AFRO-NETS> RFI: The experience of being a TB treatment supporter (2)

[Peter Songolo <psongolo40@hotmail.com>]

RFI: The experience of being a TB treatment supporter (2)
---------------------------------------------------------

The use of community health workers as supporters of treatment is 
very important to ensure continuum of care. Voluntary work has a num-
ber of problems nowadays. Our problems with CHWs and TBAs were:

1. CHWs were usually young men and as such were very unstable. They 
may leave to look for employment anytime and hence you may have to 
find and train another one. TBAs were stable as they were quite old 
in age.

2. Some CHWs felt that they should be paid for the time they spend 
treating fellow villagers. In one village the community had to pay to 
contribute money for transport to the hospital where the CHWs was 
getting his drug kit. Others wanted to charge user fees for their la-
bour.

3. Distance to the CHW or TBA may be too long. Combined with unavail-
ability of some CHWs discourages the community members from using the 
services.

4. With 70% of the Zambian population wallowing in poverty, there is 
no way people can say 'thank you' for the services rendered as was 
the case many years back when the economy was good. The concept of 
CHWs & TBAs was founded on this practice.

5. In our districts we discovered that our trained TBAs were not be-
ing utilized despite supplying them with UNICEF approved delivery 
kits. Our experience was that mothers were delivering their own 
daughters and those women who were para 3 and above would deliver on 
their own. For some reason the TBAs were no longer being utilized.

6. In a nutshell volunteers such as trained CHWs & TBAs are no longer 
effective. There is no 'FREE' labour and the spirit of volunteerism 
has drastically diminished. When these volunteers are paid, the com-
munity will consider them to be employees of the district health sys-
tem and will thus not support them.

7. At the time I was leaving my district in Dec. 1998 we did not have 
any active CHWs or TBAs. The health system was also at its worst, 
hence could not support the CHW & TBAs through support visits and 
necessary logistics such as drug or delivery kits. So, you need a 
functional health system for the CHWs to be active too.

Dr. Songolo is Public Health Specialist in the Ministry of Health, 
Botswana. The experience is from my home country, Zambia where I 
worked as M.O.I/C of my sub-district.

--
Peter Songolo
mailto:psongolo40@hotmail.com

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