Special Delivery: Volunteers on Bicycles Bring Health Care to Rural Senegal

GAMBEY, Senegal — A large black bag slung over his shoulder, Sillymane Ba pedals his rickety bicycle down a rocky, bumpy, red dirt road. He is heading from the local health centre to his village of Gambey, a community of a few hundred people living in one of Senegal’s poorest rural areas.

In his bag he carries vitamins, basic medicines and contraceptives, which he will show the villagers how to use when he arrives. He will then answer their questions on family planning, pregnancy and the prevention of sexually transmitted infections. When he has finished, he will put away his black bag, prop his bicycle against his hut, and return to work in the fields alongside them.

Sillymane Ba, like all the other residents of Gambey, is a poor farmer in rural Senegal. But he is also a member of the country’s community health worker programme, run by the Senegalese Ministry of Health and supported by UNFPA, the United Nations Population Fund. Developed with the technical assistance of the Population Council, an international NGO specializing in poverty and reproductive health, the programme is a creative attempt to bridge the gap in health services between Senegal’s rural and urban areas.

Though peaceful, democratic and relatively prosperous for a West African state, Senegal is still one of the 50 poorest countries in the world. Twenty per cent of its population lives on less than one dollar a day, with much of this poverty concentrated in the country’s underdeveloped rural areas. In the region where Mr. Ba lives, only 5 per cent of the population has access to clean water. Fewer than one in five girls go to school.

Medical facilities in these underdeveloped areas are a far cry from those available among the high-rises of Dakar, the nation’s capital. Providing services poses a great logistical challenge, which is why the government and UNFPA adopted this novel approach. By recruiting members of rural communities to serve as health conduits, the programme enables villagers, who may never have the chance to see a doctor, to bring health services home with them.

Participants, like Mr. Ba, go through training in how to explain sexual and reproductive health issues, and are then issued with the simple tools of their trade: a bicycle for transportation and a bag containing contraceptives, educational materials and basic over-the-counter medicines. The rest is up to them.

“Our goal is to bring the greatest possible level of reproductive health services to all,” says Dr. Suzanne Maiga-Konate, UNFPA Representative for Senegal. "These volunteers come directly from the populations they serve. Sensitive questions that people would never ask an outsider, they will ask of them. And if we can reach these people, we can raise the health status of this country.”

The volunteers are trained to pay special attention to the state of pregnant women in the village. They refer the women to the local health centres for three pre-natal checkups and do all they can to ensure that the women reach the centre to give birth with a skilled attendant.

Transporting a woman in labour can be difficult and expensive in this remote part of the country. To help remedy the situation, UNFPA has begun providing the villages with 'community health funds', usually around $50. The fund assists the community to pool resources for use in times of urgent need—such as when a woman experiencing complications during labour desperately needs to reach a district hospital. The villagers themselves work out the details of how to replenish the fund, usually by small monthly donations.

Working in two-person teams consisting of one man and one woman—Mr. Ba’s partner happens to be his sister, Aminata Diallou—the volunteers usually return to their communities, typically small villages composed mainly of subsistence farmers and their families. There they explain the basics of contraceptive use and how to prevent the transmission of sexually transmitted infections (STIs), including HIV. This education is surprisingly thorough for the setting—Mr. Ba’s bag contains large quantities of free condoms, but he also explains and carries more complicated and expensive items, from birth control pills to Norplant contraceptive injections.

“The people usually do not buy these,” he concedes, no surprise given the level of poverty in Senegal’s rural areas—GDP per capita is $1,800, and these villagers are far poorer than average—but the explanation of their function is free. Basic medicines and drugs sell briskly, such as supplements containing Vitamin A, an essential micronutrient in child development.

“It’s in the interest of the village…of our village,” says Ms. Diallou. In Gambey with its population of less than 300, it is quickly apparent that the siblings are related to just about everyone present. These workers are, quite literally, looking after the health of their own families. Pairs of workers often cover one or two other villages in the area as well, but the community and kinship ties diminish only slightly.

Mr. Ba, Ms. Diallou and others like them are essentially volunteers, operating at a fraction of the cost of a professional health worker. They do receive small financial incentives, keeping a percentage of the revenues from the medicines they sell. They are also advanced modest credit lines by UNFPA. But for Mr. Ba, helping his fellow villagers is his true reward.

“Even if I have nothing,” he says, “The act of aiding my community is enough for me.”

— Arthur Plews