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Joy Umutesi’s Inspiring Speech at the Conference on Public Health in Africa

By: Joy Umutesi | February 17, 2023

TIP Global Health invited Joy Umutesi, a Community Health Worker (CHW) from Rwanda, to present at the Conference on Public Health in Africa in December 2022. Joy shared the firsthand experience of the digitalization of community health services in her area, which has made reporting and communication between CHWs and health centers much easier and efficient. Joy used this opportunity to call upon policy makers to support the expansion of digitalization to all CHWs across Rwanda and globally.

Below are an adaptation of Joy’s remarks to the audience:

Good morning everyone! My name is Joy Umutesi, It is a pleasure for me to be here on behalf of Rwandan Community Health Workers. I have been a CHW since 2017, where I am in charge of maternal health care and newborn health in my village. 

In my country, each village has 4 Community Health Workers who serve approximately 1,500 to 2,000 individuals. Since I provide maternal health care, once I believe a woman is pregnant, I request to visit her at home and then advise her to go to the health center to confirm her pregnancy and to seek further health care support. My daily activities also consist of conducting home visits to pregnant women to discuss their nutrition education, their well-being, and hygiene during their pregnancy. When I find that a pregnant woman has concerning symptoms, I call an ambulance for free to rapidly transport her to the nearest health center.

I make sure that I follow each pregnant woman in my village at least 6 times during and after her pregnancy and make sure she delivers at the health center. After delivery, I follow up with both mother and her newborn for 28 days to ensure that they do not have any complications. I also provide health education to the mother about what to expect postpartum and with her newborn. These health educations include information on breastfeeding, immunizations for the newborn, monthly growth monitoring and so on.

My other two colleagues in my village focus on child care and illness management, such as malaria, pneumonia, diarrhea and simple cough, and family planning for adults. The fourth one is in charge of health promotion where they focus on education for disease prevention. Besides these specific roles, each month we all monitor the growth and screening for malnutrition among children under 5 years of age. We also conduct health education as well as culinary demonstrations for mothers in the village. 

Our supervisors, under the support of the Ministry of Health, visit us every month not only to help us keep the consistency of our routine health care service delivery but also to assess what is not going well and then advise or advocate accordingly. At the height of the Covid pandemic, especially when the hospital was at capacity, we were trained and received PPE so that we could serve at the frontline and care for Covid-19 patients in their homes. We then reported on the patient’s health progress on a daily basis.

I love my work as a CHW because I save lives and nothing else can give me joy like this. I am proud of being a CHW. I personally have seen how my work in my village has a tremendous impact. For example, since 2017, no mother in the village has died in childbirth. Overall, health outcomes have improved due to the work of the CHWs. 

Despite the pride we CHWs take in our work and the sacrifices we make to save lives, we still face several challenges. Firstly, we must manage the time we spend on paperwork in comparison to the quality of care we deliver. In my area, we are lucky we now have digitized community health services. All of our CHWs do all of their work under the guidance of E-Heza. This has helped with the ease of reporting to Health Centers, has eased communication with patients who are served by the Health Center and who need follow up upon their return home. We no longer spend much time on Z-score calculations for children’s growth charts as it’s now automatically calculated in E-Heza. The fact that the Health Center and local leaders receive the updates from our village in real-time, they are now able to be much more in tune with us than before. We are very thankful for this innovation. I would like to use this opportunity to ask for policy makers’ support to expand this digitization to all CHWs across Rwanda, and even globally. This will make the jobs of CHWs easier, thus providing more quality services and ultimately lead to improved health outcomes.

Secondly, CHWs spend much of our days and nights caring for the community. When our work is over, we go home to our families and where we need to care, feed, and plan for our own futures. We are lucky in Rwanda that CHWs receive pay based on everyone’s performance but payments are often delayed. The money we receive is often not enough to cover our living expenses. We hope that community health policy makers can strategize on how to compensate CHWs for our work better.

Though we sometimes face challenges in our supply chain, we are very thankful to the Rwanda Ministry of Health that allows each person to access care when needed and with minimal cost. 

In conclusion, supporting CHWs to work smarter, more professionally and efficiently is the only way to achieve universal health coverage. It is the CHWs that are able to reach the community members – even in hard times and difficult to access areas.

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