Door to door: the crucial link between communities and health systems

In the small mountainous country of Lesotho, most people live in rural areas. Accessing food and health care is not always easy. With more than half the country’s population living below the poverty line and one in four people living with HIV, community health workers are bringing about change.

Mamokhoplo Motale, donning a Lesotho Network of AIDS Service Organisations polo shirt, makes her rounds visiting her patients. Today she is meeting Mpho Tlabaki.

Greeting him, they sit on the outdoor steps of his home. She takes out a black notebook and asks him about his health. Then she asks him get his medicine to see if he has enough. Jotting down the pill count, she encourages him to stick to his treatment.

“I visit households and teach people about nutrition issues and how to take care of themselves when they are sick,” Ms Motale said. Looking at Mr Tlabaki, she said, “I stress to people how important it is to seek out health services.”

She sees her job as educating people about the basics.

Community health workers, who come from the communities they serve, are key to reaching people in remote areas, often with few resources, to seek out treatment and care. They represent the crucial link between communities and health systems.

Mr Tlabaki is married and has four children. In 2008, he began feeling ill, so he went to a clinic and the nurse advised him to take an HIV test. He found out that he was HIV-positive, but he didn’t believe the result. A while later, he went to another clinic for a second diagnosis. Again, he was told he was HIV-positive and he began treatment immediately.

“Treatment changed my life,” he said. “Without it, I would be dead by now.” He says it allowed him to feel strong again and to get back to work.

Community health workers increase the uptake of health services, reduce health inequalities, provide key services and improve overall health outcomes. They receive training that is shorter than that required for doctors, nurses or other health professionals, but offer essential care. Increasing the number of community health workers provides job opportunities, empowers women, bolsters national and local economies and boosts productivity by improving a nation’s health and well-being.

Investing in community health workers in Africa will enable the continent to turn the projected near doubling in its youth population through to 2050 from a potentially perilous so-called youth bulge into a dynamic demographic dividend that drives economic growth and improves living standards. In Mr Tlabaki’s case, his community health worker encouraged him to join a group of people living with HIV that she leads. They gather weekly and share their stories.

“Before I knew my status, I drank a lot, but after knowing my status that all changed,” Mr Tlabaki said. “I got counselling, so I was able to concentrate more on taking my medicine daily and eating more healthy.”

The 2 million African community health workers initiative

The 2 million African community health workers initiative aims to accelerate progress towards achieving the 90–90–90 targets by 2020 — whereby 90% of all people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads — and to lay the foundation for sustainable health systems. Endorsed by the African Union, the initiative seeks to confront the acute health workforce shortages across Africa and improve access to health services for the most marginalized populations, including people living in rural areas.

Read more in UNAIDS’ new report Right to Health.

Photo credit: Unitaid/Eric Gauss.