Community Health Workers: Everyday Heroes

The downpour of a summer rain patters outside as a group of women gather in a meeting room at the Saint Elizabeth Hospital in Tanzania. Christina, Devota (Eva), and Ivoce have been working together for years as community health care workers, and are essential in their community’s fight against HIV and TB.

“Our main duty is to provide education,” Christina says. “Our role is to ensure that new HIV patients are received and connected to resources at the facility, district, and regional levels. We are very close to the patients; we follow up to remind them of their clinic visits, and we counsel and encourage them.”

The work is fulfilling, but it can also be demanding at times.

“I can be called at night to go and attend to a patient; I receive calls any time even at night,” Ivoce says. When someone from her community living with HIV is in crisis related to her status, Ivoce shows up for them.

Despite the sporadic hours, each of these women continue to take pride in their work each day supporting their communities. As they talk about their work, they share glances of understanding with one another. Together they have gone through long work days, intensive trainings, leaned on one another for support when a new challenge arises, and built a strong community of practice. Yet the motivation of each woman is deeply personal.

Purpose in the Community

Many years ago, a woman living with HIV in Eva’s community gave birth to a child. The mother was very ill, so Eva stepped in to help. She took the child to their health appointments, and when the child was found to also be living with HIV, she continued to visit the HIV clinic to get medication for the family.

At the time, everyone knew that this clinic served people living with HIV. Rumors soon spread about Eva’s health status.

“I met many troubles [with people talking about me]—like they would say ‘we have seen Eva at the health center; she is sick.’ I never cared because I was ready to save the life of this woman and her child so they can have a better life,” says Eva.

The child did survive, and is now in university.

“The way I managed to help this child, I felt I should help others as well,” Eva explains. “This example gives me strength, and reminds me that I am important in the community.”

Christina has had similar experiences that motivate her to continue her work.

“There was a baby I was servicing whose caregiver said it was no use taking her to the hospital because if she took those drugs she may die,” says Christina. “But I encouraged and encouraged her. I went back and visited her home four times, educating her about how much better the treatment has gotten.

“I told her that one day she would come to see the children of this child. Finally, the caregiver accepted to have the child treated, and together, took the child to the hospital. The child is now 17 years old and pursuing higher education.”

“I am proud of my work,” Christina continued, “especially because for a long time, people believed that if a baby is positive, it can’t live long.”

This used to be true, and even as drugs first came out, they were not optimized for babies and they had severe side effects. “But that is not true anymore,” Christina says. “Now they can grow and become adults.”

“I started this service a long time ago when we were selected to work under the charge at the time of Uhai Center. We were taking care of orphans, especially supporting those who were HIV-positive. I say it is the compassion I have had for long time and, and it continues to motivate me today.”

Steps in a Personal Health Journey

“There are two things I am most proud of,” Ivoce says. “The first is of myself—I have accepted myself as I am, including my HIV diagnosis, and been able to care for my health. This was not easy, but I am proud to say that I did it.

Ivoce was diagnosed with HIV in 2014.

“At first I got scared… I was very sick, to the point where I wasn’t able to recognize myself. But after that, I continued to get treatment and get better.”

“In 2015 the ward was looking for people who were living with HIV so that they can provide services to their fellows at the ward level, so I got that chance to become a volunteer service provider,” says Ivoce. “Whenever someone finds out about their status, I try to convince them to take heart. I tell them I am also HIV-positive, so they will also be like me. I tell them to please use medication and they will be okay.

“Since I was recruited from my ward to be a community health worker, I have discovered nearly 300 people living with HIV in my ward,” says Ivoce. “I am an example there. Many have thanked me, others have died, but I’ve tried my best to help everyone.”

Pride in Community Impact

Community health workers are key in all points of the HIV care and treatment cascade – from case identification, which they assist by counselling new patients on disclosure and referring partners and children for HIV testing, to HIV treatment, where they educate clients about treatment options and dispel misinformation. Even months into treatment, community health workers ensure retention to care by reminding clients about appointments and providing emotional support and encouragement as newly diagnosed clients figure out how to live positively in a way that is safe, fulfilling, and healthy, often in the face of stigma or structural challenges to treatment adherence.

“I am very proud that through my self-acceptance I’ve been able to encourage others to accept themselves,” Ivoce says. “When one accepts themselves, they feel good, and they are more willing to invest in themselves, to improve their self-awareness and continue taking drugs. I am also inspired by all the young people that I have been able to care for, or who my colleagues have been able to care for—there are so many now who are now in university, and this brings me great pride!”

“The way I see the job I am doing really it helps the community,” says Eva, one of the community health workers. “We have saved a lot of people through educating them about taking medication and testing, and many are continuing to take their drugs. I see people who have been down but they are now working and come to collect their medication and are taking care of their families. They are happy and have peace because I have managed to counsel them, and I thank God I was able to do that with confidence. At first, they were pointing fingers at us but I thank God we are able to do it.”

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) supports these community health workers through the USAID Boresha Afya Project North and Central Zone implemented together with EngenderHealth and the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children. The project provides their technical assistance, builds their skills in community outreach, case identification, and records management.