Zimbabwe’s bid to professionalise village health workers

Village health workers across Zimbabwe are the backbone of the country’s healthcare system, carrying out newborn checks, nutrition education, and disease screening. Plans are underway to bring them onto the government payroll.

Village health workers like Virginia Chakandinakira are essential to Zimbabwe's health system, but they lack formal recognition and a guaranteed salary. Photo: Farai Shawn Matiashe

Under the blazing summer sun at her home in eastern Zimbabwe, village health worker Virginia Chakandinakira devotedly weighs babies on a scale.

The 54-year-old, herself the mother of one, from Chishakwe village just outside Mutare, Zimbabwe’s third-largest city, places a baby in a soft-fabric weighing sling in a small examination room. The bag is attached to a hook on a suspended scale, hanging freely in the middle of the room.

Chakandinakira steadies the sling as it lifts, making sure the baby is secure and comfortable. The baby’s wriggly movements cause the bag to sway slightly, and she waits for the gentle pendulum motion to settle. She then reads the measurement aloud, lowers the sling again and unhooks it, then hands the baby over to her waiting mother, reassuring her that the infant’s weight is healthy.

Chakandinakira has been doing this work every week since 2013, when she trained as a village health worker. “I always wanted to help the community. When the village head nominated me in 2013, I grabbed the opportunity without thinking twice,” she says with a grin.

Zimbabwe’s 22,000 village health workers are the backbone of the country’s health system, bridging the gap between communities and professional health workers. But the lack of formal recognition and a guaranteed salary leaves them struggling to sustain their work.

Bridging gaps in primary healthcare

In a pattern familiar across much of Africa, Zimbabwe has lost thousands of nurses and doctors to countries like the UK and the US who leave in search of higher salaries and better working conditions. In 2023, the World Health Organization (WHO) revealed that 4,600 health workers had left the country since 2019. Currently, Zimbabwe is facing a shortfall of at least 14,000 health workers, according to the Health Ministry.

The country faces a severe doctor shortage. As of 2023, there were 1.4 doctors per 10,000 people, less than the African mean of 2.6, and way under the WHO recommendation of a physician density of 10 doctors per 10,000 people.

This is where village health workers come in. Across Zimbabwe, they strengthen prevention, early intervention, and follow-up care, which are all critical to strong primary healthcare outcomes.

Village health workers across Zimbabwe conduct infant checks and screen for malnutrition using a MUAC (mid-upper arm circumference) tape. Photo: Farai Shawn Matiashe

Chakandinakira’s daily routine includes traversing on foot the mountainous terrains of Zimbabwe’s eastern highlands, visiting homes in Chishakwe and Gwidibira villages. “Other than weighing children, I give them vitamin C and screen for malnutrition using a MUAC [mid-upper arm circumference] tape,” she explains. “For adults, I test for malaria, blood sugar, and blood pressure.”

Chakandinakira has a bicycle, but the terrain is difficult for her to navigate, so she walks up the mountains, covering long distances to deliver essential healthcare information and services. She often carries a backpack filled with medical supplies like pregnancy test kits and birth control pills.

Through community health clubs—informal groups where women gather for support and share learnings on their lived experiences—she educates villagers about safe hygiene practices and food and nutrition. She also identifies sick people, referring them to the local Chitakatira clinic for treatment by nurses and other health workers.

Long-serving and widely respected

Village health workers are widely trusted and respected within their communities. In rural areas where access to health facilities can be limited, they are often the first point of contact for health information and guidance.

Chakandinakira is especially busy during outbreaks of diseases like measles, cholera, and malaria. A recent surge in malaria saw the disease infecting more than 130,000 people and claiming more than 300 lives. “I mobilise mothers and their babies to bring them to a nearby centre for vaccination. I did that during the 2022 measles outbreak,” Chakandinakira says.

However, she is not welcome in some homes. In Zimbabwe, there are religious groups that do not believe in seeking medical care when people are sick, preferring instead to pray for their recovery.

“These people do not want to go to the clinic. By the time neighbours alert me, their situation would have deteriorated,” Chakandinakira says, recounting how she saved the life of one such man from succumbing to malaria last year.

However, she says she has been making progress with these groups, convincing them to seek healthcare under special arrangements, like giving them medical supplies at night while staying out of sight.

“Village health workers continue up to today to augment the work being done by the mainstream health sector.”

Itai Rusike, executive director at Community Working Group on Health, which works to improve health service delivery in Zimbabwe, says village health workers were key to Zimbabwe’s successful expansion of primary healthcare in the early 1980s.

“They played a central role in closing the gap between public health services and communities at local levels by bringing health services outreach to communities and facilitating community roles in health delivery services,” he says, noting they continue to play a key role in healthcare delivery.

“Village health workers continue up to today to augment the work being done by the mainstream health sector, raising awareness, giving health advice, monitoring growth of children under five years, mobilising communities during outreach programmes and for immunisation, including as trusted sources of information for community health literacy,” Rusike says.

Not on the government payroll

Despite the important role played by village health workers in keeping communities healthy across Zimbabwe, they are not on the government’s payroll. Instead, they rely on handouts from NGOs for essentials like bicycles, personal protective equipment, and smartphones for reporting. Village health workers sometimes also receive allowances when they attend training workshops run by NGOs.

But not every village health worker benefits from these initiatives. Some are left out, while others go for months or even years without receiving promised allowances.

Chakandinakira says that when she was recruited, she was told that the work was voluntary, but she would receive USD$35 quarterly. However, even this paltry allowance is not paid consistently. “We have not been given [it] for two quarters now,” she says.

Despite the important role played by village health workers in Zimbabwe, Virginia Chakandinakira and her colleagues are not on the government’s payroll. Photo: Farai Shawn Matiashe

Sometimes she needs to pay for data herself so she can submit patient reports on her phone. Zimbabwe has some of the world’s highest mobile internet data prices. “At times we get [paid for] data but often not. I end up using my own data so that I can just report. Other village health workers do not have smartphones.”

Chakandinakira, a peasant farmer who survives on raising chickens for income, used to get her allowance from the United Nations Children’s Fund (UNICEF) until funding cuts last year, when The Global Fund took over the village health workers' welfare. Her responsibilities as a village health worker keep her so busy that she cannot take any other jobs.

Formal recognition of village health workers

In December 2024, Zimbabwe’s Ministry of Health and Child Care announced a plan to absorb all of the country’s village health workers into its paid workforce by 2027. Though their proposed salary is not yet known, they will likely receive some perks of formal employment. Nurses, for example, earn about US$270 a month and enjoy benefits like health insurance and a pension.

Rusike says there is broad support for the absorption of village health workers into the government payroll system. It is seen as an effective form of task shifting to address the shortage of health workers across the country, particularly in rural areas.

“It is [our] policy to formalise their employment and ensure that they are on the government's payroll. Soon, the first batches of village health workers will be recruited.”

“Even though village health workers do not replace the requirement for adequately trained staff at primary care levels, they are a key cadre in the health system, fully aware of the health needs and aspirations of their communities,” Rusike says. “This makes them an invaluable asset in advancing community-oriented health delivery. They should be supported.”

Brian Berkhout, director of Buffalo Bicycle Zimbabwe, which supports village health workers with bicycles in the country, says formalising roles helps bring clarity around responsibilities, training, and supervision, which supports effective collaboration across the health system.

“In practice, village health workers already play an important role in health promotion, referrals, follow-up care, and community engagement. Clear role definitions allow this work to be well coordinated with clinics and health facilities, ensuring that care at the community level complements facility-based services,” Berkhout says.

Rusike highlights the importance of strengthening the health system from within, noting the risks of relying too heavily on external support. “There is an urgent need to invest in village health workers by increasing domestic health financing and moving away from the current overreliance on external donors, as it is not sustainable and poses a security threat in the event that donors decide to pull out for whatever reason,” he says.

Sleiman Kwidini, Zimbabwe’s deputy minister of health and childcare, says the ministry has already opened some vacancies for village health workers, though posts remain limited. “It is [our] policy to formalise their employment and ensure that they are on the government's payroll. Soon, the first batches of village health workers will be recruited,” he says.

The Ministry of Health and Child Care admits that inadequate financial resources remain a challenge to the proposed plan. Zimbabwe is experiencing an economic malaise amid a US$21bn debt and struggles to pay its health workers and adequately fund the health sector, with much of the budget in local currency and subject to high inflation.

Virginia Chakandinakira outside her home in Chishakwe, Mutare. A government salary would provide her with much-needed financial support. Photo: Farai Shawn Matiashe

For village health workers like Chakandinakira, a government salary would provide much-needed financial support and recognition for the vital role they play in their communities. But with the government slow to formalise their employment, Chakandinakira is worried that age will catch up with her before she can earn a decent living from the job she loves most.

“I am getting old. If they keep on delaying, I am afraid I will not be able to see the benefits,” she says.