Village health teams get bicycles

Amref's distribution of bicycles and insecticide-treated bed nets to village health teams, leads to questions that do not have straightforward answers, reports Richard M Kavuma

John Michael Ekeu hands over a bicycle and bed-net to Janet Abieto. Photograph: Richard M Kavuma

The 66 men and women smiled broadly and joked with one another as they each received a bicycle from Amref at the NGO's office in Katine. Merok is one of the six parishes that make up Katine sub-county and it now has 66 village health team (VHT) members. They recently completed 10 days of training by Amref to strengthen their work as drug distributors, health educators and sanitation promoters at village level.

Amref has given them bicycles to overcome a key challenge – transport. The week before, each VHT also got an insecticide-treated bed net to keep away mosquitoes that cause malaria, the number one killer in Uganda.

First to emerge was Janet Abieto from Abari village. The 33-year-old smiled shyly as she noticed my camera, before stopping as if to mount the bicycle to check its height. Noticing that some parts of the bike were still wrapped in polythene, she began peeling it away with the impatience borne of excitement.

Bicycles are the major means of transport in Katine, and the Indian-made, $70 Hero and Roadmaster brands given out here are popular in Uganda. Bicycles are crucial for VHTs because their work involves collecting drugs from the main health centre (located as far as 10 kilometres away), attending meetings and mobilising scattered households for educational and other activities.

Handing over the items, the sub-county's secretary for health and education, John Michael Ekeu, acknowledged that being a VHT member was a very demanding task. He thanked Amref for the support and the VHTs for their dedication. "Since you have volunteered, please do it with one heart," Ekeu told them all. "And if you meet difficulties, please do not hesitate to report to us."

Dr Charles Luwaga, the Katine project officer for health, reminded the VHTs that the bicycles were given to them to do official work and not for personal business. In effect these bicycles belong to the villages for which the volunteers work.

"If you visit a friend riding this bicycle, do not forget to carry out health education: if you notice sanitation issues in your friend's home, talk about them," Luwaga explained.

A VHT walks away with her bicycle. Photograph: Richard M Kavuma

But the VHTs were full of questions. "If you say that the bicycle belongs to the village, then anyone in the village might come and say, 'lend me that bicycle that Amref gave you.'" one man complained.

Another one asked: "If you lend the bicycle to someone who wants to take a patient to hospital and it gets stolen from there, what happens?"

In the end Luwaga clarified that the VHTs were to use discretion, as they would do with their own bicycles. Only time will tell, however, whether these community resources will be safe in private hands. As Luwaga anticipated, some issues will remain tricky.

"Some of you ladies are married: these bicycles are not for your husbands. Please tell your husband that, 'this bicycle is for me to do VHT work'," he said, attracting a bemused murmur from the women's corner.

But there was no dampening the excitement. In fact, some VHTs took their bicycles before the assembly team had fully tightened all the screws.

Meanwhile the VHTs reported back on how the distribution of bed nets they received the previous week had gone. It was terrible. Why? Because the demand was high and there were not enough nets. After training, each VHT is given 15 bed nets to distribute, making it 30 nets per village. With some villages having as many as 130 households, it was always going to be difficult deciding who to give them to.

"We decided to give them to children under five," said Willy Ecau, a VHT from Omariai village in Katine parish. "There are many of those, but we chose one child from different households. We tried to balance that by taking one household from one end, another from the other end."