Millennium Promise - Extreme Poverty Ends Here

There are currently 48 community health workers (CHWs) in Ruhiira, eight of them are supervisors who provide guidance and ensure quality guidelines. But this number of CHWs is too low—because so much of the area's population lives in isolated farm houses, more CHWs are needed. Each CHW visits about 200 households a month, though an ideal caseload is closer to 50-100 per month. This project will reduce caseloads by hiring and training new workers.

Health workers test for and treat malaria. They ensure patients follow protocols for TB and HIV. They provide bed nets, de-worming pills for children that cost only pennies, therapy to reverse severe dehydration from waterborne diarrhea. They weigh children and enroll them in nutritional programs. For women, they provide follow-up pregnancy care and family planning counseling. When necessary, they call in emergency situations.

The project goal of $12,500 hires, trains, supervises and equips one new CHWs, who will provide care to 200 families or about 1,000 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.”

In this photo, CHW Getrude Kyarisima carries her medical supplies on her back as she rides her bike between homes she is visiting to provide health care services. Gertrude is employed by this program which provides rural access to healthcare, her job is a win-win: she receives training for meaningful work and a paycheck, while her clients receive badly needed care. It all sounds great, but still you may wonder, how do I know if a project I am supporting—like “Support a Community Health Worker in Uganda’--is actually working and improving day-to-day life for people over the long term?

Measuring effectiveness is a major differentiator for Millennium Promise among aid organizations. They are not merely doing “good works,” but ensuring that the villages they work with are showing steady progress on all the UN Development Goals for reduced poverty, increased nutrition, education, business development and diminished rates of disease and maternal and infant mortality. In Ruhiira, David Siriri is one person who’s responsible for tracking data and meeting targets.

“As Science Coordinator for the Ruhiira Millennium Village , “ David explains, “I ensure the sound technical design of projects and that implementation plans respond both to the project model and community priorities. I also conduct measurements, monitor activities and generate data that informs project design and tracks achievement of targets.”

So what does David think about how the community health worker program, and its effect on the overall health indices affecting people in the Ruhiira area? According to David, the CHW or community health worker program is one of the major factors contributing to overall health improvements, as CHWs visit homes to treat malaria, AIDS, provide post-natal care and family planning counseling, advise on water purification the usage of new cook stoves and the importance of modernizing latrines:

“Since November, 30, 2009, 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 continues to decline Monthly childbirths in all health units now stands at over 400. The project registered zero maternal death in the cluster during December 2009. The emergency medical response system has been strengthened with nurses trained in emergency 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."

Check back to 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”.

How do you transform a group of 48 smart and committed subsistence farmers (like the health workers in this photo, with their medical backpacks) into a team that provides the healthcare awareness, training and access to more than 50,000 people? First, you train them really well. Then you rely on a team of eight supervisors to coach and guide them to solve all kinds of problems.

As a team, community health workers, or CHWs, across Ruhiira are focusing their efforts on a single, major goal: Millennium Development #4: Reducing child mortality for children under 5 years old. CHWs are required to report all cases of deaths of children under age 5 to their supervisors. Then supervisors immediately visit the family in order to conduct an evaluation. They also provide "sensitization" or awareness training on specific issues such as child nutrition, sanitization, immunization, effective LLIN (long lasting insecticidal nets used to prevent malaria) and the importance of pre- and post-natal care.

Since they are on call 24/7, a CHW supervisor’s day can begin and end at any time. Not only are they designated a "catchment area"--part of the Millennium Village project territory where a certain number of households are located--just as any other CHW, but also they have the added responsibility of managing, monitoring and training the CHW program as a whole.

Each supervisor collects weekly reports from all CHWs under her or his charge and gathers feedback from the community, before identifying weaknesses and challenges and discussing them with the CHW group as a whole. This strengthens teamwork, provides moral support, and ultimately enables CHWs to serve the community more effectively. Because their clients' homes are often miles out of their own catchment zones, bicycles and cell phones become more crucial than ever!

Supervisors also run training sessions which build on the initial one-month intensive training session undergone by all CHWs before they start work. In this way, CHWs are constantly kept up-to-date on key issues such as HIV/AIDS, malaria, diarrhea and safe water practices, TB, family planning, pre- and post-natal care and infant growth monitoring. Supervisors also assist when specialists are brought in to train on more specific tropical diseases. And the results on the ground are proof of the fact that CHWs are taking this information and translating it into real, effective change. In the Ntungu parish, for example, 90% of births now take place in the clinic, whereas before MVP intervention only a handful would have made it to the nearest hospital for a midwife-assisted labor.