Millennium Promise - Extreme Poverty Ends Here

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”.

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.

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”.