Sylvie Schumacher, MA
Sylvie Schumacher first finished her basic studies in history, social anthropology and comparative religious studies at the University of Basel before earning her Master’s degree at the Centre for African Studies in 2008. Switching to this interdisciplinary Master’s programme offered her the opportunity to deepen her understanding of the basic human and social experience of health and illness.
Having gained professional experience in international health, she discovered her health research skills while working in applied nursing research at the Psychiatric University Hospital in Zurich. Since then she has advanced her abilities in qualitative and quantitative health and social sciences from a life-course perspective and is now striving for an practice-oriented PhD project dealing with “Health promotion in social settings affected by chronic illness”.
The potential of Community Health Workers and the creation of social security in Tanzania. Are microcredit programmes an option for safeguarding the provision of health services at the community level?
In numerous African countries, volunteers from the communities act as intermediaries in health activities (promotive, preventive curative measures e.g. in managing malaria episodes). Despite little training and support, these Community Health Workers (CHWs) can play a significant role in filling the health service gap between patients and health facilities.
In order to sustain their readiness to work and to assure the quality of their services, it is crucial for their communities as well as for the public and private health partners to integrate them into a web of moral, practical, material and financial support. In their daily lives, CHWs simultaneously act in these multiple and diverse spheres of meaning and action where they maintain numerous relationships which may intertwine, and in which the actors continuously negotiate their mutual rights and duties of support. In order to fulfil their duties and make use of their rights they invest various social and material resources into processes of mutual exchange. Ideally, these resources are interchanged among the various intertwined spheres of life and work, and by reinforcing each other they have the effect of creating CHWs’ social security.
In a resource-constrained setting, cash inputs can have a powerful impact. This is in the form of microcredits which are controlled by microfinance institutions and disbursed at low yet cost-covering interest rates mainly to women. But the methods of implementation of such financial products seldom account for their clients’ socioeconomic situation. The requested strict discipline to repay in weekly installments can compromise poor clients’ livelihoods if they can only make the payments by taking a new loan or selling their assets and hence get trapped in a spiral of debts. However, it is definitely feasible for microfinance institutions to respect individual strokes of fate (death, severe illness, climatically owed loss of capital goods or the like) and to adapt the installments to the seasons of dearth and abundance.
Especially during the rainy season the burden of disease is high while access to health care is inadequate for the majority of people, making interruption of work and expenses due to illness the leading cause of payment problems. If financial services are offered in combination with business education and with health services, this integration can contribute to reducing transaction costs on the supply side as well as increasing the clients’ benefits in terms of satisfaction of their needs. With BRAC (Building Resources Across Communities) in Bangladesh as well as in Tanzania CWHs in the health programme are at the same time clients of its microcredit programme and acquire additional social and material resources (knowledge, relationships, practical support, reputation as well as credits, means of production, income) for various spheres of life to secure their livelihoods.