Community Health Workers by Alma A.

Alma Aldrich

H(T), Nyaruguru District, Southern Province

In the past 18 years, Rwanda has made incredible progress in the area of gender development and gender relations. The government has made a conscious effort to include gender into most of its programs in policies, including a Ministry of Gender and Family Promotion, and enacting gender quotas into almost all levels of representative government. Today, Rwanda has the highest percentage of women parliamentarians (56%) in the world. Critics of gender quotas and other government policies often argue these policies are top down and do not address issues on the ground.

As a community health volunteer, my primary work involves collaborating with my health center nutritionist, community health workers, and caregivers on childhood malnutrition. Sometimes, when mothers of malnourished children come in with clear evidence of domestic abuse, or tell me stories of their marital problems, I feel discouraged and inclined to agree with the argument that most gender policies in Rwanda are too top down.

More often, however, I am encouraged by the incredible work and 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 and relations at the grassroots level.

Each village in Rwanda has four elected CHWs. Two are binomes (these two, by law must be one woman and one man), charged with overseeing overall healthcare of their neighbors. They are generally equipped with iron supplements, malaria medications, among other things. A third CHW is charged with maternal and infant health. This CHW advises pregnant women and mothers, and oversees child growth monitoring among other things. The fourth CHW is in charge of social affairs: a broad mandate which can include assisting in domestic disputes between husband and wife or checking up on orphan lead households. CHWs are often invited to trainings put on by local health centers, the Ministry of Health, and international NGOs.

The position of CHW is unpaid, but holds significant prestige and clout in the community. A large majority CHWs who work with my health center are women. I am filled with excitement and hope when I see these women --often older, with little to no formal education (outside the current health trainings they attend) -- lead health education sessions and growth monitoring in their communities. Men and women alike seek advice and assistance from female CHWs and acknowledge their expertise in the area of health. For their part, female and male CHWs discuss with me the obvious role of women as main decision makers in the household when it comes to health, and tailor their interventions accordingly.

While many cultural attitudes in Rwanda remain seriously gender imbalanced, I am confident that daily activities by strong female and male leaders, like Community Health Workers, are slowly changing the attitudes of all Rwandans towards a better understanding of the value provided by both genders in progress and development.