The unsung heroes in the health system

Monday March 25 2019

Community Health Worker Leonida Adolf pays a

Community Health Worker Leonida Adolf pays a house call to one of the residents of her village in Kagera Region. PHOTO| JOHN NAMKWAHE 

By John Namkwahe @johnteck3

Kagera. Leonida Adolf, 43, is a resident of Bisole village in Muleba District, Kagera Region, she has dedicated her life to serve her community as volunteer-Community Health Worker (CHW).

Adolf represents many of the CHWs who work on a voluntary basis with communities to provide information on the availability of health care services in the remote and peripheral area.

However, despite their pivotal role in the delivery of healthcare services in the communities, the government yet to fully recognized their contribution in terms of budget allocations to support their work, something that undermines the role of CHWs in the health system.

This week, Adolf narrates her career path to Your Health, citing it is journey that 17 years ago, a time when most pregnant women in the village were giving birth at home, leading to high rates of maternal and infant mortality rates due to delivery-related complications such as severe bleeding.

“I received training on reproductive health at Kagondo Hospital in 2002 and 2007 respectively. The knowledge that I acquired has helped me to reach and attend more women in the village. I visit at least 10 households a day,” she says.

In June 2006, she entered an agreement with the village council to be paid some Sh5, 000 per month as wages, however, the agreement was terminated in six months after the new village took over the reign.


“I was using that money for transport, but after the contract was terminated, I have been using my pocket money to reach out to the villagers,” says, Ms Adolf.

She adds: The current village administration is not interested in paying the wages on the ground that villagers can now access medical services from nearby public health facilities.

Just like other CHWs, Leonida where she keeps all records of new-born children in the village who need to receive vaccination and other essential medication to ensure they grow healthy.

“I usually write down the details of the mothers and babies including the names of places they live and phone contacts so that I can easily monitor them,” she says.

Awarded certificate of appreciation

Ms Adolf and many other CHWs in the region in 2010 were awarded Certificates by the Regional Health Coordinator signed by the Kagera Regional Medical Officer (DMO) in appreciation for their contribution to improve healthcare in the region.

“I and my colleagues from different parts of the region attended a five-day capacity building workshop on Reproductive and Child Health convened by the government and we were awarded certificates,” says Ms Adolf.

Her testimony

Leonida recalls the day she managed to reach one of the patients in the village called Veronica Iventi who gave birth to her first child at home and failed to take her child to the clinic for vaccination.

According to Ms Adolf, the baby had developed health complications after missing the essential vaccination.

“She gave birth to her first child so she did not know that the baby was supposed to receive the vaccinations including measles jab. She did not also attend clinic during pregnancy that is why she was not educated enough on the importance of the vaccination,” she says.

It is recommended all children get two doses of MMR measles vaccine, starting with the first dose at 12 through 15 months, and the second dose at 4 through 6 years of age. She eventually managed to reach and educate her about the need and importance to vaccinate the baby.

“After educating her on the importance of vaccination, since then she takes her children at the dispensary for vaccination,” Ms Adolf says.

Having learnt the hard way Iventi advises fellow women to take their children to the post-natal clinic for vaccination.

“I was surprised to see Leonida coming to my house. She then informed me that she had been looking for me for a long time. On the same day, she took me to Kagondo Hospital and my baby was vaccinated. She took my details and registered me in her book,” says Ms Iventi.

Since that nearly fatal mistake Iventi, a mother of five now, has always taken her children for vaccination.

Empowered by MCSP project

Ms Adolf was among the CHWs and other health professionals in Mara and Kagera regions who benefited from a five-year project dubbed ‘Maternal and Child Survival Programme’ implemented by Jhpiego in partnership with the Ministry of Health, Community Development, Gender, Elderly and Children funded by the USAID.

The $32 million project which was established in 2014 to end Maternal deaths, Malaria control, cancer prevention, building capacity among stakeholders through various outreach programmes and harmonizing nursing and midwifery education curricula and improve vaccination coverage in the two regions.

“The MCSP programme enabled me to acquire new health methodologies on how to deal with sick women mainly pregnant women and children below five years old before they are rushed to the health facilities for specialized treatment,” says Adolf.

Referring to the positive impacts of the project, Ms Adolf says the programme has helped to improve vaccination coverage in the district.

“Since the project was established, vaccination services are accessible to every newborn child in the village. It is indeed a great achievement,” she says.

Apart from her daily responsibilities as CHW, Ms Adolf engages in agricultural activities, growing vegetables, banana, cassava and maize to feed her five children. Referring to parental responsibilities, Ms Adolf admits that she always puts her family first as she wakes up early in the morning to take care of family chores such as housecleaning, cooking food and other activities.


Placidia Muganguzi is in charge of the Reproductive and Child Health (RCH) at St Joseph Hospital in Kagondo operated by the Catholic diocese in Muleba District, the hospital’s healthcare providers and CHWs closely cooperate to reach many people mainly pregnant women and new mothers and babies living in remote area.

She says that one of the key issues that affect vaccination coverage service in some areas in the district, is the tendency of residents or villagers to shift from one place to another.

This, she says makes it difficult for healthcare providers and CHWs to monitor their vaccination.

“CHWs are doing a good job. I urge the government to allocate sufficient fund to support them. We sometimes give them funds to help them reach more people in the remote areas,” says Muganguzi.

Referring to the positive impacts of the MCSP at the hospital, Muganguzi says that vaccination coverage had improved from 75-90 per cent.

Government pledge

Kagera Regional Medical Officer (DMO), Dr Marco Mbata was recently quoted saying the government through President’s Office – Regional Administration and Local Government was contemplating to employ qualified CHWs across the country with a view to expanding delivery of healthcare services in public health facilities.

“We will make sure that they first get special training before integrating them into the national health workforce to ensure reliability, efficacy and organizational sustainability. Embedding CHWs within primary healthcare systems is a powerful way to improve healthcare service,” said Dr Mbata.

This follows an earlier pledge by the government in 2018 through health ministry to employ at least 30, 000 by 2020 who would be distributed to over 1, 500 villages across the country.

“We are working on the matter, and more information will be provided upon the completion of the discussions,” said the health minister Ms Ummy Mwalimu when she spoke to The Citizen’s sister paper ‘Mwananchi’.

Referring to the positive impact of the MCSP, Dr Mbata highlighted that the immunization/vaccination coverage has improved in the region from 81-92 per cent.

He also highlighted that through the MCSP, the majority of health professionals had benefited through capacity building programmes. He further gave assurance of his office’s commitment to continue cooperating with the development partners. Maternal and infant mortality rate has dropped, currently stands at below 57 per cent, according to the RMO.

The RMO’s comments on CHWs were backed up by both Missenyi District Medical Officer Dr Hamis Abdallah and Dr Modest Lwakahemula, Muleba District Medical Officer (DMO) who both commended the CHWs contribution to collect data at the community level and as a result, a database has been created that is used as a reference to cross-check and integrate District (HMIS), among other significant roles.