S. Fund for UNICEF from a donation by Eli Lilly and Company to the U.S. Fund for UNICEF (UNICEF USA).

UNICEF does not endorse any company, brand, product or service.