Between 2008 and 2019, VillageReach led efforts in the Kwitanda catchment area in Malawi to strengthen the health system at the community and facility levels by increasing health worker capacity, implementing cost-effective interventions, supporting preventative health programs, implementing community-based treatment programs, and improving communication systems between community health workers and health centers. Here are the impact stories of two community health workers from Kwitanda.
Anstey Lwanda: Profile of a Community Health Worker
Anstey Lwanda is a health surveillance assistant (HSA) in Kwitanda, Malawi. Married with two children, Anstey is from a village in Ntcheu district, a district neighboring Balaka where she now lives and works. Having completed Form 4 of primary school, Anstey received eight weeks of training to be a community health worker and has worked as an HSA since 1999.
Anstey became an HSA because she wanted to help people and help her friends – both of which she now does. When she was 22, she started working at the Balaka Town Assembly. In this position, she focused on sanitation work in mostly urban areas. Even though it wasn’t part of her job, Anstey regularly went on her own to under-five clinics in rural areas. There, she would work with HSAs to keep up her skills so that someday she could support these communities on her own.
In 2006, Anstey made a career shift to become an HSA. She now works in Kwitanda, where VillageReach supported a training to certify Anstey and several of her colleagues in the integrated management of childhood illness (IMCI) – an international protocol of both preventative and curative measures to promote the well-being of children under-five.
One of Anstey’s primary responsibilities is to run a village clinic that is in part funded by VillageReach. She operates the clinic, which supports four villages, two days per week. While Anstey has treated cases of diarrhea, pneumonia, and conjunctivitis, most of the children she has seen presented with malaria. Every year, more than 6 million people in Malawi contract malaria. The infection kills nearly 800,000 children around the world every year, despite it being completely preventable and curable. In 2008, malaria rates for children under-five in Malawi were over 100% because some children contracted the disease twice. Extending treatment and prevention services through village clinics – like Anstey does – helps to increase access to quality services in otherwise underserved communities.
Each catchment area has a monthly clinic to support the healthy growth and development of young children in the Kwitanda area. At the clinics, Anstey administers vaccines, provides growth monitoring, and gives health talks for her catchment area. Sometimes she will see up to seventy children in one day. Overall, Anstey enjoys teaching her community how “to live in healthy ways.”
On the days Anstey is not operating a village clinic or an under-five clinic, she goes into her catchment area to do home visits, treat water, inspect villages, meet with Village Health Committees and bicycle ambulance committees, and supervise the bicycle ambulance. She travels there by bicycle from her home, which is about fifteen minutes away.
“The place I live is far from where I work,” Anstey says, “If I lived in my catchment, I could do the Village Clinic every day.” On other days, Anstey travels even further – several times a month she makes the thirty-minute trip to Kwitanda Health Center for data collection and reporting.
When Anstey isn’t working, she enjoys listening to the radio, loves local music, and likes dancing. She goes to church – where she met her husband, who is also an HSA – and loves African food like Nsima (maize porridge) and Nkwani (pumpkin leaves). Anstey believes that working makes her life better: she can afford to keep her children healthy, they can all sleep under mosquito nets and are careful to take water from boreholes. She is thrilled that the community can benefit from her work, and her only wish? “Some days I wish I was a nurse to help my community more.”
Gladys: Profile of a Community Health Worker
Gladys joined VillageReach in May 2009. She is stationed in the Dziwe area, and manages three villages – Sitima, Kasonya and Chipumi – serving nearly 900 people. Exceptionally well trained for this responsibility, Galdys has a Malawi School Certificate of Education, as well as certificates in Participatory and Hygiene Transformation, First Aid, and Community Therapeutic Care. Gladys has recently been trained in maternal and neonatal health, to try to reduce deaths among mothers and infants in her catchment area. The knowledge she gained in this training will be especially useful in her community where women may travel as many as 19 kilometers to seek maternal care. Her effort as a frontline health worker will help reduce the distance between mothers and the support that they need to keep themselves and their children safe and healthy.
In Malawi, more than one quarter of all childhood deaths are attributable to the precarious neonatal period. As of 2009, the country’s under-five mortality was ranked 26th highest in the world at approximately 110 deaths per 1,000 children (down from 218 in 1990). Of this total, roughly 62% occur in the first year of life (69/1,000) and 27% occur in the first month of life (30/1,000). Approximately 30% of annual neonatal deaths are attributable to infection, 22% to birth asphyxia, and another 30% to preterm delivery – a reflection of international trends. Generally speaking, significant gaps in care exist around exclusive breastfeeding duration, antenatal care coverage, skilled birth attendance, and post-natal care coverage. Not only are these indicators unacceptably low, but they also reflect a large disparity between rich and poor sectors of the Malawian population – indicating that the capacity exists to improve health in these areas, but dissemination and coverage is currently limiting care.
Galdys’ work to improve the lives of mothers and babies in the Kwitanda community is incredibly important. She has formed a maternal and neonatal health committee with fifteen volunteers to mobilize and educate the population on topics such as: breastfeeding, hygiene, and maternal nutrition. Additionally she makes home visits to encourage pregnant women to attend antenatal clinic in Kwitanda Health Center or Liwonde Health Center (in addition to many others) where mothers can receive a free bed net and other important distributions such as iron, which will help ensure a healthy pregnancy. Equally important, Gladys also encourages expecting mothers to give birth at Balaka district hospital with a skilled birth attendant to improve the rate of safe and healthy deliveries in her catchment area.
Additionally, Gladys educates the community about family planning methods and the benefits of having a small family, including more resources to give to each child. Like the counseling cards which she uses for maternal and child health, Galdys uses simple materials to support her educational visits. She provides counseling three times for pregnant women and three times after giving birth.
Gladys’ schedule is busy. She sees 6-14 patients on any given day and manages nearly 100 cases every month. Gladys also operates a village clinic where she sees patients between two months and five years of age and treats them mostly for pneumonia, diarrhea, and red eye. She also checks for danger signs, gives first doses of treatment, and refers complicated patients to the health center.
Fortunately, Gladys loves her work. An exemplary frontline health worker, she likes helping people close to their homes where she can help community members change their behavior for better health. “When I started in my catchment area,” Gladys told us, “there was no hand washing facilities. But now because of my efforts and health education, there are 20. As you know health behavior change takes a long time.” We hope that she’s with us for the long haul.