Bugesera District reduced stunting rates by 13 percentage points in five years from 2015 to 2020, one of the biggest reduction rates in that period. Being one of the 13 districts where a World Bank-funded project was implemented to tackle malnutrition and stunting, Bugesera’s fight was led by community health workers based at the village level. There are more than 50,000 community health workers who are the champions of primary healthcare. Vestine Mukashema is one of the more than 230 community health workers in Ngeruka Sector. She has volunteered for more than five years, performing different tasks meant to improve well-being, especially the lives of pregnant women and children under five. “When we notice a pregnant woman, we encourage her to go to the health centre to follow up on her situation so that when she gives birth, the baby will be healthy. We also have to make sure that the mother takes a balanced diet,” she said. In Ngeruka, there are four community health workers in each village in three categories; · female maternal health assistant (agents de santé maternelle [ASM]) tasked with maternal and new-born health, community-based family planning, and health promotion · male-female Binome (pair) jointly responsible for integrated community case management of malaria, pneumonia, and diarrhoea in children · community-based family planning, and nutrition, including monthly screening of children aged under five years, and the one in charge of health promotion. “Community health workers today are motivated for the work they do. They have been trained to respond to primary healthcare issues and they get some incentives according to their performance,” Ruth Kemirembe, the director of health in Bugesera District, said. In addition to their different focuses of intervention, all the community health workers have been trained to be versatile in the other activities. “When they take part in the activities meant for the improvement of the mother and child's health, they know that their contribution is impactful. In our district, we have reduced 13 percentage points from stunting and they have certainly played a key role in that achievement. We will continue to rely on them as we fight the stunting rate.” Mukashema is an ASM community health worker, whose main activities are mainly centred on following up on women’s antenatal care visits to the health centre and thereafter until the child turns two. “Community health workers play a very crucial role. For the ones called ‘Binome’, who treat malaria, diarrhoea and pneumonia, they deal with more than 90 per cent of all cases in a year even before they are referred to the health facility,” explains Jeannine Uhiriwe, the coordinator of community health workers at Ngeruka Health Centre. With these village-based careers, the burden on health facilities is reduced significantly and they only have to deal with severe cases. They also track malnutrition and stunting among children under five. They are equipped with materials like the child length mat, which assesses if a child’s height-for-age measurement is within the normal range relative to their age. There is also mid-upper arm circumference, MUAC, a measurement that allows health workers to quickly determine if a child is acutely malnourished, and a scale. “In Ngeruka, when the malnutrition rate was very high, authorities introduced a village kitchen where children and their parents spent days getting a balanced diet, and they recovered from the condition,” said Andre Ahishakiye, a community health worker. For vulnerable households that receive the nutritious porridge flour known as ‘Shisha Kibondo’, the community workers make sure pregnant women and children under five years consume it as intended. Residents of Bugesera commend the role played by the community health workers in their community. “If there’s a family that has a malnourished child, the community workers are very quick to respond. They visit the family to see what the problem is and help the parents solve it,” Petronille Mukayitesi, said. “Also, if a child has a fever, they give first aid medication to prevent it from getting worse, before the child is taken to hospital.”
