Millennium Promise - Extreme Poverty Ends Here

Ruhiira is an area where most families live on isolated hillsides, far from clinics. So caseloads in Ruhiira are very high. Each worker visits 200 isolated rural homes a month, bridging the gap to the healthcare system for 1,000 people.

Each day, workers travel large distances over difficult terrain. To help them, the project provides bicycles. However, the hilly terrain causes wear and tear and frequent breakdowns. To be useful, bicycles require regular servicing, repair and replacement. $6,000 provides bicycle transportation for 48 community health workers. This project enables the timely delivery of healthcare to the homes of 9,600 families and 48,000 people.

A newly trained group of community health workers displays the training manuals that will guide their work in the field.

Health interventions run by Millennium Promise—including 6 newly renovated clinics and the community health worker program—reduce malarial disease and hookworm, transmission of HIV, and infant mortality for about 100,000 people in the communities around Ruhiira, Uganda.

The community health worker program has helped the people of Ruhiira, Uganda make great strides toward achieving Millennium Development Goal #6: Combat HIV/AIDS, Malaria and other diseases.

Jeffrey Sachs, Director of Columbia University's Earth Institute, is unequivocal about the importance of CHWs to developing thriving communities: "Training a professional cadre of community health workers in rural Africa is one of the most immediate and effective ways to reduce needless deaths and help communities to escape from the poverty trap.”

And he's not alone. When The New York Times reported in September, 2009 that the global number of early childhood deaths fell below 9 million for the first time, they attributed the success in Malawi, at least, to more than 10,000 high-school educated village health workers whom they called “Malawi’s most powerful weapon."

"With a minimum 10 weeks of training, medical checklists to aid them in diagnosing childhood killers and hardy bicycles to get around, they dispense medicines and give injections, tasks only doctors and nurses do in many other countries,” reports The Times.

What makes CHWs so effective? In Ruhiira, Uganda, the answer goes beyond tools like medical backpacks, bicycles, and cell phones, directly to the highly motivated individuals who dedicate themselves to saving lives and educating their communities.

“The project is important because, before we were recruited as CHWs, our community lacked a lot of health information," explains Asiimwe Museveni John, a Senior Community Health Worker in Ntungu Parish, who is responsible for 155 households. "Pregnant mothers were ignorant of antenatal checkups. In fact, before the MVP, a pregnant mother would move 30 to 40km to access antenatal services. Delivery at a health facility was almost unheard of. In my parish, the immunization coverage has now gone up because of the routine sensitization programs we conduct."

And Asiimwe attests to the difference his vocation has made in his own life: "Before the project, I was jobless. I finished my studies and had no job. I was a farmer. As a CHW, I am now able to earn some money to support my family.”

“I'm curious,” asks one of our site visitors named Zak, writing in to ask us a question about the Millennium Villages project in Ruhiira, Uganda. “Why [does] a donation provide a bike for a health worker for specifically a period of time, versus outright? It seems that a certain amount of money would simply buy a bicycle and then the health worker would just have it.”

Zak assured us he was a supporter, “First, I love this program. I think it's a wonderful, effective idea,” but he needed to know more. We realized that many of you who support the project may be wondering the same thing.

We sent Zak's question to the project team, and they sent us back this picture of Turihare Nicolas, bicycle repairman at Kabuyanda village. And they explained that he’s one busy guy.

The first time the project team in Uganda ran a bicycle project, they funded the bicycles, but when they broke down, they were unusable, and everyone was disappointed. This time, the Uganda team requested that we fund both the bicycle AND the maintenance of the bicycle. The bicycles they are using are simple, hardy cruising bikes. But the terrain and the weather are extremely rough on them. So it costs $125 a year to supply the bike and the program to maintain the bike.

Ruhiira is an area where most families live on isolated hillsides, far from clinics. The only way they can receive healthcare is for a health worker to visit their homes. So caseloads for health workers in Ruhiira are very high. Each worker visits 200 isolated rural homes a month, bridging the gap to the healthcare system for 1,000 people. Each day, workers travel large distances over difficult terrain. Bicycles make their work possible. However, the hilly terrain causes wear and tear and frequent breakdowns. To be useful, bicycles require regular servicing, repair and replacement.

The project goal of $6,000 provides bicycle transportation for 48 community health workers. This project enables the timely delivery of healthcare to the homes of 9,600 families and 48,000 people. Check back see how the project is doing, and remember to encourage your friends to consider making a donation.

This photo shows how people in Ruhiira cook in a typical Ugandan kitchen. The stoves or firepits can be very inefficient, burning large quantities of fuel, and sending unhealthy fumes into the air. Replacing those stoves with fuel efficient, low-emission models will improve the deforestation of the environment, air quality and lung function for people. Stove replacement is just one of the many holistic initiatives that the Uganda team's science coordinator discusses in the interview below, when he explains why the project is so successful.

What is your role in the project?
My name is David Siriri, the Science Coordinator of the Ruhiira Millennium Villages Project. I am responsible for ensuring sound technical design and implementation of project activities in a way that responds to the project model and community priorities. I also conduct measurements, monitoring and activity evaluation to generate data that informs project design and track achievement of project targets.
What progress has been made since 11/30/2009?
The community health workers continued to be the first responders in providing basic treatment and referring patients to health units. As a result, prevalence and severity of malaria continued to decline while monthly child births in all health units now stands at over 400. The project registered zero maternal death in the cluster during December 2009. The emergence medical response system has been strengthened with nurses trained in emergence handling and ambulance dispatch. The operating theatre at Kabuyanda health unit is now functional after a few months breakdown. Clinical staff have been trained in use of medical equipment donated by General Electric and can now perform scans for better pregnancy management. The number of households using water treatment chemicals has increased after an initial cultural resistance. As a result, the diarrhea disease burden at health units has decreased. Villagers started using improved cook stoves introduced by MVP. This has reduced indoor air pollution which causes respiratory tract diseases and has saved up to 45% of cooking fuel wood in families using the stoves. New roads were opened and old ones rehabilitated, increasing accessibility to markets and health units.
How important is this project to you?
My biggest motivation is seeing people’s lives transformed. I have for the last 12 years worked with different research and development agencies but never before has my work made real community transformations like at the Millennium Villages Project. What is different here is having an integrated holistic approach to development in which all issues affecting human livelihoods are tackled at the concurently, empowering communities to take lead in planning their future and investing their own resources in implementing their chosen interventions, and having significant development assistance that reaches the intended target. These key ingredients have combined to bring hope and dignity to the many lives that were bound by shackles of extreme poverty.

One great thing about getting involved with a Millennium Village in Uganda, is that there’s a lot that people in the developed world can learn about the amazing social organization and mutual support that can be found in rural Sub-Saharan Africa. The most local level of organization is the village that consists of 50 to 70 households and 250 to 1,000 people, depending on family size. Everyone participates in a local council, which is governed by a chairman and a 9-person executive committee.

Before any village joins the Millennium Village project, the local council must vote to participate, select key initiatives to work on, and contribute 15 percent of project costs. Here’s how one LCI (local committee level 1) chairman views the Millennium Village project, from the perspective of the area’s very first village, Ruhiira—this is where the initial research was conducted and where residents first voted to join the Millennium Villages.
An interview with Tindyebwa Johnson, Farmer and LCI Chairman Ruhiira cell:
“Before the MVP project came, we were badly off. We lacked good health services, the roads were poor and inaccessible, the schooling conditions were very poor and generally life was miserable. The MVP has within a short time done what would have taken government over 100 years to do. Now we have enough food to eat and we are making good money from selling bananas because the roads are now very good and farmers have been involved in several trainings and are now in registered groups. The health facilities are now fully functional and well equipped, classrooms have been built and children can now eat at school.

Me as a person, I am now seeing great change in the community, business is now moving fast. I now find it easy to lead my people because the services are good. Many of our community members have now got jobs because of MVP, some of the facilitators, enumerators, health staff, radio staffs have got jobs”.

The Millennium Village project has brought better roads and mobilized Community Health Workers (CHW), but one look at the landscape of the village is enough to tell you that these steps alone are not sufficient for effective healthcare to reach the most isolated areas of the village. Each CHW covers between 150 to 270 households. Not only are households scattered across huge distances, but also the terrain separating them poses huge challenges. But thanks to the introduction of bicycles in 2007, the CHWs can now cover all households within their catchment area, moving very quickly between them.

According to senior health worker Museveni, seen in this photo on his bike, along with mobiles phones, bicycles have had by far the highest impact on the work of the CHWs, particularly in terms of speed of emergency response and the ability to transport patients who are in need of treatment but unable to afford transport to hospital by boda-boda motorbikes (a taxi ride via scooter).

Naomi Handa Williams, an intern from Millennium Promise Japan, saw the results of this impact firsthand as she accompanied a CHW on a house call for a post-natal check with a mom and her healthy newborn baby Anna.

The week earlier, the mother had called for CHW assistance as she began bleeding heavily during a difficult labor. "The mother told me: Thanks to the speed afforded by the bicycle, the CHW reached the house in time to slow the bleeding and mobilize boys from the neighborhood to help push her on the bike to the Ruhiira Health Clinic." Once at the clinic, the mom received medical assistance and delivered healthy baby Anna.

Now, visiting with the healthy mother and baby, Naomi says, she can only imagine that without his bicycle, in decent repair, this happy scene would not have taken place. "Had the CHW been delayed, both mother and baby would most likely not have made it."