Bulawayo City Council has approved a recommendation to expand the city’s community health worker (CHW) establishment from 219 to 318.
This move is aimed at strengthening primary healthcare delivery amid growing population demands and an expanding urban footprint.
The proposal was tabled by the city’s health services director, Edwin Mzingwane Sibanda, on May 8.
It follows a revised human capital work study which found that the city’s health outreach system has become overstretched following the commissioning of new clinics in Emganwini and Mahatshula in 2023.
Officials told council that the current CHW structure, established in 2020, no longer reflects the realities on the ground, with workers covering increasingly large and geographically dispersed communities.
The department argued that long travel distances between service points were reducing efficiency and weakening community-level health interventions.
“The expansion is necessary to ensure effective coverage of all communities, especially new settlements,” the Health Services director said, adding that the revised structure would improve outreach, vaccination coverage, and early disease detection.
However, the proposal sparked concern among some councillors over the financial implications. Councillor Khalazani Ndlovu questioned whether council had the fiscal capacity to support the increased establishment, noting that the current CHW cohort was already facing inconsistent remuneration.
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“There is a risk that we are expanding numbers without first stabilising payments to those already on the ground,” she cautioned.
In response, the health services department clarified that CHWs are intended to receive a stipend equivalent to a Grade 1 salary, working three days per week. There is also potential alignment with funding models used in other jurisdictions where donor support, such as the Global Fund, supplements government health programmes.
Despite these concerns, council resolved to recommend the expansion, citing the urgent need to align staffing levels with service demand.
The CHWs serve as the first point of contact for households, providing vital services including vaccination campaigns, maternal health education, TB and HIV adherence support, and disease surveillance.
Their role became particularly critical during the Covid-19 pandemic and subsequent cholera outbreaks, where they assisted with contact tracing and oral rehydration distribution.
In 2024, the government launched a national CHW policy framework proposing harmonised incentives, but implementation has been slow due to fiscal constraints.
Nationally, CHWs have long advocated for standardised remuneration, as stipends vary widely between urban and rural councils, leading to periodic work stoppages.
Some municipalities have partnered with NGOs and international donors, including Unicef and the World Health Organisation, to top up stipends, while others rely solely on local authority budgets.
