This post was originally published on the website of Ashoka Changemakers.
Just 17 years ago, civil war in Rwanda culminated in a horrific 100-day genocide that killed between 800,000 and 1,000,000 citizens. Today, however, the country is making notable strides towards the United Nation’s Millennium Development Goals, and against all odds has doubled the life expectancy of its citizens. Despite the scars left by decades of violence, Rwanda’s story is changing into one of hope and pragmatic determination at the local and national level.Through an ambitious set of health reforms, the country is saving the lives of children and mothers. The backbone of Rwanda’s newly-decentralized health system is its vast network of over 45,000 local community health workers. Each village elects three members to serve as trained community health workers — one each for maternal health, child health, and community health.
Because 85 percent of Rwanda’s people live in rural agrarian areas, more than an hour’s walk from the nearest health center, the presence of local health workers is vital, particularly for pregnant women.
NGOs and Grassroots Health Organizations Maximize Impact Through Community Health Workers
Community health workers are proving to be critical local liaisons for NGOs like the Rwanda Village Concept Project (RVCP), a civic-sector organization run by medical students from the National University of Rwanda and GlobeMed, a U.S.-based network of student health volunteers. RVCP and GlobeMed have partnered with a rural health clinic in Butare, Rwanda to improve maternal health in the area.
The program is piloting maternal health education classes combined with an income-generation program. After completing a full course in maternal health, mothers receive a goat, free access to a leased plot of land, and supplies to farm sweet potatoes for additional food and income. The goat provides milk for the family, as well as income through selling its offspring.
“The income-generation aspect was crucial to making the educational portion of the program successful,” said Alyssa Smaldino, program director at GlobeMed. “With both knowledge and the means to achieve the necessary changes, the women became truly empowered to improve their health and the health of their children.”
The pilot program had a rocky start — at first, only about half of the 50 women consistently attended the classes. But once word spread through community health workers and women who had successfully completed the program, women began bringing their friends and family to the courses as well. As a result of increased demand, the RVCP-GlobeMed maternal health project will expand to operate twice a year.
“Partnering with RVCP and the community health workers fostered a true grassroots involvement in the project,” said Smaldino. “The village leader and the health workers are all locally-elected individuals that have the trust of the people in their communities. The women in the program also had a great deal of trust and admiration for the medical students of RVCP. I think those relationships were absolutely essential for the 100-percent buy-in from the community.”
A new report on the benefits of the program is due in 2011, but thus far, the nearly double increase in attendance of the RVCP-GlobeMed maternal health classes reflects a significant surge in community interest in improving maternal health.
A Virtuous Circle: Good Governance Stretches Aid Dollars
Driven by the Ministry of Health, Rwanda’s pragmatic and well-planned approach to development is garnering increased attention from a growing number of international entities and NGOs eager to send aid to a country that has proven itself capable of maximizing each aid dollar.
For example, UNICEF is leveraging the powerful local presence of community health workers for a maternal health initiative called Rapid-SMS scheme, which lends cell phones to pregnant women who register with a health clinic.
The pilot has been operating for two years in the northern region of Musanze, home to dramatic volcanoes and the country’s famed population of reclusive mountain gorillas. The mountainous terrain and the remote location of its villages also make travel extremely difficult for pregnant women needing care.
However, the cell phones allow pregnant women to send text messages to the nearest health clinic, either to seek advice or to inform the clinic of impending labor. The clinic is then able to deploy an ambulance to transport her to receive medical care. In the year since the program began, there were no reported maternal deaths in Musanze —compared to ten in 2008.
The government is looking to expand the Rapid-SMS scheme and has recently purchased 67 ambulances, one for each of its district hospitals. While capacity and resources are still scarce, it’s a big step forward.
Are Rwanda’s remarkable achievements replicable in other countries? Possibly. Smaldino said, “Rwanda is unique in that it’s a small country and many of the demographic and cultural factors are similar across its regions. So a decentralized system might work better here than elsewhere. Nevertheless, I think the real improvements show that a strong commitment from the government and a willingness of development organizations to work with the government and support change at the local level can be highly effective.”
GlobeMed is a current network partner of the Making More Health competition. A network of university students who partner with grassroots organizations around the world, its mission is to improve the health of people living in poverty by empowering students and communities to work together around the world. Through their involvement in GlobeMed, students commit to a life of leadership in global health and social justice.
The GlobeMed Network currently includes 46 chapters at university campuses throughout the country, each of which has a unique partner organization. The Network is coordinated and supported by its National Office in Evanston, IL. The grassroots health organizations supported by its chapters span the world from Rwanda to Detroit.