Under the relentless midday sun of Mwaluphamba, deep in Matuga Sub-county, Kwale County, Mwanamisi Kitumbua, a Community Health Promoter (CHP), steadies her bicycle and wipes the sweat from her brow. Dust swirls beneath her wheels as she navigates the familiar path to Christine’s home. Her journey today, like many before, is not just about reaching her destination; it is about saving lives through disease prevention, health promotion and education, one household at a time. She pedals with purpose toward Christine’s home, a new mother she has closely supported through pregnancy and now into motherhood.
Christine Mnyazi, just six days post-partum and looking a bit exhausted, greets her warmly. The bond between them is evident. Mwanamisi first visited when the baby was two days old, ensuring the newborn was off to a healthy start. Trained as part of the basic modules through Amref Health Africa by the Ministry of Health for Community Health Promoters (CHPs), she knows the importance of these early visits.
“During her pregnancy, Christine’s blood count dropped to a dangerous level of seven grams per deciliter (g/dL),” Mwanamisi recalls. “She had to be admitted as it was too low for an expectant mother. Too risky for both of them. But she made it. And now, I am here to make sure they continue to thrive.”
Inside the modest home, Mwanamisi’s trained eyes scan the baby, checking her fragile body, the healing umbilical cord, and signs of proper nutrition. She guides Christine on the best way to hold the baby during breastfeeding, gently demonstrating after cleaning her hands with soap and water.
“Usishike makasi. Lishike titi lote.” Loosely translated “Don’t just hold the nipple; support the entire breast,” she advises.
Christine listens intently, adjusting her grip. Small lessons, but ones that can make a difference between a thriving or struggling infant.
Then Mwanahamisi turns to Christine herself. “How are you feeling?” she asks. Christine hesitates before lifting the hem of her dress exposing swollen feet. Concern sparks across Mwanamisi’s face, could this be a lingering effect of the low blood count? She advises Christine, “Please eat more leafy greens and fruits. Also, please visit our link facility, Mwaluphamba Dispensary to get to the root of the swollen feet and also get the baby immunized”, logging the details into her eCHIS app.
Switching gears, Mwanamisi gently broaches another critical topic, family planning. Christine listens as she explains the different contraceptive methods and the importance of spacing children for both health and economic reasons.
“I once tried the pills, but the side effects were unbearable,” Christine admits.
Mwanahamisi nods understandingly, offering alternatives. “Progestin-only pills (POPs) won’t affect breastfeeding, and IUCDs are a long-term option.”
Christine weighs her options, finally deciding, “I’ll go to the facility after having a discussion with my husband on the best contraceptive method for our young growing family.”
As Mwanamisi climbs back onto her bicycle, she reminds Christine, “Don’t forget to go to the dispensary for your feet, immunization for the baby and family planning.”
She rides off toward her next home visit, her fifth of the day. Before receiving the bicycle, she could only manage three visits daily. Now, with this simple yet transformative tool, she reaches up to ten households in a day.
The Struggle for Mobility in Rural Community Health Service Delivery
While the professionalization of CHPs across the country has been greatly commended, those in rural areas still face a persistent challenge of mobility. Many, like Mwanamisi, used to walk for miles to meet their 100-household targets, their efforts constrained by time and distance.
Recognizing this, Amref Health Africa, in collaboration with World Bicycle Relief, distributed 100 bicycles to CHPs in Kwale County in April 2024. A vital step, yet a mere fraction of what is needed, as Kwale has 1,680 CHPs, many serving vast, sparsely populated regions.
The impact has been immediate. Alfani Mohammed, the facility in charge at Mwaluphamba Dispensary, notes a surge in referrals. “This is my fourth year here, but in the past year alone, I’ve seen a rise in patients coming in, mostly referrals from CHPs. The bicycles have made a difference,” he says.
The increased mobility of CHPs has also played a role in boosting registrations for the Social Health Authority (SHA) program. Kache Ndupha, the Kwale County Community Health Focal Person, acknowledges the difference. “We’ve noted a significant increase in the number of people registering for SHA from the CHUs with bicycles. With CHPs reaching more households, they can educate more families on the benefits of health insurance, leading to more registrations,” she explains.
Beyond healthcare, the bicycles have transformed the daily life of CHPs. Mzee Zua Karani, a CHP from Pumwani CHU, explains how it has eased his struggles beyond work. “In my arid village, clean water is scarce. Before, I could only carry one jerrycan. Now, with my bicycle, I make multiple trips while carrying multiple jerrycans and ensure my family always has clean water,” he shares.
Still, challenges remain. Spare parts are difficult to find, and many CHPs only received a pump but lack essential repair tools. “The bicycle is great, but we need a full toolkit: a spanner, a lock, and other essentials. Otherwise, if it breaks down, we are back to walking,” Mzee Zua adds.
Looking Ahead: The Future of CHP Mobility
The evidence is clear; equipping CHPs with reliable transportation significantly improves service delivery amongst communities. CHPs with bicycles serve more households, ensuring early interventions, improved maternal care, and timely referrals.
This issue will take centre stage at AHAIC 2025, where World Bicycle Relief, Amref Health Africa, Johnson & Johnson, and ELMA Philanthropies will co-host a session titled “Beyond Professionalized CHWs: Mobility, the Missing Piece.” The discussion will bring together policymakers, health experts, and community leaders to explore sustainable solutions for CHW mobility in Africa.
For Mwanahamisi, Karani, Christine, and countless others, the road to better healthcare begins with something as simple and as powerful as two wheels beneath their feet.