Busasamana, Rwanda—Sitting on the floor of her mud-walled hut, Jacqueline Nyanzera cradles her three-day-old son in her arms and proudly shows him off to Jean Umurarwa. Mama Jean, as the community health worker is known in this village, places a tablet in her watering can to purify the water, lathers soap and washes her hands before picking up the newborn.
During her visit, Mama Jean will inspect baby Caleb for signs of jaundice and dehydration, examine his belly button and check on his feeding schedule. It’s all part of her routine to prevent the needless deaths of women and their children.
This community health worker has been visiting the Nyanzera home since Jacqueline, 32, became pregnant with her fourth child. Mama Jean counseled the young mother throughout her pregnancy, accompanied her during each antenatal visit and traveled with her to the clinic when she began to labor.
“My eldest two children were not born in the clinic because I didn’t go to the clinic in time and I was very afraid,” says Jacqueline, as her 12-year-old daughter, Angelique, listens carefully. “This time, because of Mama Jean, I made it to the clinic on time. At the clinic, they helped me to know how to breathe and push, and helped when the baby was stuck.”
Mama Jean is among the 15,000 community health workers educating women and families in Rwanda about basic health needs and maternal and newborn care; they are key figures in the Ministry of Health’s strategy to improve maternal and child health. Of those, nearly 12,000—including Mama Jean—have received their training through the U.S. global flagship Maternal and Child Health Integrated Program (MCHIP), which is led by Jhpiego.
The community health workers learn about the danger signs of pregnancy, newborn health, family planning methods and immunization needs of children. They encourage women to give birth in a health facility with the help of a skilled attendant, one of the leading factors for a healthy and safe delivery. To ensure that Rwandan women are well cared for in health facilities, MCHIP also works to strengthen health providers’ knowledge of emergency obstetric and newborn care and active management of the third stage of labor.
As part of its efforts to reduce maternal and newborn deaths, MCHIP has developed a list of essential drugs for maternal health in partnership with the Rwandan Ministry of Health. This list has been adopted and now serves as a guideline in each facility to ensure that the proper drugs are in place when a woman needs them.
In this village of Busasamana, located about two hours south of the capital, Kigali, Mama Jean sees more than 150 women every month to provide counseling on family planning, prevention of malaria and the importance of prenatal care. Walking down rugged roads lined with coffee plants, she goes house to house, carrying her watering can, client logbook and community education manual. Currently, she is following 13 women who are at various stages of their pregnancy and encouraging them to attend each of the four required prenatal care visits.
“Before my training, I wasn’t quite sure of why I was doing some things and sometimes I didn’t feel like they were necessary,’’ she confides. “Now I realize why I am doing these things.”
Mama Jean’s supervisor, Rehana Uwinmana, accompanies her on this day. In reviewing the community health worker’s log, she shares with a visitor the meticulous and systematic entries.
“Initially in Rwanda, some of us didn’t believe that someone with a sixth grade education would be able to do such a job and take such careful notations,” says Rehana.
Since the annual trainings, Rehana says she has noticed that the deaths of women and newborns in this community have declined. “Previously, each month, we saw about four to five deaths each month. Since the last three months, we haven’t had a single death,” she says.
In the same period, Rehana says, there hasn’t been a single home birth or delivery en route to the health facility; an improvement over the three or four non-facility births per month.
Recent data confirm Rehana’s observations. In 2005, the maternal mortality ratio in Rwanda was 750 deaths per 100,000 live births. Last year, it was 350. According to the United Nations, Rwanda is very likely to meet—and possibly even surpass—the Millennium Development Goal targets for child and maternal mortality by 2015, in part thanks to the Rwandan Ministry of Health’s efforts, the work of organizations such as Jhpiego, and the dedication of providers and community health workers like Mama Jean.
As Mama Jean rightly notes, “There are no mothers dying now in the community, and when there is no death, there is no unhappiness.”