Mumbi Malama, CHW
Across Africa, Community Health Workers are playing a crucial part in creating demand for the COVID-19 vaccine. Zambia's Mumbi Malama explains what drives her to do this vital work without financial reward.
Since the onset of the COVID-19 pandemic, Community Health Workers (CHWs) across Africa have been at the heart of efforts to stop the spread: raising awareness and helping to prevent transmission, as well as identifying potential cases and referring them for treatment. In most countries – Ethiopia and Rwanda being two notable exceptions – CHWs do this vital work on a voluntary basis.
In Zambia, Community Health Workers are known as Community-Based Volunteers (CBVs). In June 2021, UK supporters attending the launch of our #VaccineSolidarity campaign had the opportunity to meet Mumbi Malama, a CBV based in Copperbelt Province. Mumbi spoke powerfully of her passion for her work and the need for CBVs to be better equipped and protected. We followed up with her via Zoom so she could give us a bit more detail.
Never off duty
A newly-qualified primary school teacher, Mumbi is awaiting deployment by the government. In the meantime, she supports her community in her capacity as a CBV – sometimes for up to nine hours a day. “People follow me; they follow me home!” she laughs. “At night, they come. Even over the weekends. If they come over the weekend, I assist them and give them information.” If she’s never really off duty, how does she manage her time? “I balance,” she says. “I have a husband. When I knock off, I go home, first I cook and take care of my children.”
"If I'm scared, how am I going to help others?"
Currently, one of the biggest challenges Mumbi and her fellow CBVs face is people’s reluctance to seek care or visit health facilities for fear of catching COVID-19. “There are so many diseases in the community: malaria, TB [tuberculosis],” says Mumbi. “So we [CBVs] also raise awareness about that, to make sure people come to the clinic. In fact, just the day before yesterday, we were going around the community with a mobile clinic, encouraging people to come and get treatment for TB.”
At the onset of the pandemic, “I used to feel like that [nervous],” says Mumbi. “But now I’ve decided, If I’m scared, how am I going to help other people? So I’m just strong, at the moment. I mask up, I sanitise when I’m in the community.”
“I love my community, I love my people. So I continue.”
When asked what motivates her to continue this sometimes very challenging work without the prospect of payment, Mumbi waves away the question. “I just love working! I just love working for people,” she says. “And I love my community, I love my people. So I continue.”
Dedicated as she is, Mumbi recognises that she and her fellow CBVs require additional support – even if it doesn’t come in the form of a salary. “The most important thing we need is equipment: textbooks, IEC (information, education and communication) materials, and identification – t-shirts, for example – so that people in the community can know that we are coming from the health facility,” she says. She is also keen to receive further training: specifically, training related to COVID-19 vaccination, so that she can address vaccine hesitancy in her community and help accelerate uptake.
“We know these are fights that we can win.”
“The fear of vaccines is not only related to COVID-19,” says Brenda Mubita, Amref Zambia’s Programme Manager in Copperbelt Province. “Each time we have a new vaccine, even for childhood illnesses, I think – as a person who’s been working in maternal and child health [for a long time] – I’ve seen a lot of resistance. You always get a lot of myths and misconceptions. So this is not something new: that’s why we have the strength to fight on, because we know these are fights that we’ve undergone [and won].”
“She’s right,” agrees Mumbi. “We keep educating people and telling them the best thing to do is to get vaccinated. Because COVID is real. People are dying. And I also advise them to check on the television, to hear the radio station, so they can get new information.” CBVs are in a unique position because they are members of the communities they support: in fact, they are elected by their communities. “The fact that I’m found at the clinic, and found with them, [means] they trust me,” says Mumbi.
As long as I’m living, I’ll keep doing my job. [Regardless of] the fact that I’m not being paid, I’ll continue doing that. Because it gives me satisfaction.
Leveraging the power of community-based health workers
Amref Zambia’s work in the coming months will leverage the power of CBVs to address myths and misconceptions surrounding the COVID-19 vaccine. “We’re building on a project we ran last year which used Leap, Amref’s mobile learning platform, to train CBVs on COVID-19,” says Programme Assistant Alice Kampengele. “It has since been scaled up, and we’re now planning to train 2,500 Community Health Assistants (CHAs)* in all 116 districts of the country, as well as 1,000 Community-Based Volunteers (CBVs) in Central and Southern Province. In view of how the situation has changed with the introduction of the vaccine, we plan on introducing a [training] topic on COVID-19 vaccination to address the myths in the community as well.”
“I would just love to say that CHWs are important, because they work in the community and they are found with people,” says Mumbi. “So, whichever information that comes concerning health, it’s easy to hear from them, because they’re found with them [the community], they stay with them, and they trust them. So we need to be considered.”
* “An additional cadre of Community Health Assistant (CHA) was introduced some five years ago to help plug the skills gap, explains Progamme Manager Brenda Mubita. “CHAs follow a comprehensive 18-month training programme at a formal learning institution before being deployed. In contrast to CBVs, they are compensated for their work. They can also treat minor ailments as well as doing health promotion activities in their catchment areas,” explains Brenda. “They are allocated to clinics where they’re supposed to work from as well as from their catchment areas. In fact a number of them are even on the government payroll: they get a salary from the government. Not everyone has already been put on the payroll, but that’s the plan, is for the government to put all the CHAs on the payroll.”
Banner image: A COVID-19 vaccination clinic in Zambia (c) Aubrey Sinyangwe, 2021. Mumbi is not pictured.