Between 18 to 22 October 2021, the Financing Alliance for Health (FAH) conducted an on-the-ground evaluation of community health (CH) models in Kara region, Togo – with the aim of collecting the requisite data that would form the basis of formulating recommendations for the best options for Togo’s Community Health program. During the field visit, (FAH)’s Tapsoba Boukary had the privilege to speak with Bassar N’gadjassain, a passionate Community Health Worker working in Bitchabé’s peripheral care unit. Bassar reiterated a very strong message that CHWs play a crucial role in health systems and should be adequately motivated and supported in their work.

The following is a full account of the exclusive interview:

Could you please tell us about yourself?

I am Bassar N’gadjassain, a Community Health Agent from Bawelessi Village. Bawelessi is located 7 kilometers from Bitchabé’s peripheral care unit, in Bassar area, Kara. I am 34 years old and married to two women with nine children. I am also a farmer by profession in addition to working as a CHW for 13 years.

How did you become a CHW?

 My work as a CHW began in 2008 when the lady who was working in the village as a CHW returned to her home village to assist her sick mother. The population unanimously appointed me as a substitute CHW. Initially, I used to work exclusively in nutrition but later I was also entrusted with malaria and Integrated Management of Childhood Illnesses (IMCI).

What are you most proud of in your role as a CHW?

I love being a CHW. Before I became one, I never knew the diseases that kill children, women, and the elderly. But now, as a CHW, I have received a lot of training on several diseases, their causes and how to treat them. Previously, children used to succumb to various childhood illnesses, particularly malaria but since I became a CHW and took charge of managing diseases like malaria in children, the death rates are almost non-existent.

When a child falls ill, they call me on phone even when I am in the farm, or they come to inform me physically. I usually screen the children for common diseases and treat them and refer serious cases to Bitchabé peripheral care unit. I also encourage people to seek medical attention in health facilities when they are sick, a feat that has seen a reduction in the number of deaths in my village. As a result, I have been encouraged to keep up the good work as what I do saves people’s lives.

I feel proud knowing that I have saved lives. One day, my elder brother’s daughter was bitten by a snake in the field. I was at the farm when I was informed about the ordeal. When I got home, I realized the girl had not been taken to a health facility. After looking for anti-snake venom in vain, I decided to call ‘Borne Fontaine’, a local NGO, to ask for financial support. The girl was treated at the peripheral care unit with the NGO’s support and is currently doing well. If it wasn’t for me, the girl would have died – this made people to respect me even more and it makes me love what I do for my community even more.

What difficulties do you encounter in your work as a CHW?

We, CHWs work much harder than those in the offices because we also have to engage in other activities such as farming to make a living as there is no adequate motivation. If you leave the farm to help a case, the farm remains uncultivated that day because you cannot take a child to a health unit and come back to work in the farm. If we had adequate motivation, I could easily pay someone to cultivate my farm. The current stipend for CHWs ranges between 2000 and 5000 CFA francs– a measly amount that can barely meet one’s basic needs. This is causing a lot of unrest among CHWs, with a majority complaining and others choosing to devote their time to other activities to earn their keep.

Also, we do not have suitable means of transport. We get bicycles but I cannot take a woman in labor on a bicycle to Bitchabé. It is not practical as it is too slow. I have often had to lend my motorbike to transport cases to the peripheral care unit to discourage women from giving birth at home. In addition, our family members are not taken care of for free and we do not have equipment such as torches and boots as well as solar panels to charge our phones in order to receive calls from the sick. Moreover, there is a massive shortage of medicines.

Knowing that even with my volunteering I cannot become a civil servant and be salaried because I lack formal education often discourages me. Therefore, I have to focus on other activities as well to look after my family.