The women leading Rwanda’s community health care delivery

Portrait of Uwinogoye Lucie, a community health worker for the last 12 years in Karama village of Nyanza District.

It was a privilege to meet so many powerful women in elite, decision-making roles during the 2019 IWMF reporting trip to Rwanda. Minister of Health, Dr. Diane Gashumba; Deputy Director General of the Rwanda Social Security Board, Dr. Solange Hakiba; Manager of Mahama Refugee Camp, Goethe Murebwayire. But the women who impacted me the most over our two-week reporting trip were those on the frontlines of healthcare delivery at the hyperlocal level. Rwanda engages a strong force of 60,000 Community health workers (CHWs) countrywide who deliver basic health services, antenatal check-ups, and can diagnose and treat malaria, diarrhea, and pneumonia before further referrals direct the public to health posts, clinics, and hospitals. Elected by their own communities, each village has four CHWs splitting these duties. There is a “binome” partnership of one male and one female delivering basic care, one female maternal health worker, and a recently-installed fourth CHW also delivering basic health services.

According to Minister of Health Dr. Gashumba, 66 percent of community health workers in Rwanda are women. But there’s one sector I visited where that number skyrockets – where 97 percent of CHWs are women. “Since the beginning, most of the male CHWs have been resigning from their responsibilities because they see it takes time,” says Mukandahiro Claudine, the Community Health Environmental Officer of Busasamana Sector in Nyanza District. The supervisor of 114 CHWs, 110 of whom are women, Claudine says that the prospects of work in nearby Nyanza town draw most men to remote labor, limiting their ability to honor the commitments of the CHW role. “Community health workers have to be in the community, sometimes spending the whole day there taking care of the families in the neighborhood. Men are busy and don’t accept that responsibility.” 

Lucie welcoming a family into her home for healthcare delivery.

Lucie prepares to administer a Rapid Diagnostic Test to Ange for malaria.

Uwinogoye Lucie, a 45-year-old community health worker from Karama village, reports to Claudine on a monthly basis with health updates from her community. A CHW for the last 12 years, Lucie replaced a male binome in her village after he failed the initial entry exam following his community nomination. Healthcare is a family affair for Lucie. Her mother was one of Rwanda’s very first community health workers in a pilot program launched in 1995, setting the framework for what is now Rwanda’s first line of healthcare delivery. 

“The way I saw my mother receiving the community, I was inspired to also take care of my neighborhood,” Lucie remembers of her mother’s healthcare delivery duties. Lucie’s mother continues her work as a CHW in nearby Kidaturura village in rural Nyanza.

A fingerprick is necessary for Rapid Diagnostic Testing for malaria. The test gives results in minutes.

Lucie and the two other community health workers in her village (the fourth has yet to be elected) complete their monthly reporting.

Lucie’s authentic joy in providing community healthcare services made her the most inspiring health professional I met during our IWMF reporting trip. “You have first to love it, to be passionate about it, and also to be humble in making sure you have to understand yourself, you have to take that responsibility to keep in your mind,” Lucie says about her work as a community health worker. “As you love it, it is easy for you.”

Lucie washes and dries her dishes in the early morning.

Solange, Ange, and their mother sit with Lucie as she fills out a referral form for Ange following a negative malaria test.

Ange’s identification card for Mutuelle de Sante, the national health insurance program that covers 81 percent of Rwandese people.

Lucie watches children play outside her home.