Community Development

Simple health measures go far in Zambia's villages

In Brief: 

At the William Masethla Bahá'í Institute in Zambia, training for volunteer health educators focuses on preventative care and service to the entire community. 

At the William Masethla Bahá'í Institute in Zambia, training for volunteer health educators focuses on preventative care and service to the entire community

LUSAKA, Zambia - Henry Kasondah's livelihood comes from his work in the soil. The 35-year-old farmer grows rice, maize and cassava on a plot of land in Makuya village, Mwinilingua District, about 550 kilometers from the capitol in this central African nation.

His avocation, however, is his work with people as a volunteer village community health worker. It is an assignment he has undertaken since 1988, when he received initial training at the William Masethla Bahá'í Institute, which is itself located about 65 kilometers north of Lusaka near Liteta in Central Province.

"Before my training as a health educator, we had a big problem in my community," Mr. Kasondah said recently during a refresher course at the Institute. "In the rainy season the grass grows very tall. Small children and drunkards didn't bother to go to the bush to relieve themselves. They used the road instead.

"But after my training, I talked to the chief. I told him about the problem of people defecating in the road. The chief was not happy about this. He sent his retainers to announce to everyone that each family must have their own toilet, rubbish pit, dish rack and bath room. Now almost every family in our village has these things," Mr. Kasondah said.

They are simple measures, really: knowing the importance of digging and using a latrine and a rubbish pit; learning to let the dishes dry on a rack in the sterilizing sunshine; and understanding that one should wash up before preparing food and eating.

The difficult part is to get this kind of knowledge - and other basic health care information - into the outlying villages where government services are scarce.

In this effort, the Government has promoted the development of a network of community health educators. Asked to spend just 10 hours a week giving their fellow villagers such information, the health educators are on the front lines of primary health care in Zambia.

Since 1987, the Bahá'í community of Zambia has been working with the Government to provide free training to interested individuals - and to use its network of communities to help identify and encourage volunteers at the local level.

While other major non-governmental organizations in Zambia also offer such training, the Bahá'í Primary Health Care Project is distinctive for the way in which certain "moral" qualities - such as service and sacrifice - are discussed during training sessions. This helps to instill an extra measure of commitment.

"We have trained many health workers in the government and we have a high drop out rate," said Kate Bwalya, a public health nurse for the Ministry of Health, who is not a Bahá'í. "They willingly volunteer to get trained but they are not wholeheartedly prepared to serve. They need something to sustain their zeal. They don't seem to know who they are really serving.

"But the Bahá'í-trained health educators know that they are serving," said Ms. Bwalya, who worked in Mwinilingua District in the late 1980s where the Bahá'í project was first launched and who now works at the Mwachisompola Health Demonstration Zone Hospital about 15 kilometers from the Institute. "And from what I see, the difference between the two programs is the spiritual stand.

"When we have a refresher course for the government-trained health workers, there is always much discussion about monetary incentives. These questions are not there in the Bahá'í course." 

--- Kate Bwalya, public health nurse

"When we have a refresher course for the government-trained health workers, there is always much discussion about monetary incentives," Ms. Bwalya said. "These questions are not there in the Bahá'í course."

Link to the Grassroots

Since 1987, some 132 community health educators have been trained at the Institute or through outreach programs. These health educators come from widely scattered regions in Zambia; the program is linked into the network of local Bahá'í communities, which provide grassroots support to the educators.

"The link to the local community through the Bahá'í local Spiritual Assemblies is a key element of the project," said Allan Fuller, who is project administrator for the Canadian Bahá'í International Development Service, which helps to secure technical and financial support from donor agencies for the Zambia project. "That way, at the local level, people are not getting involved because of some promise of gain; people are getting involved because of a certain set of values which emphasize service to the community. This link to the local community, instead of just to individuals, also makes for a far more sustainable program."

The Zambia Bahá'í community has about 15,000 members country-wide, and it is organized into about 145 local Spiritual Assemblies, which are the freely elected governing councils that administer the affairs of the community at the local level. Some 80 local Spiritual Assemblies are involved in the community health educator program.

The primary goal of the educators, however, is not to serve the local Bahá'í community when they return; rather, they are to serve their entire village. Likewise, they need not be Bahá'ís to receive the training and be included in the program's structure. At a training session in June 1995, for example, only 10 of the 24 participants were Bahá'ís.

Currently, the project operates on a two-year cycle. During the last two years, some 26 new educators were given training, and refresher courses were provided to some 21 previously trained educators. Reports received from some of them indicate that they have made some 689 home visits, given 192 health lessons in primary schools, and given 234 public talks. They have demonstrated making the special drink for oral rehydration therapy 372 times. They reported that there are 422 new latrines, 463 new rubbish pits 602 new dish racks and 189 wells improved in their communities

"The Zambia Bahá'í Primary Health Care intends to assist the Government of Zambia in achieving Health for All by the Year 2000," said Stephanie Parrott, who is the project manager. "And beyond simply training community health educators, we visualize this as comprehensive health education program which recognizes that health education goes beyond information dissemination by helping people to translate the information into informed decision-making for improvements in health behavior."

Another evidence of the success of the project is the degree to which Institute-trained educators have become involved in other community development activities. In Northwestern Province, three educators, one woman and two men, have been appointed to committees by the Ministry of Waters Affairs to assist in the construction of wells using community participation. Another educator in the Province now works as a community-based "nutrition technician" in an internationally funded agricultural development project. In Northern Province, two educators have been given employment at local clinics to provide health education to those who come to the clinic.

The curriculum for the educators trained by the Institute draws on a number of materials, among them the Facts for Life program produced by UNICEF, WHO, and UNESCO, and on a booklet entitled "Raising Healthy Children," which was produced by the Bahá'í community of Kenya. The curriculum covers simple sanitation, first aid, oral rehydration therapy, breast-feeding, nutrition, and common diseases. The emphasis of the curriculum is on preventative care and communication skills.

Gender Equity a Key Goal

When women receive health knowledge, the payoff for their children and families is great, and the project has made gender equity a key goal. To this end, the curriculum emphasizes the importance of treating women and men equally, and puts efforts to give women knowledge about breast-feeding, immunization for children, and oral rehydration as key targets.

Communities are also encouraged to select and send women for training sessions - although in many cases the difficulties of travel and the responsibilities of child-rearing make this difficult. Overall, however, 27 percent of the educators trained by the Institute have been women.

"While these statistics are fairly good in comparison to other community health education programs, we are not satisfied with them," said Ms. Parrott. "So we are looking at various strategies to address this. One reason few women attend the training sessions is that many women are not comfortable traveling the long distance to the Institute. So to encourage participation of women, a training will be held next year in Northwestern Province, for example."

Flint Sanyikosa was trained at the Institute in 1988. A 30-year-old farmer from the village of Kingovwa, Mr. Sanyikosa says he tries to apply the principle of equality to his work. "I teach men that they should assist their wives in jobs like farming, collecting firewood and taking care of the children," said Mr. Sanyikosa at a recent refresher course.

He says that not only has his work as an educator helped his village, it has also helped his family. "Before, the children were not eating different foods, they were eating only meat and cassava leaves, and their bodies were not looking healthy," said Mr. Sanyikosa. "After my training I came to know that we needed three kinds of food, and my family began to eat differently. We have added beans, eggs and vegetables like cabbage to our diet. There is a difference from the old days."