A community meeting to receive health messages from a CHW.

Community-level perception of a public health intervention is tantamount to the success or failure of its uptake. Programs generated in the West can often be perceived as irrelevant, culturally removed, or unimportant by the local population. Local buy-in is critical and, as development professionals have learned again and again, without it projects fail.  

Community Health Workers (CHWs) and in-country partners are the bridge to the communities that Western organizations and their programs seek to serve. Together they have the power to generate much needed positive perception and buy-in. The Center for Infectious Disease Research in Zambia (CIDRZ), in partnership with the Zambia Ministry of Health (MOH), is one such in-country collaboration partnering with UK-based Absolute Return for Kids (ARK). With a program supported by ARK, CIDRZ is working to reduce childhood deaths due to diarrhea by utilizing a comprehensive approach that incorporates prevention (introduction of a rotavirus vaccine), treatment (training of clinicians and CHWs), and control (community education and awareness-raising) activities. Communities are educated through group sessions at clinics, CHW consultation at the home, and monthly meetings facilitated by CHWs and Community-based Organizations.

Kenneth Mumba, a CHW serving the urban-poor community of Kamonga in Lusaka, told us that mothers don't often visit the clinic, so it is best to bring health messages right to their doorsteps.

CHWs come from the communities they serve, are respected by the community, and perceived as authorities and resources. Commencing in December 2011, CIDRZ conducted a paid one-month training for CHWs on Better Health Outcomes through Mentoring and Assessments. CHWs then went back to their communities, visiting household-by-household, teaching the importance of using ORS and zinc, hand washing, safe water storage and treatment, etc., and performing demonstrations. They educate on personal sanitation and hygiene and give recommendations on treatment options and where to seek treatment if a child becomes ill. They were instrumental in the rollout of rotavirus vaccination in Lusaka Province, giving education and information about the vaccine, raising the broader communities' awareness about vaccination and health improvements in general. CHWs generally make 50 home visits per day and are responsible for about 500 households. Trust and relationships are built through these interactions, and information is disseminated and made locally relevant, which generates positive perception and ultimately, greater acceptance and success of CIDRZs' and ARKs' initiative.

Josephine Tubalange, CHW, assisting a mother using an infant scale at a Kazimvua Rural Health Center in Lusaka Province.

In the rural village of Chigwilizano, which means “to be united,” a community where CIDRZ is utilizing CHWs, Josephine Tubalange couldn't contain her pride in being a CHW for her community: “I[t] feel[s] very nice to serve, and the final reward comes from God. There is a lot of reward from those thank you's I get.” Agnes Mulenga, another CHW in Chigwilizano Village, demonstrated home-visits for us, educating mothers of two children on the importance of sanitation, covering her water tank, chlorinating  water, and handwashing hands with soap.

Agnes Mulenga, CHW, demonstrating a home-visit, educating a mother on the importance of diarrhea prevention through sanitation and hygiene practices, including covering her water tank, chlorinating water, washing hands, and using soap.

Every year more than 15,000 children die in Zambia due to diarrhea-related dehydration, and lack of awareness at the community level of prevention and treatment options is a main contributor.Utilizing the CHW interface is smart public health practice, and CHWs' in-roads and influence in the community are significant. Focused health messaging and community mobilization by CHWs is combating child diarrheal disease. Thanks to them and the education and training they received at CIDRZ, an educated and informed population is in-the-know and willing to adopt interventions that save lives.

Photo credits, top to bottom: PATH/Lisa Anderson (1), PATH/Gareth Bentley (2-4)