BRIDGING GAPS IN HEALTH CARE PROVISION

NAMIBIA: bridging the gaps

in health care provision



BREAST IS BEST: Health extension worker Tjivina discusses breastfeeding with a Himba woman in Opuwo

 By Moses Magadza

Opuwo – 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 (HEWs) after undergoing comprehensive training in the provision of Community Based Health Care Services (CBHCS) under an initiative spearheaded by the Namibian Government with 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 pilot tested 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.

Tjivero’s Omukuyu Village is a mountainous, sparsely populated area nearly 900 kilometres as the crow flies from the capital Windhoek.

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

Since the HEWs 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, immobilise a broken bone, arm or leg.

TOMORROW MOTHERS: These Himba maidens will benefit from the HEW programme

 

“I know what to do in cases of poisoning, shock and 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 HEW were trained to ask, observe then act. When they work with women they look for signs of ill-health such as swelling of 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 and promotion. We help communities to 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 illnesses and preventable illnesses in child health,” she says.

When dealing with children, the HEWs look also 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 care giver to make sure that the child is going for proper immunisation.

Tjivero explains that the HEW training included 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, family violence, healthy parenting skills and how to take care of people living with disabilities.

The HEW programme has been successfully implemented countries that include Zambia, Ethiopia, Malawi, Guatemala, and Eritrea and Kamwi is optimistic that it would 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 children under-five 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.”

IN LUCK: These Himba women and their children are prime targets of the Health Extension Programme

As the 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 would be deployed in their own villages, they would travel on foot because many of the places inhabited by the Himba are too difficult even for all-terrain vehicles. Bicycles will 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 HEW is a son to 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 would support the communities in his region of approximately 81 400 people to prevent them from becoming sick. He is pleased to learn that the programme will focus on prevention and promotion of health, adding that it was not easy to provide health services to the Himba people because they often retreated into mountains with their cattle. The HEW have been trained to follow them wherever they go.

Van der Walt says the HEW programme has elevated the status of the HEW within their communities.

“They have gained skills and confidence to take care of other people’s health. They are the stars now and respected in the community.”

Ms Micaela Marques De Soussa, the UNICEF Representative to Namibia says the HEW programme would 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 HEW as well as community support, the HEW programme will succeed.