Mtwara: As Benjamin William Mkapa Foundation Continues to thrive deeply to make healthcare be accessible to all Tanzanian citizens. Mtwara citizens have been among the beneficiaries of the door-to-door COVID-19 campaign. Healthcare workers at Mtopwa Village in Nanyamba Town Council have been visiting households to make sure COVID-19 education and vaccination are accessible to everyone, especially to groups with special needs.

“As you can see, I am aging. I was told that a vaccine can save me from getting more serious health problems if I catch coronavirus. But at first I feared. Some neighbours were saying the vaccines are unsafe. But a health worker came to educate me about the benefits of being vaccinated’’ says Kapela who had just got his shot of the Pfizer vaccine while at his home.

Zanzibar:  When the COVID -19 pandemic hit in Zanzibar, Makunduchi Hospital, which serves as a district Hospital in Southern Unguja, was already in a bigger challenged to conduct its routine health services due to shortage of health workforce. With only 34 (19%) available Health Care Workers out of 181 requirements, the increased flow of clients at the facility mismatches the available human resources to battle with the needs including response to COVID -19 interventions.

“We were caught at a surprise because many clients were flowing at our facility and the fact that we are serving whole district, we had to stretch ourselves with the available staff to provide better services from 8:00am until 3:30 pm everyday as we couldn’t afford going beyond late hours due to shortage of manpower.” Says Dr. Amour Muhsin Burhan, the Acting facility In-charge.

Zanzibar:  It felt like an eternity, after waiting for too long to see the start of COVID-19 vaccination services at Selem Primary Health Care Unit+ (PHCU+) in Unguja—the largest and most populated Island of the Zanzibar archipelago. Then, finally in August 2021 the facility was earmarked as a vaccination center by the Ministry of Health. However, people’s hopes to be vaccinated almost vanished. No services were available as expected.

At the time, Josephine Maboko, the Facility In-charge of Selem PHCU+ was the only clinical officer available, alongside10 nurses who were providing medical services to the high volume of clients flocking to the facility.

“It was really challenging. I was the only clinician here providing routine health services, yet there were directives to provide COVID -19 services as well,’’ says Maboko.

Sealing The Cracks: CHW’s Ensuring Inclusive Services for Children With Disabilities.

The Benjamin William Mkapa Foundation in collaboration with AMREF Health Africa under the support of IRISH AID implements the Ustawi wa Mwanamke Project UMP Project in Mwanza and Simiyu Regions. The project strengthens the implementation of Community Based Health Provision (CBHP) and Maternal and Neonatal Child Health (MNCH) with integration of COVID 19 response activities and increase access to health services.

The Ustawi wa Mwanamke Project (UMP) Project is implemented in 334 villages where there are 334 Community Health Workers and 30 Enrolled Nurses were recruited and posted to 29 health facilities to improve Reproductive Maternal and Newborn Child Health (RMNCH) services in Itilima DC, Kwimba DC and  Misungwi DC.

In the course of their duties, 6 disabled children were identified by CHW’s, linked with the Social Welfare Office and thereafter provided with wheelchairs and clothes by World Vision Tanzania. These include 3 disabled children from Ikungulipu village and 3 others that the CHW Officer linked to the Social Welfare Officer from Itilima DC.

Children with disabilities are a mostly marginalized and excluded group. They are almost invisible in society and especially in rural areas where access to suitable services for them as well as knowledge regarding child disabilities is limited thus increasing their vulnerability.

4.2 million Tanzanians live with disabilities and 48% do not attend school. 2.3% of the disabled out-of-school are children. There are many gaps in the implementation of policies and regulations for the disabled and this negatively impacts on the services for the disabled.

The CHW deployed by Mkapa Foundation enable early detection and diagnosis and applying the appropriate interventions including early detection of malnourishment from poor feeding and neglect. Assistive devices for the disabled are not easily available especially in the rural areas but the CHW’s mobility promotes coordination between stakeholders thus enabling combined assistance for the children.

Success like this is possible because CHW’s do awareness raising, strengthen child protection mechanisms, and enable early detection and referral where necessary. They also engage with families and communities appreciatively seeking solutions and mobilizing support.

As the old adage goes; when people come together, they can mend a crack in the sky. Two among the six children who received wheelchairs

“Community health education interventions create the space for us to talk to parents and carers, advise them as well as make referrals”
Samson Busiga CHW
Itilima

Felista’s Story: Tackling Cultural Beliefs and Malnutrition

Felista Nzumbi is the first child in the Nzumbi household. She is 3 years and 6 months old. At first glance, one could mistake her for a wizened old midget but Felista is a child overcoming severe malnutrition. She was born to Nzumbi and Christina in August of 2018 in the tropics of Itilima in Simiyu region. Her parents are farmers as well as cattle keepers just like most of the population there.

Felista was discovered by Samson Busiga, one of the 334 Community Health Workers dispatched to 334 villages in Simiyu (102 Itilima, 119 Kwimba and 112 Misungwi) where the Benjamin William Mkapa Foundation in collaboration with Amref Health Africa under the support of Irish Aid were implementing the Ustawi Wa Mwanamke Project (UMP) in Mwanza and Simiyu Regions. The project aimed at improving the wellbeing of women and girls by strengthening the implementation of CBHP and MNCH with integration of COVID-19 response activities and consequently increasing access to health services.

Samson was doing his usual round of “Huduma ya Mkoba” services in the village when he came across Felista at her parents’ home. “Huduma ya Mkoba” is a proactive exercisewhere child health services like immunization, growth and development monitoring are brought to the village outside of the health facility by the Community Health Worker carrying his “Mkoba”. “Mkoba” means bag in Swahili, this was therefore his bag of essential supplies. Felista was 9 months old then but only weighed 4.6 kgs, slightly more than half the normal weight. She had all the classic symptoms of malnutrition presented through growth failure, stunting, wasting and inactivity, hollow cheeks andsunkeneyes.

Her parents had not taken her to hospital. They believed it to be a local congenital disease called “Nyamswa” of which the symptoms are engorged veins in the neck and head.They knew it severely affected the health of children but kept her home and her health kept deteriorating to the extent she couldn’t even drink her porridge. Samson the Community Health Worker explained to them the cause of her illness and convinced them that it was treatable. He referred them to Luguru Health Centre for treatment and management. “Her parents believed she was born that way and was destined to be poor, that it was “Nyamswa” and so nothing could be done, this belief is there and even in their traditional dances” CHW Samson says.

Felista’s recovery was slow but steady as she began to walk and show positive cognitive psycho-motor development where previously she had been a sick, poorly feeding listless child who could neither walk nor stand.

Although Tanzania is making significant progress in addressing malnutrition thanks to interventions like the Ustawi wa Mwanamke project that Mkapa Foundation is implementing in Simiyu; malnutrition rates are still high where the population of under-five stands at 9.3 million out of which 5% present wasting and 32% stunting.

The far-reaching consequences of malnutrition in childhood are dire including future impaired cognitive and psychomotor functions. It also leaves one susceptible to infections and organ diseases.

In Itilima102 CHWs deployed by Mkapa Foundation are involved by the District Nutritionist Officer in mobilizing households’ participation in nutrition days in the district. This activity enables proper surveillance, active case finding and identification of severely malnourished children in the community thus enabling proper interventions like Samson did for Felista. It also helps to address negative cultural beliefs and practices that sustain malnutrition. Most importantly Interventions like these impact on positive national outcomes too. There is a Maasai saying that “Happiness is as good as food”. Acknowledging most likely, how important nutrition is.

Mkapa Foundation with support from UNICEF Tanzania trained 108 mothers who are living with HIV /AIDS to become Peer –Mothers thus creating a broad mechanism of support for fellow mothers. All the mothers underwent the Prevention of Mother To Child Transmission PMTCT program and some of them are currently PMTCT clients.

The reason for the training was to assist newly diagnosed pregnant mothers and those who were breastfeeding by offering them psycho-social support. The support was to enable and encourage the mothers to adhere to their ART regimen as this would significantly reduce their Viral Load and therefore minimize their chances of infecting their children, meaning the ART would suppress the amount of HIV in the mother to the extent that the baby could be free of infection.

If you could walk into any Ante-Natal Clinic and count 100 expecting women, and follow up on them after delivery and confirmatory tests, about 7 children would be found to have been infected with the HIV/AIDS virus.

A pregnant HIV positive woman can infect her child with the virus during pregnancy, the process of childbirth or when breastfeeding. Without ART there is a 15% to 45% chance that the baby will be infected. Peer mothers offer a valuable support in mother’s HIV care. Mothers are more comfortable with their peers and are apt to opening up more to them, exchanging ideas and opening up enough to reduce psychosocial challenges.

In the outskirts of Dar in Mbezi juu is a dispensary called Ndumbwi. On any ordinary day at the HIV/AIDS care and treatment clinic you will find there a beautiful fair girl called Rehema talking to mothers both young and the not so young. Rehema is a 26 year old HIV+ peer mother counselor who advices HIV+ mothers and the newly diagnosed.       She talks about her work as a HIV+ Peer Mother. “When the mothers come in, you find some who area in denial regarding their status and some who know their status but do not adhere to their ART regimen”

“I had some challenges when I started out because mothers did not know who I was. I noticed some had neglected themselves, had skin eruptions and their children were poorly. I did not give up. I talked to them every day and some began to relent. I traced several mothers who had been lost to follow-up and brought them back to full adherence and clinic attendance.”

“I had a friend who was in denial. Try as I did she would not budge! I watched her health decline, I watched her infect her baby who eventually also died. She died too. It was devastating and I made a pact that I would do everything I could to prevent mothers’ unnecessarily infecting their children and dying , so I could talk all day citing myself as an example and winning them over”.

Stigma and discrimination greatly affects mental health and timely disclosure but the embracement offered by the Peer- Mothers greatly reduces stigma and promotes mental health enabling the HIV mothers to confront their fears of physical decline and death turning it all around to shared positivity and easier follow-up of care and treatment.

According to WHO over 100 million people end up impoverished after illness and being subjected to unforeseen health expense of a magnitude they cannot bear.  Universal Health Coverage (UHC) aims to enable equity in access to quality health services while protecting individuals, families and communities   against helpless financial crisis.

The Mkapa Foundation is addressing Universal Health Coverage by its strategic focus of enhanced financial solutions to accelerate access to health and related services.  This is to ensure the poor and the vulnerable access the appropriate quality health services by advancing improved Community Health Fund (iCHF), an alternative health insurance scheme meant to cover the informal sector and rural communities with essential services up to the regional hospital with referral from primary facilities. Insurance enrollment in Tanzania is at 9% for women and 9.5% for men and this includes 4.5% through community based insurance.

The Mkapa Foundation has stepped up mobilization by Community Health Workers increasing information and education on the benefits of iCHF and now Itilima, which is one of the 6 districts in Simiyu Region with a last census report of about 313,000 inhabitants, is witnessing commendable strides in iCHF enrollment as community members increasingly turn up to be enrolled. From 6-12^th January 2022; 428 households were enrolled creating revenue of 12.8M for the district coffers.

This is a result of intensified efforts by the district team and CHW’s. The target is to enroll 3000 households by March 2022

The enrollment is a result of intensified sensitization and awareness activities in the community, as compared to sensitization and awareness previously being confined to the health facilities and dispensaries only.

“ .also the enrollment of households continues and we are following up every step of the way ensuring they already have been entered into the system and can wait for their cards from the regional office”

Explaining the cause for this successful turnout for enrollment, the coordinator thus elaborated

“Before the focus was enrollment at dispensaries and health facilities but now the District Medical Officer and Community Health Worker coordinator have increased mobilization and awareness raising.”

This demonstrates that cooperation of the Regional Authorities, Council Health Management Teams (CHMT’s), Facility in charges, Community Health Workers (CHWs), Community members, ward and village leaders is important in rolling out iCHF.

iCHF serves the low income bracket of people living below the poverty line, it ensures a safety net guarding against the indignity of being helpless in the face of illness.