Namibia’s
first health extension
programme
gains momentum
·
Nearly 600 health extension workers now in five
regions
·
Development partners willing to do more
·
Government pumps in money
By Moses
Magadza in Namibia
 |
| PROUD: UNICEF Namibia Rep Ms. Micaela De Soussa |
WINDHOEK (July 15, 2014)- The
United Nations Children’s Fund (UNICEF) in Namibia has described Namibia’s
first ever Health Extension Programme (HEP) as a largely successful initiative
that has exceeded expectations.
The
Minister of Health and Social Services Dr Richard Kamwi launched the pilot
phase of the country’s Health Extension programme on April 12, 2012 in Opuwo in
Kunene Region.
Financially
and technically supported by UNICEF, the United States Agency for International
Development (USAID) and other partners that include the World Health
Organisation, the programme started off with only 34 Health Extension Workers
(HEWs).
Part
of an ambitious primary health care strategy, the programme seeks to improve
health service delivery and to ensure that marginalised populations and communities
are linked to health care services. Initially it aimed to reduce maternal
mortality and the deaths of children under the age of five years from
preventable diseases among the Himba, a community of pastoral nomads that roam
the hard-to-reach Kunene with their cattle and goats in search of water and
grazing.
Armed
with six months of training and vital skills to save lives of women and
children, the pioneering HEWs fanned out into the Kunene region, determined to
make a difference.
Many
people - including Hon Josua Hoebeb, the Governor of Kunene – hailed the HEP
and wished the new HEWs success. However, few people believed that they would
last very long. Kunene is one of the harshest regions in Namibia. Much of it mountainous,
sandy, dry and has little cellphone coverage. The Himba people who were the
primary beneficiaries of the HEP programme are very mobile and often retreat
into the mountains with their livestock. This leaves the HEWs with no option
but to follow them wherever they go.
More
than a year after it was launched, Ms Micaela Marques De Soussa, the UNICEF Representative
to Namibia, says the HEW has exceeded expectations. It has not only perservered,
but has also grown.
In
May this year 552 more HEWs graduated from five regions of Kunene, Zambezi,
Kavango, Ohangwena and Omusati. In Kunene, where the programme was launched,
there are now 192 HEWs.
In
an interview this week De Soussa admitted that – typical of all other grand
initiatives – the HEP had experienced teething problems, many of them related
to logistics which were being addressed.
When
the programme began there were reports of some HEWs being paid late.
Investigations have revealed that the delays were largely due to the fact that
the process of absorbing the HEWs onto the payroll of the MoHSS was cumbersome.
It involved navigating through red tape as the process had to go through the
Ministry of Finance and the Public Service Commission. However, while this was
happening, development partners gave the HEWs monthly allowances. Many of them are
now on the MoHSS payroll.
These hurdles notwithstanding, De Soussa said
the programme has grown and is making a difference.
 |
| SAFE: Himba mother and child |
Stressing
that health for all is a fundamental right, De Soussa said the HEP programme
was catalysing efforts to achieve equitable access to quality health care.
“The
HEWs are providing an opportunity to mitigate the disparities in communities in
terms of health by being the brokers for health services for everyone including
women and children,” she said.
She
conceded that some of the HEWs worked under very trying conditions. She was,
however, full of praise for their tenacity.
“The
first major challenge the HEWs faced was distance. They had to walk and some of
them had to cover catchment areas of more than 20 square kilometres.”
She
said the fact that more regions had also embraced the HEP was further proof of
its popularity.
“The
demand for HEWs is incredible because more regions want to join in.”
She
said although there had been a few drop outs as some HEWs switched to other
careers, or could not cope with the harsh conditions under which they operated,
the majority had remained largely committed. To
alleviate the plight of the HEWs, the MoHSS is reportedly working towards
providing them with rain coats and boots so that they can be better equipped.
De
Soussa said monitoring and evaluation mechanisms had been built into the
programme to determine its success or otherwise. The
National Steering Committee (NSC) on Health Extension Work (HEW) under the
MoHSS was preparing annual and three-year work plans for the HEP.
“There
is a master plan that spells out detailed activities under each component
namely: leadership and coordination; capacity building; service delivery; human
resources and finances; supply chain management; Health information system (HIS);
Monitoring and Evaluation; and research. The plan also identifies responsible
parties to carry out those activities and budgetary commitments of the MoHSS
and key stakeholders that include UNCEF and USAID,” she explained.
Additionally,
regional steering committees had been set up in five northern regions where
stakeholders oversee the HEP.
“In
terms of evaluation, there is an annual review meeting planned at national
level as well as quarterly meetings at regional level to review progress
against set targets,” De Soussa added.
Buoyed
by the success of the pilot HEP, De Soussa said UNICEF would continue to render
technical and financial support to the programme. Working with USAID, UNICEF
would support institutionalisation of HEP training with a focus on refresher
training and introducing integrated community case management.
Starting
from this July and with the support of UNICEF, WHO and other partners, the
MoHSS will organise stakeholders’ meetings to garner more support for the HEP.
“Integrated
refresher training will take place with the introduction of water, sanitation
and hygiene interventions as well as emergency preparedness and response,” De
Soussa revealed.
An
additional 941 HEWs are set to be trained from September 2014 to April 2015 to
cover nine regions: Omusati, Oshana, Oshikoto, Ohangwena, Kavango, Zambezi,
Karas, Otjizundjupa and Hardap. Expectations are that by the end of April 2015,
there would be approximately 1500 HEWs operating in Namibia to bridge the gap
between health facilities and communities.
Although
the HEP started with financial support from Tech Resources Limited through
UNCEF Canada, the MoHSS has now fully taken over the programme, allocating approximately
N$55 million to scale up the programme over three years.
Trained
to ask, observe and act, HEWs have been used effectively to provide community
health education to prevent morbidity and mortality a in various countries that
that include Zambia,
Ethiopia, Malawi, Guatemala, and Eritrea.
 |
| LOOKING OUT: A Health Extension Worker examines a Himba child in Kunene Region, Namibia |
When dealing with children, for example, HEWs 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.
In an earlier interview in Omukuyu Village in Opuwo,
Vemupomanda Tjivero, one of the first HEWs be trained, said: “I know what to do
in cases of poisoning and shock, and how to perform resuscitation. We were
taught about maternal and natal reproductive health. I know the danger signs
when a woman is pregnant.”
While some observers hail the government for
introducing the programme, they call for the training of more nurses to
supervise the HEWs. Speaking on condition of anonymity, one observer said:
“HEPs are options for countries in which money is an issue. The HEP needs to be
supported by trained health workers who supervise them.”
The observer said elsewhere steps have been taken to
ensure that the HEP does not become part of the government system; that “it
remains a people’s or community programme. Otherwise the HEWs start demanding
unsustainable perks.”
Experts say that the fundamentals of health are based
on what individual citizens can do for themselves including simple things like
brushing their teeth, bathing, eating right, keeping their environment clean,
identifying who is vulnerable, and
seeking attention in good time when unwell.
The role of HEWs is therefore to provide survival skills
and understanding related to health to individuals within communities.
Ends/.
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