Parallel health systems create insecurities in low and middle income countries
Strengthening the integration between national community-based health worker (CBHW) programmes and other health systems in low and middle income countries is crucial for measures to have the intended effect throughout the national primary health care system. This is what Joseph Mumba Zulu states in his thesis work at Umeå University.
“National CBHW programmes, where individuals after a short postsecondary health education, are allowed to undertake simple health-related tasks, especially in rural areas, are of great benefit to countries where the health care system needs to be established and strengthened. What can be seen in Zambia is how the health workers face resistance both from the health care for not being integrated in the health care system, as well as from a sceptical community. It is a huge and important challenge to get both health care systems to work together,” says Joseph Mumba Zulu at the Department of Public Health and Clinical Medicine at Umeå University.
An important reason for introducing a system with health workers, such as health assistants (CHAs), in Zambia, was the huge shortage of staff in the established health care system. In order for health care not to completely collapse, the national Ministry of Health agreed to implement an integration strategy, which involved the so-called community-based health assistants.
The task of the health assistants is, after having undertaken a one-year training course, to support the community with health care services in villages and in rural areas. The tasks involve providing basic medical care in malaria-infected areas, aid patients infected with TB and HIV/Aids, but also to support and give advice to expectant mothers, especially about the possibilities of receiving antenatal care and health care during child birth in the already established health care system. Another task for the health assistants is to provide preventive activities by educating community members, for instance in maintaining clean drinking water to prevent the spread of disease.
In his thesis, Joseph Mumba Zulu has studied the success of the health assistant initiative in Zambia. The result shows mainly two big challenges. Since health assistants is a new occupational group, they have had distinct problems in becoming integrated into the health sector. Joseph Mumba Zulu determines that there is unclarity in the health care system over what tasks the health assistants should implement and what authority they have in performing health care services. Also, the health care assistants themselves show insecurities about what to do and what they should refer to the already established health care. The health care assistants are often faced with scepticism from the community in rural areas, both because of ignorance about what tasks the health assistants have, but most importantly because they often lack the basic resources to implement health care efforts, continues Joseph Mumba Zulu. This is, for instance, evident in the lack of drugs for the treatment of malaria.
“For the health assistant initiative to become an efficiently operative part of the health care system, political decisions are required regarding the health care organisation, so that collaborations can be improved, but also resolutions about resources are needed in order to enable health assistants to gain the trust of the health care and the community,” says Joseph Mumba Zulu.
Joseph Mumba Zulu was born in Zambia. He is an anthropologist and postgraduate student at the Department of Public Health and Clinical Medicine, the division for Epidemiology and Global Health at Umeå University.
On Friday 8 May Joseph Mumba Zulu, Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, defends his thesis entitled “Integration of national community-based health worker programmes in health systems. Lessons learned from Zambia and other low and middle income countries”.
The opponent is Professor Helen Schneider, School of Public Health, University of Western Cape, Bellville, South Africa.
Supervisor is Professor Anna-Karin Hurtig.
The defence will take place at 13:00 in the Caring Sciences Building, Auditorium (Aulan, Vårdvetarhuset) at Umeå University.