Millennium Promise - Extreme Poverty Ends Here

“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.

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."

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.

My name is Naomi, and I am an intern with Millennium Promise Japan, assigned to the Ruhiira project. Recently I spent a morning with Helen, one of two resident midwives at the bustling Ruhiira Health Centre, and I'd like to share one of the stories I heard with you.

One of the women who came in during my visit with Helen was 20 year-old Stella who is expecting her third child, seen here in this photo with Helen the midwife. She says, "third child," although the first two children tragically died during labor. Both times, Stella labored at home without medical assistance. Discovering this, Helen immediately began making arrangements for Stella's next birth to be conducted via C-section at the operating theatre in the Kabuyanda parish of the village.

Then Helen thoroughly examined Stella. She tested for HIV, Stella tested negative! She checked Stella's hemoglobin levels, and took her blood pressure. After determining Stella had strong vital signs, Helen advised Stella about good nutritional practices during pregnancy. Then she felt for the position of the baby’s head and they even let me listen to the baby's heartbeat! Helen is optimistic that this next birth will be problem-free. “Now I know her situation and her history, I can keep a close eye on her progress,” says Helen, and she schedules an appointment for Stella for next week.

Stella truly embodies the way the Millennium Villages project transforms lives and restores hope to people for whom hope was running out.

“I test, I review, I advise, I treat– and I’m a mother myself," laughs Helen. "I often feel like I’m doing the jobs of three people!” Indeed, despite her receiving an average of 10 expectant mothers per morning and being on call for labors and deliveries 24/7, I watch her greet each expectant mother with a big smile. I’m truly amazed by her energy! What’s more, as gender issues remain something of a challenge, I also see her playing the role of supportive husband, and it’s clear the women in her care depend on her for a lot more than some pills and a blood test.

Since midwives were introduced to the clinic in 2007, not one mother delivering in the clinic has died during childbirth, a wonderful example of progress being made towards achieving Millennium Development Goal #5: Improve Maternal Health. The project team credits both an excellent level of pre-natal care and to midwife assistance during labor.

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”.

"Since I'm from Japan, I’ve experienced my fair share of ludicrously high-tech toilets," says Naomi Handa Williams, an intern from Millennium Promise Japan, newly arrived in Ruhiira. "Think heated seats and a confusing array of buttons which produce hot water, gusts of air, singing…you name it." Yet when Naomi witnessed first-hand the huge leap between the new design of latrines for Ruhiira and its predecessor, she felt as if it were a technological advance that could rival the Japanese! "Although," she admits, "you’d be forgiven for considering the new design latrine still somewhat ‘primitive’."

‘So this is the old design latrine…and this is the new design!’ says Hillary, who is on the MVP Infrastructure team, and in this photo is proudly showing Naomi the bold new structure.

To date, 215 household latrines have been completed within the Kisyoro and Bugonji parishes in Ruhiira, with many more in progress. They are all constructed using local materials, the labor shared between professionals and the households themselves, which is crucial in providing the new owners with a sense of ownership and investment. Each household is required to dig their own pit, which must be 30 feet deep.

"Looking down into one of the pits I realized what painstakingly slow and hard work it must be, with an improvised pulley made from a jerrican and string used to transport the dug up earth to the top," says Naomi.

"This is the bit which most slows down the building process, as people don’t have the time to be doing such things," Hillary tells her. "It is very time-consuming - they need to earn a living too!" Once the pit is complete, a skeleton erected from eucalyptus is tied together using banana fibres, before being fitted with an iron roof, a vent pipe, and a door. Each household is given a half bag of cement to lay on the floor, to make for easier cleaning and improved hygiene, as well as a sand plat, which serves as a solid, washable platform above the pit. Once this is completed, mud patching helps fill the gaps between the eucalyptus branches, with the final touch being a spreading of cow dung and sand mixture over the walls to create a smooth finish.

The funding project posted on GoodAdds, "Provide Latrines in Uganda and Clean Up Water," aims to address some of these difficulties by engaging local construction crews, paying them for their work and providing oversight and guidance.

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”.

"A day in the life of a villager in Ruhiira is guaranteed to beat any session at the gym," says Naomi, an intern from Millennium Promise Japan, who's looking at the region with a pair of fresh eyes. "And water is the main reason why life is so difficult." For the majority of families in Ruhiira, or at least for the women and children, the first task of the day is fetching water. Naomi found it especially interesting when meeting with various families to discuss water, that the conversation couldn’t begin without the woman of the house. "Ordinarily the men will do most of the talking, but as fetching water is decidedly women’s work, what women had to say was, for once, most important!"

Without a doubt, distance and incline are the biggest challenges people face when fetching water. In the dry season, water can be as far as 3km (just under 2 miles) away…and the walk back with 20 liters (about 10 gallons) inside your jerrican (a large flat-sided container that carries liquids, like the one carried by the boy in this photo) can seem even father. This distance would be problematic enough were it not for the terrain: most water sources and run-off ponds are situated at the bottom of precarious hillsides and valleys.

During rainy season, families can find water closer—usually only 1.5km away, but often from a pond gathering run-off water. The run-off carries with it all things imaginable down the hills, the murky brown color of the end result is enhanced by cows who come for a bath every now and then! Unfortunately, if poor quality water is available closer, people will use it instead of the safe water source provided by the Millennium Villages project. As yet, boiling water is often viewed with suspicion. So potential health risks are huge.

That is why, until more reliable water sources can be secured closer to residences, that families must continue to use water purification techniques accurately. With 1 in 2 Africans suffering from waterborne diseases at any time, scrupulous attention to this relatively simple process can make a big difference in family health.

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.

This photo shows Olivias Kyarimpa outside her home in Omururama, a village that is taking part in the Millennium Village project in the Ruhiira, Uganda area. In her hands she is holding the Pur water purifier tablets that her family uses every day to keep their drinking water safe. She learned how and why to use the tablets from a health worker who visited her home. Our project empowers community health workers (local people who receive training in public health and medicine) to visit families and small villages to deliver water purification supplies and to explain: 1) how to purify their water at home using safe containers and Pur tablets; and, 2) why it is critical for them to exercise vigilance over their water supply.

David Siriri, the Science Coordinator for the Ruhiira Millennium Villages project explains: “There was an initial cultural resistance to using water treatment chemicals. But the number of households using these supplies effectively is steadily increasing. As a result, we have found that the diarrhea disease burden at our health units has significantly decreased.”

Water-born diseases such as cholera and diarrhea are extremely prevalent all over Africa, where half of all people may be stricken at any time. In Ruhiira, much of the water supply has been contaminated because of run-off from poor sewerage and farm animals. Children under five are at greatest risk of dying from diarrheal diseases contracted from contaminated water.

This practical, yet direct, response is one of many successful applied approaches that enable Millennium Villages to provide clean water in the short term, while laying the foundation for longer term solutions. Check back to see how the project is doing, and remember to encourage your friends to consider making a donation.