Community Health Workers by Alma A.

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Alma AldrichH(T), Nyaruguru District, Southern Province




In the past 18 years, Rwanda has made incredible progress inthe area of gender development and gender relations. The government has made aconscious effort to include gender into most of its programs in policies,including a Ministry of Genderand Family Promotion, and enacting gender quotas into almost alllevels of representative government. Today, Rwanda has the highest percentageof women parliamentarians (56%) in theworld. Critics of gender quotas and other government policies often arguethese policies are top down and do not address issues on the ground.
As a community health volunteer, my primary work involvescollaborating with my health center nutritionist, community health workers, andcaregivers on childhood malnutrition. Sometimes, when mothers of malnourishedchildren come in with clear evidence of domestic abuse, or tell me stories oftheir marital problems, I feel discouraged and inclined to agree with theargument that most gender policies in Rwanda are too top down.
More often, however, I am encouraged by the incredible workand resilience I see coming mostly from Rwanda’s Community Health Workers(CHWs). These women and men work daily to improve the health of all Rwandans,and in doing so are challenging and changing previously held gender roles andrelations at the grassroots level.
Each village in Rwanda has four elected CHWs. Two are binomes (these two, by law must be onewoman and one man), charged with overseeing overall healthcare of theirneighbors. They are generally equipped with iron supplements, malariamedications, among other things. A third CHW is charged with maternal andinfant health. This CHW advises pregnant women and mothers, and oversees childgrowth monitoring among other things. The fourth CHW is in charge of socialaffairs: a broad mandate which can include assisting in domestic disputesbetween husband and wife or checking up on orphan lead households. CHWs areoften invited to trainings put on by local health centers, the Ministry ofHealth, and international NGOs.
The position of CHW is unpaid, but holds significantprestige and clout in the community. A large majority CHWs who work with myhealth center are women. I am filled with excitement and hope when I see thesewomen --often older, with little to no formal education (outside the currenthealth trainings they attend) -- lead health education sessions and growth monitoringin their communities. Men and women alike seek advice and assistance fromfemale CHWs and acknowledge their expertise in the area of health. For theirpart, female and male CHWs discuss with me the obvious role of women as maindecision makers in the household when it comes to health, and tailor theirinterventions accordingly.
While many cultural attitudes in Rwanda remain seriouslygender imbalanced, I am confident that daily activities by strong female andmale leaders, like Community Health Workers, are slowly changing the attitudesof all Rwandans towards a better understanding of the value provided by both gendersin progress and development.