“A well-selected, well-trained, well-equipped, well-supervised and well-motivated CHW is an excellent community development actor like Mr. MAKIYE Poziyoufey“
Togo’s health system is organized according to a three-level health pyramid, including (i) the central level, (ii) the intermediate level, and (iii) the peripheral level with forty (40) health districts and more than 600 types 1 and 2 Public Health Units (PHUs). As part of the National Health Development Plan (PNDS) 2017-2022, the Togolese Republic has prioritized community health in its strategic axis 5, which is transversal to achieving all the country’s health objectives. The government proposes, among other strategies, accelerating the transfer of skills to Community Health Workers (CHWs) and other strategies contributing to bringing care closer to the communities.
The health system at the health district level comprises three levels, the first of which is the community health worker, then the peripheral health care unit, and finally the district hospital. The national health policy stipulates that each village of at least 400 inhabitants must have at least 1 Community Health Worker. Thus, the village of Kinizao, which has a population of 500, belongs to the Peripheral Care Unit (USP) of Konina, which is in the chaoudjo health district in the central region in one of the five regions of the country. The central region is in the northern part of the country.
During our visit, we met Mr. Makiye Poziyoufey, 41 years old, and the only Community Health Worker working in the village of Konina for the last 15 years. In our interaction, he had a wealth of knowledge to share drawn from his vast experience as a Community Health Worker.
What motivated you to become a CHW? Are there any specific gaps that you saw that you felt you needed to address? What were you doing before you became a CHW?
I was elected as a CHW when a Non-Governmental Organization (NGO) came to my village in Konina. This NGO talked a lot about community health, but its main objective was to help the people of the village to set up a health insurance scheme. This was the first time I heard about Health Care Mutual organization addressing center for prenatal consultations, childbirth, postnatal consultations, monitoring the growth of their children, vaccination, malaria, tuberculosis, diarrhea, anemia, etc. Shortly after, an open election was held in the village to choose the Community Health Worker. We were two candidates on the list, and I was elected. At the time, everyone was dealing with various health issues. There were problems with hygiene and sanitation in the village. The NGO pinpointed certain issues in the community, such as children not being de-wormed or vaccinated, and very few were taken to health centers to monitor their growth or in case of illness. There were several women who did not go to health centers for their antenatal care (ANC), deliveries, prenatal consultations, etc. Honestly, these problems were also very evident to us but there were no avenues at the time to articulate these issues and come up with ways of countering them.
Before I became a CHW, I worked 100% in subsistence agriculture in my village where I own a small farm.
What is your role as a CHW?
My role as a CHW is to sensitize the population of my village to adopt health-friendly behaviors and to actively support the health workers during the different campaigns carried out periodically. There have been campaigns on chemo, prevention of seasonal malaria (SPC), Child Health Days (CHD), poli among others, that health workers actively participate in. I am also responsible for the early detection and management of life-threatening ailments in children under five and adults, management of certain childhood diseases such as diarrhea, cough, and anemia, measurement of the brachial perimeter, visiting pregnant women, referral of pregnant women to health centers, case finding and follow-up of tuberculosis patients in the community, general home visits, search for those lost to vaccination among others.
What is your typical day like?
My day always starts with setting up a work programme in a locality, a neighborhood, for example, then informing my endogenous, i.e., the person in charge of monitoring and supervising me, but also informing the head of the neighborhood where I am to carry out my activity. After breakfast, I gather my working materials and head for the selected district or locality.
Getting to the target population is sometimes tricky and can be a tedious process as sometimes it will involve trekking for long distances to get to my destination. Sometimes I take advantage of the hours after Church Mass where people are already gathered to carry out certain activities. These types of activities take me time, between 3 and 4 hours. Home visits e.g., for HIV, are usually much shorter as I go directly to the target household. During my free time, I continue to work on my farm which is done before or after the household visits depending on how my day is scheduled.
What has been the greatest moment in your work as a CHW so far?
The biggest moment in my 15 years of CHW activities was just 2 weeks after my election to this exciting role. I remember two weeks into my service, a two-year-old child had a severe case of anemia which was not known at the time to the parents. The child’s father reached out to me to ask for assistance in getting his child’s health back on track. I quickly contacted a nurse at the health center and asked for an appointment which was granted the same day. I accompanied the sick child together with his parents to the health center and stayed on until the child was fully diagnosed. He was also admitted the same day upon the nurse’s recommendation for close monitoring. I took it upon myself to visit the child every day to also monitor his progress until the day he was released from the hospital. Today, the child is in high school and doing very well in school. His father still doesn’t stop thanking me for the support I gave him toward his child’s recovery.
There is another instance about three years ago where I got to assist a pregnant woman. At nine months into her pregnancy, no prenatal consultation had been done, let alone an ultrasound. When I heard about her case, I went to her home and sensitized her husband, who agreed to have the ultrasound done, which revealed a twin pregnancy. The same day, the woman went into labor, and the husband called me again. By the time we got organized to go to the health center, the first child was delivered home, and we later proceeded to the health center where the other one was delivered. As I look back, I shudder at the thought of the woman not knowing that she was carrying twins and the risks it would have posed to her and her unborn babies, as she had not been ready for a double delivery prior to the ultrasound.
It’s moments like those that define my work and that gives my work as a Community Health Worker meaning. Knowing that I am serving my community in my little-big way.
What changes have you seen in your community since you started your role as a CHW?
The changes are many and noticeable. Nowadays, there are no more women giving birth at home in Konina. ANC and post-natal consultations are carried out regularly. Children are vaccinated regularly, and their growth is monitored. In the village, as soon as a health problem occurs in a household, I am automatically informed. And if I don’t have the resources (knowledge, materials, and medicines, etc.) to deal with the case, then it is referred to the local health centers. The population no longer resists referral as in the past. They are even quick to go. For the newborns, every Friday the mothers take them for a follow-up of their growth without even being reminded. It has become an ingrained habit for them. I am very happy with what the people of Konina have become in terms of taking care of their health. Hygiene is much more observed in households compared to the past. The mothers and their children are clean. Their houses are clean too. I am really happy about this.
Do you think the government is doing enough to support CHWs? What more could be done to support your work?
I can say that the government is making efforts to improve the working conditions of CHWs. Thanks to the government, we were trained in managing several health problems before we started our role as CHWs. We are undergoing refresher training; we have also over the years been given some equipment to work with. We also have an incentive of 5,000 FCFA (~$10) per month.
It’s not much and we appreciate the efforts that have gone into making our work easier so far. Having said that, given the efforts we make at the local level for health, we would like to have even more consideration from the Government. We would wish that the government improves our motivation by giving us at least 10,000 FCFA (~$20) per month.
We also have a challenge with logistics and movement within the community. I got a bicycle in 2016 to carry out my activities. The bike is no longer in good condition. Therefore, we would like to buy new bicycles or even provision of motorbikes for the CHWs. At an advanced age, going by bike is no longer easy, and motorbikes are more suitable now.
Further, the government should consider renewing our equipment from time to time, such as raglans, smartphones, backpacks, torches, mercury thermometers, mackintosh, boots, picture boxes, etc. Sometimes we run out of supplies and replenishment takes a bit of time thus derailing our work.
In addition to supporting from public authorities, what kind of support would you like to get from other actors in the ecosystem? For example, donors, sponsors, etc.
We have learned that several organizations such as UNICEF, UNFPA, Red Cross, Financing Alliance for Health, etc., are supporting the government in community health, especially in the push towards professionalization of our profession. I think these partners can still provide strong support to improve the living and working conditions of CHWs. The partners can give money to those who need it and know how and where to spend it for the benefit of CHWs or provide technical support to the Ministry of Health, as is the case with the Financing Alliance for Health, as you told me earlier. If we have what is necessary from the government and its technical and financial partners, then we too, the CHWs, will play our part in improving the health of the population.
Do you have any other ideas or comments?
I would like to thank the government of Togo and the partners who provide support in the framework of community health. This has enabled us to work well in our respective villages as CHWs. If the right conditions are met, then we will play our role very well so that everyone seeks to become a CHW one day.