In most parts of rural Malawi, sick villagers have to walk several kilometres to the nearest hospital, in the process reducing their chances of survival.
But, mostly, the bigger threat to health in the village communities is the reluctance to seek medical care, even in the direst of cases.
Nyuma Mpanje is from Mchonjo village just under 5kms from Ntchisi District Hospital. Yet, for the longest time, healthcare was an alien concept for her.
The mother of four aged between 12 and two, had no regard for healthcare, let alone life-saving vaccinations for her young children.
But things took a turn when community heath volunteer Richard Mandala reached out to her and took her through basic health problems.
“This opened my eyes on the importance of healthcare, especially when it comes to under-five children. I have to be honest, previously, I used to be ignorant on child healthcare. But, with the help from the health community volunteer, I now know how to care for my children, especially when it comes to malaria which used to trouble us every time,” she said.
Mandala is part of a team of 1,650 community health volunteers in Nchisi that have been trained and equipped with skills by health non-profit organisation Amref Health Africa to attend to malaria, diarrhoea and pneumonia—three of the main causes of death among under-five children in Malawi.
Amref equipped the volunteers with mobile phones through which they receive training modules and are examined at the end of each.
“Before I started the training, I was blank on key health issues but I have now learnt a lot about child healthcare and how to avoid diseases that pose a threat to child healthcare,” explains Mandala.
He notes that the intervention has helped reduce child deaths as, people now understand the need for speed in seeking seek medical care.
“People were relaxed and, in some cases, even reluctant when it came to seeking medical care for their children which led to needless and avoidable deaths among young children,” he says.
The intervention employs an appropriate mobile learning pedagogy to train from any basic phone enabling the learners to learn at their own pace and with their own mobile devices from wherever they are, according to Amref’s head of programme planning, monitoring and reporting Madalitso Tolani.
“The volunteers are given mobile phones through which they receive lessons to be completed within six weeks after which they are assessed for competence,” he says, adding that the modules were developed in association with the ministry of health
Tolani cites the cohesive partnerships between the health surveillance assistants and the community health volunteers as one of the programme’s achievements.
“The volunteers do a lot of work due to the low number of HSAs in the communities,” he says.
According to Tolani, community health volunteers are a critical player in the health ecosystem, although most of them are untrained.
“Which is why this programme is aimed at training the health workers in our communities so that they have the requisite skills to enable them to execute their work.
Fanny Jekapu is an HSA at Nkhudzi Health Centre in the district and she supervises 15 community health volunteers.
She says the volunteers are helpful as they also go deep into the communities to educate people on health issues which has enlightened communities on the need to seek medical attention at the earliest.
“Previously, people would take several days before they sought medical care for their sick children but nowadays, they bring them to the clinic as soon as they notice signs of sickness.
“As a result, there has been a significant reduction in child deaths because people now seek medical attention quicker than they used to, thereby reducing the risk for death. We have evidence because we report child deaths every month and over the past months, we have been recording zero child deaths,” she says.
Traditional Authority Kasakula notes that he has seen remarkable changes in health uptake in his area as a result of the programme.
“We have very few HSAs in the area so the coming in of these community health volunteers has helped fill that vacuum. I can proudly say that over the past year, at Kangolo Health Centre, we had very few child deaths, less than five. And this is very low compared to the previous years and I attribute this to the work that is being done by these health volunteers,” he explains.
His sentiments are echoed by Dr Lumbani Munthali, Ntchisi District’s director of health and social services
“This programme has improved a lot in terms of health indicators in the district. In terms of child mortality, Nchisi is now at 50 deaths per 1,000 live births which is way below the national level of 63 deaths per 1,000 live births,” he says.