“Community Health Workers (CHWs) will bridge the gap between the community and the formal health sector.”

In Tanzania, THET, in partnership with the Benjamin Mkapa HIV/AIDS Foundation and the Ministry of Health Community Development, Gender, the Elderly and Children (MoHCDGEC), has been training the first formal, paid cadre of CHWs in Tanzania since 2016 and nearly one thousand CHWs have now graduated.

The first formal cadre, whose training was developed by the MoHCDGEC, have been taught to deliver a vital and comprehensive package of healthcare to their communities including basic first aid, how to identify the danger signs in pregnancy, education on malaria prevention, referral process and a multitude of other responsibilities. This cadre fills the gaps between the community and the formal health sector, fitting with both what is needed but also with what is there, like a puzzle piece. Or rather they will.

The benefits of CHWs’ role are multiple. Often coming from the same villages as the patients they assist, they know how to talk to them, initiating a process to foster behaviour change so difficult to achieve when it is only produced through a top-down approach.  They can encourage women to give birth in health facilities and discuss how spacing and family planning can make a huge difference to the health and economic well-being of women and their families. They are able to explain to their communities that the government spraying for mosquitos in their houses won’t cause infertility.  They can take the time to go through it with people, to convince them slowly after building a trusting relationship.

They will also provide vital data, through the cases they see and highlighting those who do not attend facilities, which can be used to inform policy and programme design to ensure that the hardest to reach can be targeted, which will make all the difference as we work to achieve the goal  of universal health coverage.

There is still one key document missing: the scheme of service. It sets out in detail how the CHW job description fits within the health sector and the career progression that individuals can expect as well as the pay scale they will receive. Without it local government authorities cannot employ the CHWs and partnership such as ours must fight for other ways to keep them engaged until it is signed off by the MoHCDGEC.

Unfortunately, while in Mwanza, we heard stories of private hospitals employing CHWs as nurses because they are cheaper than the licensed nurses and will increase profits despite their insufficient training. We also heard of graduates of the CHW course who had left the health sector to take up casual labouring in the gold mines.

In the short term the government is working with development partners to hire the CHWs but it is only once they are on the public sector payroll that they will be able to deliver all the potential benefits they are capable of. You can have doctors, hospitals, equipment and everything else in place, but until you have a way to breakdown the cultural barriers that stop people accessing healthcare and the simple preventative care that means people don’t need to visit the doctor in the first place you can’t have universal health care. That is why THET continues to advocate and lobby for the training and crucially the employment of CHWs in Tanzania.