HEALTH IN DEVELOPING COUNTRIES
The main aim of this woman and health meeting was to exchange ideas and experiences among women from around the world : it was not intended that there be long presentations or formal speakers. For this reason we did not ask for written papers. Nonetheless, some women came with documents they wanted to make available and some had spend time working on written presentations of what they wanted to share with others.
In this section we reproduce just three of the papers — from Zimbabwe, India and Mauritius Other papers available are listed as resources at the end of this section.
WOMEN AND THE HEALTH SYSTEM IN ZIMBABWE
Margaret Nhariwa
I have come from a country that recently was at war. Through this bitter struggle a new awareness has been created amongst my people. Part of this awareness is the liberation of women. In the war, women fought side by side with men and have proved their worth.
Our Government is aware of this and is acknowledging the worth of women in developing the new country. This is evident in their creation of the New Ministry of Women's
Affairs and Development. It is to women, therefore, that our Government entrusts the development of Zimbabwe and its women. In the past women were the workers for development in the rural areas but unfortunately their efforts were taken for granted and never fully realised or appreciated by the menfolk. We owe the recognition of our worth to the role played by women in the liberation struggle.
I am going to talk to you today on the work done by the Village Health Workers (V.H.W.) I have trained. Of the 250 V.H.W. I have trained only four are men. I,as a woman,
was asked by our district committee to train the popularly elected V.H.W. So I found myself leading a team of health workers who are mainly women : not only on district level but in the Victoria Province as well. That men have entrusted this delicate matter of health into the hands of women shows how much women are trusted.
Before I talk more about the V.H.W. I will explain some of our past history. Our health system in colonial days was 80 percent based in urban areas where 25 percent of the
African population lived. The African population makes up about 90 percent of the total. The health delivery system was then heavily curative and only 10 percent preventive.
Most health problems in the Third World countries, Zimbabwe included, can be prevented or avoided by promotive and preventive measures. In my country most of the people in rural areas had very poor health facilities or none at all.
During the war even the very poor health facilities were cut off from most of the rural people. Seventy-five percent of our population had virtually no health facilities. A great
awareness of human rights was brought to the people by guerillas in the front line. From this the people were determined to build for themselves an effective health delivery
system that would last and be independent of the previous structures. That was when the local community approached me to train their V.H.W.
After independence I started training V.H.W., using the syllabus I had drafted and had sent to the people for approval. Most of the V.H.W. are young married women with a position in the community. Education was not a criterion, though most of those chosen are able to read and write.
Training
The V.H.W. initially receive a two weeks' theoretical course at Bondolfi Mission then for five and a half months they work in their respective areas. While doing this they attend weekly study days in their areas and every month they have a day at the district level when they have their monthly reports, records and study day.
The work of a V.H.W. is mainly preventive and promotive health care. We seek to promote antenatal care and normal child birth by advising pregnant mothers on the foods they should eat, the rest they need, their posture and the kind of clothes they should wear, and by stressing the importance of antenatal clinic attendance for vaccination and examination. The V.H.W. assist normal deliveries in the homes and refer complicated ones to the nearest clinic.
We also encourage breast feeding. With the commercialisation of dairy products in the past years, powdered milk was becoming more and more prevalent. And diarrhea which often terminated in malnutrition or death due to ill prepared milk was common. During the war it was difficult for commercial travellers to sell their goods thus mothers fell back to breast feeding. We now have the V.H.W teaching mothers the importance of breast milk. Our Ministry of Health is also busy promoting breast feeding. Though roads are now open and commercial travellers can reach the villages, people are not so keen on artificial feeding anymore. Less than 50 percent of the children in our area are given artificial supplementary feeding.
Nutrition
Correct nutrition, as we are all aware, is an absolute necessity if we are to improve the health of our people. So our V.H.W. give nutrition talks to mothers in their areas and advise women who are negligent in this regard. The aim is to promote locally obtainable foods and so promote the people's health. A nutrition department has been opened in our Ministry and these women will work in close collaboration with it. Where we had 2 225 malnourished children under five in January 1981, we n ow have 277 malnourished. This was achieved through the national feeding scheme introduced by the Ministry of Health, and these women worked hard to carry out the project thoroughly in our district . It is their duty to watch the nutritional state of their communities and diagnose the causes of malnutrition and together with the community seek to eradicate them.
Herbs and Self-help
We also emphasise the use of natural herbs. When we started this programme I did not have any drugs to give to these women to use for minor aliments. So naturally we resorted to the use of local herbs. In class we discussed different herbs, their uses, dosages and side effects. In most cases these drugs
have been used with effect and the cases that herbs do not help are referred to the clinic . People had lost the art of using local herbs and the belief in them so we have brought back to the local people trust in what was one quite helpful to them.
The V.H.W. constitute the channel to promote self help. The clue behind self help, as we all know, is first and foremost an awareness of facts and then the motivation to be self reliant in order to counteract these facts or to meet them. The community at large was aware of the big gap in the health delivery system — it was foreign and did not meet the demands of the community — so they desired their own type of health system. In my lessons to V.H.W. I made them aware of their rights as human beings, especially when we discussed social problems leading to bad health. It is in this setting they also realised that health means wholeness, and well being and that health is not just a matter of disease and cure. They realised that no one could bring them a better life but themselves. When the V.H.W. go back to their communities and talk on the subject of health questions always arise — what shall we do to improve this and that condition in order to attain a certain end ? Often questions are sent back to me for help and advice. I now realise that the district , and even the Province as a whole, is very keen on self development. Now the local people would like a community development centre where some local people could be trained in skills that are needed by the community to build up its area. They even would like local industries like fruit bottling, jam making and pickling, because the area has plenty of fruit and certain types of vegetables that go to waste in one season and are not available in others.
Contraception
We include education regarding contraception. The Family Planning Association of the past Government was looked upon with suspicion because people did not understand what it was all about. Side effects were not explained to the people who, when they experienced them, lost all faith in modern methods. But contraception is not a new thing amongst my people. There are old methods of family planning whereby a baby was breast fed until it was not only walking but even for some time after the baby had began to herd cattle with older boys. It was rare for a woman to have more than five children. The present Ministry has plans for the future . When the Primary Health Care Service has properly started functioning the V.H.W., who are the frontline workers, will be used to help parents plan their families under the supervision of paramedics. This will incorporate both traditional and Western methods of family planning.
Community Participation
Community participation is what I consider our biggest achievement in our health promotion activities. Many areas are still quite far away from clinics so the local people have agreed to contribute money to buy such items as aspirin and eye ointment in order to meet their local needs. The building of wells and toilets and even renovation of schools all result from their health meeting and the communities' working together to build .
One hundred eighty-five wells have been dug and most of these are deep wells. Some people contributed money to buy cement and build round their wells to protect them. We encourage the boiling of water for drinking where wells are not protected.
Most homes are now improved. The people build shelves for storing plates and other ustensils. They have shelves outside for drying plates. Pits for rubbish and composts have been dug and are being used. Dirt is no longer being thrown all over the yard . Mothers take pride in their homes and plaster the walls. Some homes are beautiful and clean, it is a pleasure to visit them.
Four hundred fifty - four pit latrines have been built and more are being built daily. The use of bush latrines is dying out . Where communities were able to collect money and work together to build a class room, a toilet , or even w o r k together to build a well they have done so. They have also worked together to improve the nutrition of the children.
I am glad that what the local women are working towards in Zimbabwe ties up with what international women are fighting for today - better health for all.
An? interview with Margaret Nhariwa conducted the week of the conference covered many of the same topics as her article. The following paragraphs, however, touch upon an area or two not discussed above.
Abortion Is strongly condemned in Zimbabwean society, and has to be done with the utmost secrecy. Legal abortions are done in hospitals during the first three months of pregnancy on medical grounds (mostly malnutrition ) , but are very rare. From January to June of 1981 , there were ten abortions
Unmarried mothers on the contrary are not stigmatized if they bring the pregnancy to term. The baby is informally adopted by the family and village. Students, trained nurses, and working women who are away from their family are the ones who may resort to abortion.
Margaret Nhariwa's reaction to the conference was the feeling that in every workshop she attended there was a common wish to denounce commercial traps such as Depo Provera, and the system In general which makes women prisoners of their biology. However, she is not in agreement with some statements such as the need to fight for legal abortion. In having abortions, she says, women are still conforming to a man-made society, while women's main aim shoukj be to change the 'machinery ' and to have a society where children are accepted.