Bridget Nanyonjo joined HAC in 2017 as a Monitoring & Evaluation Officer. Currently, she is part of the technical advising team under the Africa Resource Centre project.
In your time working with HAC, what are some of the things you have come to know about the communities where HAC is established? If it wasn’t for HAC, I would not have known that some community members skip drug appointments due to lack of transportation means to the health centers. I also got to know that HIV/Aids stigma in these communities is still at its peak which makes HIV/Aids patients skip antiretroviral drug appointments.
What is your daily motivation as you work with HAC? My motivation towards seeing that the marginalized people in the community are able to access health services regularly and at a subsided costs.
How was working during the COVID-19 lockdown like for you? As someone who works with data, it was a challenge. I had fewer data to fill out and this was because of the lockdown on transportation, the health workers could not go to the communities to serve the people.
Talk to a Health Access Connect supporter; Supporting HAC through funding is a necessary effort because we see the changes that HAC has done in the community with its few resources. Community members are now able to save money they could have spent on transport, and instead, get health services in the community. Health Access Connect has also reduced the workload health workers suffer at the health center. The HAC Medicycles program has improved the health of many clients in beneficiary communities since the health services are brought nearer.
A road in Kalangala District, Uganda is almost impassable because of regular flooding after rains.
“People had developed a tendency of refusing to go for treatment because of the distance to the health centre. Right now, we are relieved from the long lines at the public health centers. Even the number of people who seek treatment has increased,” John Baptist Lubega, a community member of Kisomole village, Rakai district commented.
Currently, travelling the long distance to the public health centre sounds like history to John and his community. But, to thousands of Ugandans living in remote areas, it is still a norm. They fail to access health services simply because of the expense and difficulty in traveling from their community to the nearest government health facility. “The minimum someone can spend in travelling from here to the nearest public health centre is 15,000 shillings ($4.05),” Luswata, one of the community members revealed.
It is for this reason that Health Access Connect (HAC) was founded in 2014. Upholding its mission to link remote communities to healthcare, HAC realised that health workers can no longer wait for patients in remote communities to reach the health facility – we must bring the health facility to the villages. “Members of the community could approach me and truthfully explain how they would love to access these health services but the long distance to the hospitals limited them. Before HAC came into this community, we had a pregnant mother in labour who passed away while on her way to the hospital, they hadn’t checked her, she didn’t give birth, she just died!” Karen Kirabo, one of HAC’s community health workers in Rakai District, revealed.
After this realization, it is then that Health Access Connect introduced its Medicycles outreach clinic model which is designed to encourage self-reliance in remote communities. This is in such a way that the members of the communities take full ownership and responsibility of their access to healthcare. “We start with a radical idea: remote communities are actually rich! We help our communities to use existing resources, for example public sector health workers, medicine, and motorcycle taxis to meet a pressing need: the lack of access to healthcare in remote areas,” Kevin Gibbons, Executive Director of Health Access Connect said.
Public health nurse travelling to the outreach site
All the services that are offered during the HAC outreach clinics are free since they are provided by government health workers. After the one day outreach clinic, health workers return on at least a bi-monthly basis to ensure continuity of health care.
With this, HAC is steadily building a reputation in the communities it serves as an organization capable of sustainably linking existing healthcare services to even the most remote and vulnerable patients. “We thank Health Access Connect and all their workers in Rakai district for the service they render to us in bringing health services to our villages. We thank the director of that organization for the great role he has played in Uganda,” John appreciated.
At the moment, Health Access Connect is working in over 40 villages and, with the donations received from #GivingTuesday, we hope to expand our operations to more communities that are too isolated to access essential services.
We had an opportunity to meet one of our frontline health workers, Kirabo Karen Rwabanda of Rakai district. Curiously, we asked her why she loves being a community health worker, and this was her passionate reply, “Seeing that people get easy and near access to medical care. Seeing that people get true medical care and they don’t just sit home without knowing where to get medical attention. Seeing that children who reach the age of immunization get immunized with the right vaccine. Seeing that all expectant mothers get immunized.”
Kirabo Karen Rwabanda, community health worker, Lwabanda village, Rakai District, Uganda
The situation before HAC
Before Health Access Connect (HAC) started bringing health services to her community, Lwabanda village, the health worker vividly recalls how discouraging it was to do her job. “I lost guts because I could sensitize people on the benefits of immunization and then encourage them to take their children for immunization. But, for people to actually walk to the health centres was impossible because of the long distance,” she explained. The members of the community could approach her and truthfully explain how they would love to access these health services but the long distance to the hospitals limited them. “Sometimes, even husbands did not want their wives to travel the long journey to the hospital. They had an assumption that their wives could use travelling to the hospital as an excuse to engage in their own plans,” Karen further explained. She narrated to us stories of expectant mothers in labour who would end up dying along the road when going to the hospital to give birth. “Before HAC came into this community, we had a pregnant mother in labour who passed away while on her way to the hospital, they hadn’t checked her, she didn’t give birth, she just died!”
As Health Access Connect, we believe that healthcare is a basic need that everyone should be entitled to and therefore nobody deserves to struggle in accessing it. “Remote areas are marginalised and experience a lot of health challenges. However, they have a potential of contributing to the improvement of their health standards through a community participatory strategy,” Ann Kugonza, one of our field officers in Kalangala commented.
HAC’s impact in Lwabanda village
Once HAC expanded its work to Lwabanda village, it introduced a transformational medicycles model which is designed to operate as a self-sustaining program in remote communities. The members of the community take ownership and responsibility of their access to healthcare as HAC alongside government partners work hand in hand with them to set up one-day outreach clinics.
With this program, Karen alongside other community health workers were able to be supported more in their jobs with a deeper training in health promotion. “The training was a lot because from it, I got more knowledgeable on how to teach the people of my community so that they can know the truth about their health,” she appreciatively commented. Her job has got a lot easier since then.
Some of the community health workers who received certificates from HAC after going through the health promotion training
“It is impossible to hear that an expectant mother has died along the journey on her way to giving birth. This is because these mothers learn alot from the antenatal classes that we give them and they get medically checked from the HAC outreach clinics. When their time to give birth approaches, they are able to work hand in hand with the doctors who come to the outreach clinics so that they can help them give birth in the public health centres,” Karen further explains, “….Even the children get immunized and every child who isn’t immunized is able to come to the HAC outreach clinics and get immunized well. We don’t have any more children who missed out on immunization.”
Karen also acknowledged the support that she got from HAC during the COVID-19 pandemic, “HAC gave us water taps and masks to protect ourselves from COVID-19. Even when we go to church, we are able to wash our hands before we enter just to ensure that COVID-19 isn’t spread amongst us.
HAC supplied soap, handwashing stations, and some PPE to support to the communities it serves during the COVID-19 emergency response.
The passionate health worker is grateful to Health Access Connect for their support in Lwabanda village and is still determined to do her job even with the COVID-19 risk. “In this situation of COVID-19, I go pick up a microphone and teach people on how they can protect themselves from COVID-19. I got lucky with masks, so I distributed them to the people.”
During this pandemic, it’s Karen alongside our other community health workers stationed in the different communities we serve that have been such a big motivation to us. The passion, determination and resilience that they’ve shown in their work is beyond! What can we say other than we love frontline health workers!
It’s stories like Sarah’s and the like that inspire us to keep chasing our mission to link remote communities to sufficient healthcare. We are determined to expand our work to other remote communities just to ensure that every citizen of Uganda has easy access to the medical assistance they deserve.
Sarah’s Story
“In a day, I would spend about 15,000 shillings ($4) travelling to Kalangala town in order to get medical assistance. On top of that, I’d have to start my journey early morning at 7am.”
Sarah (not real name), Farmer, 62 years old, Kalangala District
Sarah highlights the difficulty and expense that residents of remote villages face in accessing healthcare in remote villages. She further explained that even when she got to the health facility early enough, she could find a long line of people already waiting to receive medical treatment. In her health situation, she would join the line and sometimes had to wait hours to eventually be attended to.
For many other residents of remote communities in Uganda, what Sarah describes is ordinary. The Uganda Ministry of Health conducts annual surveys that assess the health system performance. These surveys have shown significant shortcomings in the access to and quality of health services. Complaints of long journeys and wait times have over time discouraged patients from seeking out professional health care. https://bulamuhealthcare.org/healthcare-in-uganda/
“People end up not being informed about the diseases that could possibly affect them. Someone could even be sick and they don’t know what they are suffering from.” Ellias Kyalikunda, a community health worker in Lwengo District explained how bad the situation could get in communities that don’t have easy access to health services.
HAC’s Impact
This is the gap that we as Health Access Connect (HAC) have filled over the years, through creating structural change in healthcare delivery in Uganda. With a mission to link remote communities to healthcare, HAC has been providing medical assistance to over tens of thousands of patients in remote communities. The Uganda Ministry of Health and the members of these communities greatly appreciate it.
Community Feedback
“I appreciate what HAC did so much, and I know that even the community members agree with me because when we requested for this access to medical care, they didn’t even argue. They agreed and brought these services to us. We are able to get medicine that can last two months and all you have to spend is 2,000 shillings (54 Cents).” Sarah expressed her gratitude to HAC for the burden they have lifted off her, “I know I can sell one cassava for 2,000 shillings (54 Cents) and easily access medical assistance. The best part about it is that I don’t have to travel the long journey and I can save the 13,000 shillings ($3) that I could have spent on transport.” All she has to do now is walk a short distance from her home to the outreach clinic and in a few minutes, she receives medical attention.
