- Zimbabwe’s healthcare system experienced a dramatic decline from the early 1990s, leaving hospitals under-resourced and understaffed. Like in other countries, rural areas face a more severe shortage of doctors than in cities.
- In order to fill the gaps in remote towns, the ministry of health and childcare, trains people to work as village health workers. They play a crucial role for pregnant women in rural areas, providing home-based care to the elderly and educating communities about how they can protect themselves from catching COVID-19, for instance.
- But when it comes to informing rural communities about COVID-19 vaccines, these village healthcare workers face a slew of conspiracy theories and misinformation which are often driven by social media.
On a drizzling Sunday, Lucia Chinenyanga, 42, navigates her bicycle through the bumpy terrain of Makusha township in Shurugwi district in rural Zimbabwe, 200 miles outside the country’s capital city of Harare. A handful of people, heading home from church, scurry for cover along the rocky dirt road.
Chinenyanga, a village health worker, is headed to a nearby home to educate a family on vaccines and other COVID-19 protection measures. On her way, she meets Robert Nyoka, a local. As they talk, he expresses concern about his pregnant wife receiving her second dose of the COVID-19 vaccination.
Chinenyanga assures him it’s safe. “Your wife can receive her second jab,” she says. “But should she feel any slightest side effect afterwards, she must report to the nurses to check her.”
As a village health worker, Chinenyanga oversees and responds to the health needs of people in Makusha township’s ward 9. She works at the local clinic. Her tasks include education around tuberculosis, home-based care for the elderly, monitoring pregnant women, and health awareness programmes — especially on COVID-19 vaccines. The position required three weeks of training conducted by the ministry of health and childcare, which coordinates health workers. She has worked in the village since 2019, the year before the pandemic hit Zimbabwe.
What do you do when there aren’t enough rural doctors?
While nearly two-thirds of Zimbabwe’s 15.3-million people lived in rural areas like Makusha township as of 2020, rural health facilities in the country are often under-resourced, with fewer nurses and doctors compared to urban hospitals. Village health workers such as Chinenyanga fill the gap. And although the village health workers play an essential role in the primary healthcare system, providing care for the marginalised or remote communities in rural areas, they receive little pay — the equivalent of $42 (about R670) every month from nongovernmental organisations that work with the government.
The health sector in Zimbabwe is a mix of public and private facilities; the latter are costly, charging more and offering better services compared to government-run institutions. In Shurugwi, there are three private facilities, but most local residents cannot afford those services due to poverty and opt for the public clinics. Others rely entirely on the services of health workers who do community rounds. Shurugwi consists of 13 wards, with a population of 23 350 according to a 2014 census.
The pandemic has stretched the system even more. “Over the past months, COVID-19 has increasingly become a dominant problem, killing high numbers of community members,” Chinenyanga said in January following a spike in COVID-19 cases in the country. The deaths came with shortages of pretty much every necessity: quarantine facilities, personal protective equipment, medicines and doctors. Like many places around the world, the country has also struggled with people sharing fake news about the dangers of vaccination.
Enforcing COVID-19 protocols can be draining for Chinenyanga. Every day she has to convince the rural villagers, mostly small-scale gold miners in the area, many of whom are sceptical of vaccines, to mask up, practice physical distancing, sanitise and avoid gatherings at places like pubs, where people tend to forgo prevention measures.
Despite some pockets of vaccine hesitancy, as of June 7, 2022, a total of 4.3-million Zimbabweans have been fully vaccinated for COVID-19, amounting to about 28% of the population. More than a million have received a booster shot.
“In Shurugwi, people grew scared when family members started dying of COVID-19,” Chinenyanga says. “One family would lose both the wife and the husband at the same time. This is when locals started understanding that COVID-19 wasn’t just a flu, but a deadly disease which had come to our community.”
Universal healthcare isn’t just about specialist doctors
When Zimbabwe gained independence from the United Kingdom in 1980, the new country’s health sector adopted a strong focused healthcare system, moving from only providing more advanced healthcare services for the urban population to involving more vulnerable sections of the society in rural areas. Health workers like Chinenyanga now play a pivotal role in the country’s health systems, says Samukele Hadebe, a senior researcher at the Chris Hani Institute, a South African think tank.
In rural areas, the health workers must be empowered with both finances and resources to do their job effectively, he adds, as a majority of people rely on them.
“If you come from a health background you will realise those who have succeeded in building universal healthcare or a viable healthcare system, it is not the specialist doctors,” he says. “Wherever there is a successful healthcare system, it is actually the basic community healthcare, the one that in some countries where they don’t even earn salaries. Those are the people fighting to just get recognised. Those are the people who manage the fundamental work.”
But over the years, Hadebe says, Zimbabwe’s government neglected the rural health sector by not taking care of its healthcare professionals and paying them inadequate salaries, which pushed many qualified workers to leave the country for better opportunities overseas. In Zimbabwe, the infrastructure is gone, he adds, and health workers “from the basic to the specialist are leaving the country. Why? Not just because of the salaries, but because someone will leave the country because they are worried about social security.”
‘You must have money upfront’: Why poor Zimbabweans are locked out of healthcare
Zimbabwe’s 2010 Health System Assessment from USAID, a United States (US) federal agency focused on foreign development, shows that there was a dramatic deterioration in Zimbabwe’s key health indicators beginning in the early 1990s. The current life expectancy for Zimbabwe in 2022 is just under 62 years, a 0.43% increase from 2021, according to projections from the United Nations.
With little hospital funding from the government, village health workers have to do their work with limited resources. Clinics like Chinenyanga’s in Makusha are poorly resourced and cannot accommodate patients with severe COVID-19 or other critical ailments, as there are no relevant medicines or oxygen tanks.
Even larger hospitals in Zimbabwe don’t always provide oxygen to every patient, especially if the patient can’t pay. “You must have money upfront,” Hadebe says. “And how many people can access that? So, it’s a dire situation.”
Itai Rusike, who heads the community working group on health in Zimbabwe, agrees that most rural healthcare facilities in the country were not equipped to deal with severe cases of COVID-19. In addition to the lack of oxygen tanks, he says, “we also do not have intensive care units in our rural health facilities.” Most of the rural facilities have no doctors, he adds, and the nurses who do work in rural areas may also not be well-equipped and skilled enough to deal with severe cases of COVID-19.
In November 2021, the Minister of Finance and Economic Development, Mthuli Ncube, announced that the country had acquired 20-million doses of vaccines. China reportedly committed in mid-January to donating 10-million doses over the course of 2022, which can be used for both initial and booster shots.
Rusike says that to ramp up the vaccination drive programme, community outreach is needed, especially in rural areas. “We need to take vaccination to the people,” he says, “rather than just wait for the people to come to the health facility and get vaccinated.”
“I think it is important, especially in remote locations, we come up with innovative strategies to take vaccination to the people,” he adds. “We know there are certain hard-to-reach areas where we can even use motorbikes to make sure that people can be vaccinated where they are, in their communities.”
Social media causing vaccine misinformation in rural Zimbabwe
In addition to resource shortages, Chinenyanga has experienced another serious challenge most days in her work: vaccine misinformation and disinformation.
The problem is common across rural Zimbabwe, according to Rutendo Kambarami, a communication officer at Unicef, who says that the most common reason communities are not taking the vaccine is fear.
Even though much of Zimbabwe’s population lives in rural areas, they still are connected on social media through mobile devices — and the mobile devices and social media platforms allow for plenty of access to inaccurate information and outright conspiracies about vaccines. “So we realised that we needed to give more information in order to dispel misinformation,” she said at a December workshop on COVID and mental health for journalists in Zimbabwe.
“Village health workers, as frontline workers, and even the teachers were saying: We needed to do more interpersonal communication within those areas,” she added. “So, frontline workers play an incredibly huge role in terms of even misinformation and disinformation.”
As Chinenyanga wraps up her day, after visiting several homes, she agrees that social media has contributed to misinformation. The people she serves in the Makusha community often share with her unproven remedies to treat COVID-19. She lists some of the misinformation that she’s seen so far. “People believe in steaming, that it helps. They also believe that eating Zumbani,” a woody shrub that grows in the country, “also prevents COVID-19,” she says.
Still, she manages to smile as she leans against her bicycle. She says she loves her job and its usefulness to the community. “As village health workers, our role is to share information we are taught by the ministry of health,” she says. “We prioritise prevention as the most effective tool against COVID-19.”
This reporting project was produced with the support of the International Centre for Journalists and the Hearst Foundations as part of the ICFJ-Hearst Foundations Global Health Crisis Reporting Grant.