Alphonsine Cyimayire does not remember the number of times her mobile telephone has gone off deep in the night this year but what she can remember is that every person who called each night needed help, and needed it urgently.
As a community health worker, this has not come as a surprise to her, willingly she has answered every call and a sick child here and an expectant mother there have been given the urgent care they much needed.

Cyimayire, a  community health worker in Gasaka Sector, Nyamagabe district is one of the thousands of community health workers strewn all over the country who early this year received mobile phones to help them in their work. The phones were in fulfilment of a promise made last year by President Paul Kagame.

The Ministry of Health with the support of telecommunication giants MTN and VOXIVA, a global provider of mobile phone–based systems focused on health, purchased about 17500 phones which were distributed to community health workers in the country.

"Communication was very difficult before we got these phones,” says Cyimayire. It was difficult to communicate with staff at the health centre, amongst ourselves and the community especially those who developed complications at night.”

Armed with a mobile phone, Cyimayire acknowledges that many lives have been saved. It is amazing how the sick can sometimes be strong minded to be sensible as Cyimayire recounts a particular incident.

"One night someone in charge of security in our village called me to explain the challenge before him.  A local resident; an expectant young first time mother who had been rushed to a nearby health centre in the night but had refused to undress so that she could be assessed.

"Hospital staff asked her to move into the maternity room so that they can assess her condition but she adamantly refused. Persuasion from hospital staff yielded no results; the village head deemed it prudent to call on me for assistance since he had my phone number.

According to Cyimayire, accompanied by a community health worker in charge of maternal health she went to the hospital that night but unfortunately  found that the expectant mother had forcefully demanded to be taken back home.

"We went to her home and convinced her to return to the hospital, she was in a terrible situation, she was just a few hours to give birth, and she agreed to return to the hospital where she gave birth on arrival,” she narrated.

"I am called deep in the night to intervene when a resident needs urgent attention, sometimes I am called to pass on vital health information to my colleagues who also have mobile phones, I have all the numbers of all community health workers in this area so communication is very easy,” she says.

Community health workers play a vital role in ensuring the health of their community members. They mobilise the community during different health campaigns like immunisation, distribution of mosquito nets and vaccination.
"We are also trained to offer basic treatment for illnesses like diarrhoea and malaria. Amongst us are community health workers charged with maternal health and those who are charged with offering palliative care to people living with interminable disease like HIV/Aids,” said Cyimayire.

According to Olivier Ndizeye, an official in charge of community health at Nyamagabe health centre, mobile phones have made communication easy, health messages can now be communicated much easily and the sick in the community can easily be reached.

"Local residents now know the power of the mobile telephone,” said Ndizeye, those who do not have phones usually communicate to us through their village leaders and we immediately intervene in case of an emergency.”

Ndizeye, on many occasions has also been called deep in the night to assist in the evacuation of the sick and sometimes expectant mothers to the health centre. Community health workers know his phone number and they have put it to its intended use.

"It was raining deep in the night when a community health worker called me up from Kibilizi Sector with an emergency case. An expectant mother was experiencing labour pains and her case was considered risky to be handled at home. I called at Kigeme hospital for an ambulance and it was dispatched to pick her.”

The lady had delivered by the time the ambulance arrived but according to Ndizeye, she was taken to the hospital where she was treated for a day and later discharged.

"This shows how mobile phones are important, this mother could have developed problems after giving birth but thanks to the mobile we were able to communicate and ensure that she is given the necessary care to ensure her safety and that of the new born,” said Ndizeye.

He said that plans are underway to introduce rapid SMS programme which will facilitate the sharing of health related information from village to Ministry level. He said that community health workers will be trained on the use of codes which they will use to share information giving health reports.

Gasaka Sector has 186 community health workers who according to Ndizeye have played a significant role in offering basic treatment to mainly children.

"We used to receive many cases of sick children from the communities, many of them usually spent much time in homes before accessing treatment, on arrival at the health centre we would normally refer them to the hospital because of the severity of their illnesses but today with the assistance from community health advisors these numbers have gone down because most of the minor cases are handled in time by trained community health workers,” he said.

He added: "Community health workers have played a big role in following up expectant mothers within their communities by ensuring that they undergo regular antenatal check up and giving birth from health centres where they are taken care of by health officials, this has considerably reduced cases of maternal mortality.”

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