Community Health Assistants (CHAs) enhancing health equity in Zambia

Lack of qualified human resource issue is one of the major ones many developing countries such as Zambia face. This is worse in rural areas as most of the qualified staff don’t want to stay and work there. It is no wonder therefore, that most of the rural health facilities are manned by untrained staff or nobody at all to attend to patients. This is a serious problem for Zambia, which has about 65% of its population in the rural areas. Most of the deaths in rural areas especially for the under-five children are caused by lack of access to health care facilities and medication. Maternal mortality rate is also very high in rural areas.
Some of the strategies in the past included engaging volunteers in the communities such as traditional birth attendants, (TBAs), community health workers (CHWs) and neighborhood health committees (NHCs). These have over the years helped to reduce mortality rates in rural areas as they have over the years helped with treatment and management of common childhood illnesses such as malarial, pneumonia and diarrhea. These workers are engaged on voluntary basis and the strategy hasn’t been sustainable as these workers are not paid regularly and are not usually given allowances to motivate them. Most of them are usually not adequately trained.
In 2012 however, with the help of CHAI, DFID, the Government of the Republic of Zambia through the Ministry of Health as well as many other stakeholders, started a program of training the CHAs to be deployed in rural health posts. The placement organization, Zambia Centre for Applied Health (ZCAHRD) where I have been placed for this year’s GHC fellowship, was engaged to do an evaluation of their performance and the costs associated with deploying the CHAs. This is one of the major projects that I have been involved in. Even if the results of the evaluation didn’t indicate a significant difference in the health outcomes between the intervention sites (where the CHAs were placed) and the control sites (without the CHAs), there was a considerable increase in access to health care services especially for common childhood illnesses.
Initiatives such as these which enhance health equity for those who can’t access health care especially in rural areas should be encouraged and supported. These initiative help reduce the iniquities in health care access especially in resource limited areas and should be encouraged.