Fahamu (Oxford)

Namibia - Bridging the Gap in Healthcare Provision

Opuwo — The new health extension worker programme has been successfully implemented in several countries and its supporters are optimistic that it will help Namibia fill gaps in its over-stretched health system.

At 26 years of age Vemupomanda Tjivinda commands a lot of respect among his fellow Himbas, a community of pastoral nomads that roam Namibia's hard-to-reach Kunene region with their goats and cattle in search of water and grazing.

Tjivinda is one of 34 young Himba men and women who have just graduated as Namibia's first health and extension workers after undergoing comprehensive training in the provision of Community Based Health Care Services (CBHCS) under an initiative spearheaded by the Namibian Government with the financial and technical support of UNICEF, USAID and other development partners. Dr Richard Kamwi, Namibia's Minister of Health and Social Services, launched the programme, which is being piloted in Opuwo for a year to reduce maternal mortality and the deaths of children under the age of five from preventable diseases among the Himba.

Tjivinda's Omukuyu Village is a mountainous, sparsely populated area nearly 900 kilometres from the capital Windhoek.

After six months of training, Tjivinda is confident that he has acquired vital knowledge and skills to save the lives of women and children in his village which has neither a radio signal nor cell phone network coverage and has bad roads.

Since the health workers will interact with people at the grassroots level during the course of their work, they have been trained on how to enter households and respect traditional beliefs. They have been taught basic first aid; how to stop bleeding, and how to fix a broken bone, arm, or leg.

'I know what to do in cases of poisoning andshock, and how to perform resuscitation. We were taught about maternal and natal reproductive health. I know the danger signs when a woman is pregnant,' Tjivero says during an interview while on one of his rounds in his village.

Dr Stephanie van der Walt was one of the instructors for the health extension workers. She says that the graduates were trained to ask, observe and then act. When they work with women they look for signs of ill-health such as swelling of the hands, feet or face.

'If there are any of the danger signs, they refer them to a health facility. If not, they give health education. We help communities start thinking about a birth plan, antenatal clinics and start planning ahead for the coming of the baby. During training we covered all the minor and preventable illnesses in child health,' the doctor says.

When dealing with children, the health extension workers also look out for ear, nose and throat problems as well as other danger signs which include lice, dehydration, convulsions or fits. They check the child's nutritional status, immunisation card and growth charts to determine whether the child is growing well and if the child is fully immunised. If not they refer and give health promotion for the caregiver to make sure that the child is going for proper immunisation.

Tjivinda explains that their programme included training on HIV/AIDS, TB and malaria as well as issues related to social welfare and disabilities. It touched on social grants for people aged 60 years and older, elderly abuse in the community, domestic violence, healthy parenting skills and how to take care of people living with disabilities.

The health extension worker programme has been successfully implemented in countries that include Zambia, Ethiopia, Malawi, Guatemala, and Eritrea and Kamwi is optimistic that it will help Namibia fill gaps in its over-stretched health system.

Kamwi says in spite of the improvements in the provision of primary health care services since independence in 1990, Namibia still faces major challenges especially in the efforts to ensure equitable access to health care services.

'The disease burden of rural Namibia is basically communicable diseases, maternal health problems and malnutrition, especially in children under five suffering from preventable illnesses such as pneumonia, diarrhoea, malaria, malnutrition and others. These can be prevented through implementation or delivery of existing cost effective interventions at community or household level or through family oriented community based services.'

As the Health Extension Workers (HEW) programme gets underway in Opuwo, each of the HEWs is expected to attend to 250 people within a radius of 40 kilometres over the next year. Van der Walt says although the HEW will be deployed in their own villages, they will travel on foot because many of the places inhabited by the Himba are too difficult even for all-terrain vehicles. Bicycles would not work because most areas are sandy.

However, the programme enjoys the full backing of the government, local officials and traditional leaders. One of the new HEWs is the son of Himba Chief Tjambiru, who attended the graduation.

Hon. Josua Hoebeb, the Governor for Kunene region has also welcomed the programme, saying that his hope is that it will support the communities in his region of approximately 81,400 people and prevent them from falling sick. He is pleased to learn that the programme will focus on prevention and promotion of health, adding that it is not easy to provide health services to the Himba people because they often retreat into the mountains with their cattle. The HEWs have been trained to follow them wherever they go.

Van der Walt says the HEW programme has elevated the status of the HEWs within their communities. 'They have gained skills and confidence to take care of other people's health. They are the stars now and are respected in the community.'

Ms Micaela Marques De Soussa, the UNICEF Representative to Namibia says the HEW programme will bridge the gap between the haves and have nots in terms of bringing basic quality health services to the communities.

'The skills gained by this cadre of committed men and women will ensure that those children and mothers, especially the poorest, the most vulnerable and those living in the most remote areas of this region are reached with essential information and quality services,' De Soussa says.

De Soussa is conviced that with the political will of the Government of Namibia, the determination of Tjivero and other HEWs, as well as community support, the HEW programme will succeed.

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