Triumph of Community Health Workers in Zambia: Story of Josephine, Katwamba

Story by Wesley Kipng’enoh, Fundraising Content Manager

It turns out that the right thing to do is a community-friendly thing, a life-saving decision, and the most loving thing too. The right thing is to provide access to health services to mothers and children by working with Community Health Workers. 

Community health workers – wonderful folks the world can’t turn without, or at least this is true in Zambia. Take a look at Josephine, for example. She has been a backbone to her local area in Chifubu, in the Zambia city of Ndola, providing community health support.  

“What is in my heart is the love I have for my community. I don’t want my people to suffer, the women and children especially,” she says. 

Josephine Katwamba has a loving heart that lives out in the open and is visible in her eyes when she speaks. “Knowledge is a powerful thing,” she says, and indeed delivering health information to mothers is critical in quality health provision. She is holding a six-month-old baby at their home, whom she has visited with her mum, Hope Tabitha, to check their health status. Many young mothers often feel alone during pregnancy, and community health workers like Josephine provide psychosocial support and take them through what to expect and what to look out for during the pregnancy journey.  

When we meet her at the local health centre, Josephine is addressing a group of pregnant and breastfeeding mums about reproductive health. “My favourite part of my job is to see that a mother doesn’t die with a pregnancy.” She tells us. During the health centre session, Josephine delivers what would otherwise be a sensitive topic in her culture. Still, her friendly delivery, wrapped in laughter and assertiveness, brings the message home to these women.  

She knows too well that she is the critical link between mothers and the formal health system, and she is right. “I don’t want pregnant women and mothers to suffer because I am their eyes, and at the same time, I am the eyes of the clinic,” she affirms. 

Josephine lives in a low-income settlement just outside of the city. In this area, old stone houses hug together, sharing thin walls forming a row of storybook-perfect rustic rooftops. Most residents are involved in informal jobs and struggle to make ends meet, let alone ability to pay for health services. But there’s a sense of buoyancy of optimism that floats in the community. Here, neighbours talk to each other across the wooden fences, sharing evening banter, and kids peep through the fences as some crawl through, playing games under chattering trees.  

Vulnerable Communities 

The community she comes from is affected by high levels of poverty and repeated cases of communicable diseases that have traumatised vulnerable groups- mothers and under-five children. Stigma and lack of information are some of the factors affecting mothers’ access to health services in the locality. Mothers still take time before going for their first appointment after conceiving and choose to go to the clinic a few weeks before the delivery date. This has often resulted in emergency cases where the mothers and their families are caught off guard.  

Josephine recalls how she was called one night, three years ago, when a pregnant mother had an emergency. “I was ashamed as a woman when I arrived,” she says. A mum had delivered a baby in an outdoor pit latrine, and no one was helping. “The baby was just on the floor of the toilet.” She recalls, almost with a visible twinge on her face. “I felt bad because many people were there”, she narrates. 

Armed with skills she was trained on and a torch, she helped the mum in what she says were moments of shame, despair and vulnerability. “I held the baby and put it on the mother’s tummy, as I had been taught,” she rallied people to get a car that rushed the mum and her newborn to the hospital. For her, it’s a miracle as both the mum and the baby and mum were attended to at the hospital and survived.  

“The baby is now grown and 3 years.” She smiles.  

Closing The Gap’s Role 

Josephine’s role is critical as she helps her community meet unmet health needs in a culturally appropriate manner to improve access to health services. She is the frontline worker who hears, sees and advocates for the needs of individuals and the community. She helps address health status inequities by supporting and encouraging stigmatised mothers to feel free to access maternal health services. “I am bringing the community and the clinic together and filling that gap,” She asserts. 

Josephine was among 1300 community health workers trained in Respective Maternal Care through the Closing The Gap project. During the training, she learnt about providing health education and behaviour change motivation, including means to support mothers to adhere to health recommendations. This is especially useful for pregnant mothers who may sometimes delay making critical decisions that could affect their health and that of their unborn. 

She was also mentored and supported to provide essential services like screening and notice signs of danger at the initial stages.  “I have a Blood pressure machine that I use in the community,” she says. With that, silent killers like Blood pressure can be addressed and referred to on time. Blood pressure, for instance, is among the leading causes of emergency cases like preeclampsia or over bleeding during childbirth. 

Her unavailability could mean life and death in her trauma-hit low-income community. When the community needs to find love, reassurance, care and access to health service access, they know they can count on her.  

But she says that there’s a need to have more community health workers. “People have grown in numbers, and it’s important that we have more community health workers like me.”