Empowerment of Women as Village Leaders in Health

The United Nations Sustainable Development Goals 3 Good Health and Well-Being and 5 Gender Equity particularly relate to women, nursing, and primary health care. https://sdgs.un.org/#goal_section. The World Health Organization (WHO), Nursing Now and the International Council of Nurses (ICN) in 2020 are seeking new global models of health care delivery (https://www.who.int/hrh/news/2018/nursing_now_campaign/en/). The domain of nursing is health maintenance, promotion, and prevention of disease and disability, framed by a holistic approach to the human condition within a local, regional, national, global focus. Nursing offers a different perspective from the medical disease-focused model.  Presented here is a nursing holistic health model for the 21 Century that is forming now in Rwanda, Africa. 

A continuation of the Pilot Phase, in the village of Rwamagana, Rwanda, this project directly relates to Gates Foundation belief in gender equity and improving health, as well as WHO 2020 Year of the Nurse & Midwife, and UN Sustainable Development Goals 3 & 5 – ‘Women Empowered Good Health and Well-Being’. Through assessing from the women in their homes their identification of health needs of the village/community, validate with schools/parents/teachers, community health workers, and local authorities, then develop Train the Trainer programs for community health workers and nurses in Rwanda to learn how to supervise community health workers.

Through Train the Trainer Programs sustainability and capacity development can be achieved. This project empowers the most vulnerable in the community, the women, the voiceless, yet the ones with real knowledge and un-tapped power to know their own, children, families, and village/ community needs. This is a grassroots project focusing on the health and education needs that are identified by women and their communities; it is not a program told by outsiders what are the community needs, rather, by including schools/parents/teachers, community health workers, and local authorities, there is a buy-in from the grassroots.

The need originally validated by the then Minister of Health for training of community health workers, citing “Eighty percent of the population live in rural areas, and that is where 80% of the burden of disease is.” Yet noting “there is little to no training of the thousands of community health workers throughout the country.” We have the ‘buy-in’ from the nursing community, starting with the Chief Nursing Officer in the Ministry of Health, and the first president of the Rwandan Nurses and Midwives Association who said "we need well educated nurses and community health workers, you have my buy-in 100 percent, I would like to be involved in evaluation.  Now the Dean of the local School of Nursing and faculty are anxious to be participants. Faculty and graduates are fluent in English and the local language of Kinyarwanda.

With the local NGO and staff, in 2016 we visited the initial site for the project in Rwamagana; interviewed women and community health workers in their homes; participated in community meetings; met with local authorities; visited and talked with staff of the Neighborhood Health Center asking what they wanted from professional nurses to help develop Train the Trainer programs. From these meetings, we developed the Concept Note/Proposal “Grassroots Empowerment of Women as Gatekeepers of the Health of the Community”. Some of the health needs identified by the women in recent years are ensuring vaccinations are current, truancy, need for primary school while mothers are in the fields picking crops, sexual abuse of girls by male relatives. In post-genocide Rwanda, there will always be a need for ongoing trauma healing therapies, which exist but not consistently in the rural village level within access to women/children/families.

In May 2019 I presented this project to an international conference of nurses in Nairobi. Public health nursing educators from Uganda and Kenya said they have the same need for community health worker training, and said they would like to be involved as Trainers. From the U.S., I now have a few nurse educators with backgrounds in health projects in Africa and neighboring countries to Rwanda and will be part of the project at present. On ground nursing educators and graduates from the local School of Nursing will be involved in assisting in going into women’s homes and gathering the women’s identification of health needs, then validate with schools/parents/teachers, community health workers, and local authorities.

From there we will develop Train the Trainer programs, and if there are local experts related to identified health needs, include them as Trainers. We will also develop evaluation and outcome tools. 

The second visits will be to evaluate the Train the Trainer programs based on the health needs identified and validated and the evaluation and outcome Tools developed. Based on this data, Training will be revised, and health needs will be assessed again, for health needs change and evolve.

Phase II and data from evaluations and outcomes measured by degree of accomplishment of health and education needs identified, replicate model in other villages throughout Rwanda, with applicability to other underserved populations globally, starting with the women as the knowledge source to identify health and education needs.

A practice and education model to bring to other villages throughout Rwanda, fragile societies in East Africa and other continents, including fragile communities in the U.S. and other developed countries.  

  A continuation of the Pilot Phase, in the village of Rwamagana, Rwanda, this project directly relates to the Gates Foundation belief in gender equity and improving health, as well as WHO 2020 Year of the Nurse & Midwife, and UN Sustainable Development Goals 3 & 5 – ‘Women Empowered Good Health and Well-Being’. Through assessing from the women in their homes their identification of health needs of the village/community, validate with schools/parents/teachers, community health workers, and local authorities, then develop Train the Trainer programs for community health workers and nurses in Rwanda to learn how to supervise community health workers.

Through Train the Trainer Programs sustainability and capacity development can be achieved. This project empowers the most vulnerable in the community, the women, the voiceless, yet the ones with real knowledge and un-tapped power to know their own, children, families, and village/ community needs. This is a grassroots project focusing on the health and education needs that are identified by women and their communities; it is not a program told by outsiders what are the community needs, rather, by including schools/parents/teachers, community health workers, and local authorities, there is a buy-in from the grassroots.

The need originally validated by the then Minister of Health for training of community health workers, citing “Eighty percent of the population live in rural areas, and that is where 80% of the burden of disease is.” Yet noting “there is little to no training of the thousands of community health workers throughout the country.” We have the ‘buy-in’ from the nursing community, starting with the Chief Nursing Officer in the Ministry of Health, and the first president of the Rwandan Nurses and Midwives Association. Now the Dean of the local School of Nursing and faculty are anxious to be participants. Faculty and graduates are fluent in English and the local language of Kinyarwanda.

Collaborating with the local School of Nursing ensures an holistic approach and model of health of women/children/ family/community. It expands the narrower focus of the medical and sick care model, leading to Gates Foundation belief and focus on improving health leading to “productive lives” through grassroots education.

Collaborating with a local NGO, which has several community sites throughout Rwanda, conducting community meetings with women, schools/parents/teachers and local authorities. However, the missing link is follow-up when health needs are identified. Our project fulfills this need for assessments and health education through Train the Trainer programs for community health workers and local nurses in Rwanda to learn how to supervise the community health workers. The local NGO vision since its founding has been child and youth focused programs addressing special needs of orphans headed household affected by the genocide and/or HIV/AIDS, young girls’ victims of violence and other vulnerable children. The focus of the local NGO has expanded realizing to achieve the original mission, women must be at the center as the knowledge holders of the health needs of the community. The program of assessing health needs of the community from the women, then validating with schools/parents/teachers, community health workers, and local authorities, achieves the women’s and community identified needs for health and education. Train the Trainer programs for community health workers and local nurses to learn how to supervise community health workers, leads to sustainability and capacity development to achieve ‘Women Empowered Good Health and Well-being in the community.

With the local NGO and staff, in 2016 we visited the initial site for the project in Rwamagana; interviewed women and community health workers in their homes; participated in community meetings; met with local authorities; visited and talked with staff of the Neighborhood Health Center asking what they wanted from professional nurses to help develop Train the Trainer programs. From these meetings, we developed the Concept Note/Proposal “Grassroots Empowerment of Women as Gatekeepers of the Health of the Community”. Some of the health needs identified by the women in recent years are ensuring vaccinations are current, truancy, need for primary school while mothers are in the fields picking crops, sexual abuse of girls by male relatives. In post-genocide Rwanda, there will always be a need for ongoing trauma healing therapies, which exist but not consistently in the rural village level within access to women/children/families.

In May 2019 I presented this project to an international conference of nurses in Nairobi. Public health nursing educators from Uganda and Kenya said they have the same need for community health worker training and said they would like to be involved as Trainers. From the U.S., I now have three nurse educators with vast experience in global health projects in rural villages in Africa and neighboring countries to Rwanda, who will be part of the project in the near future as consultants in assisting in developing Evaluation Tools with the local School of Nursing.  On ground nursing educators and graduates from the local School of Nursing will be involved in assisting in going visits to women’s homes and gathering the women’s identification of health needs, then validate with schools/parents/teachers, community health workers, and local authorities.

From there we will develop Train the Trainer programs, and if there are local experts related to identified health needs, include them as Trainers. We will also develop evaluation and outcome tools.  

Evaluate the Train the Trainer programs based on the health needs identified and validated and the evaluation and outcome Tools developed. Based on this data, Training will be revised, and health needs will be assessed again, for health needs change and evolve.

Data from evaluations and outcomes measured by degree of accomplishment of health and education needs identified, replicate model in other villages throughout Rwanda, with applicability to other underserved populations globally, starting with the women as the knowledge source to identify health and education needs.

A practice and education model to bring to other villages throughout Rwanda, fragile societies in East Africa and other continents, including fragile communities in the U.S. and other developed countries.  

In 2016, with the local NGO and staff of Uyisenga ni Imanzi (UNM), I visited the initial site for the project in Rwamagana, a rural village about 40 miles east of the capital. Along with the staff of UNM, we interviewed women in their homes, participated in community meetings, met with local authorities, and talked with staff of the Neighborhood Health Center. These discussions led to their identification of health needs of the village/community. A missing link was identified in the process of obtaining healthcare: lack of communication between local women and regional healthcare professionals and follow-through after health needs are identified. We also asked all what they wanted from professional nurses. Local nurses noted a lack of continuing education since graduation; they feared their practice was not up-to-date. This input from nurses identified a direct need for involvement with the local School of Nursing to provide ongoing continuing education to meet local nurses and community health workers ongoing village needs.

A gap and a model

Armed with anecdotal data, we began to develop a model of empowerment of women leaders in health. The model is twofold: 1) Train the Trainer programs to teach community health workers (CHWs) to recognize and report emerging diseases; and 2) Train the Trainer programs to teach local nurses how to supervise CHWs and provide for continuing education to upgrade CHWs knowledge and skills. We developed a specific program titled “Grassroots Empowerment of Women as Gatekeepers of the Health of the Community.”

Continued validation of needs identified from women in villages came from schools/parents/teachers, community health workers, and local authorities. We now have the new model of global health nursing for the 21st century – nurse-led Train the Trainer programs for community health workers that can be replicated in many countries around the world. This project empowers the most vulnerable in the community, the women, the voiceless. They are the ones with real knowledge and un-tapped power to know their own need and those of the children, families, and village/ community.

Expanding the network toward sustainability

In May 2019, I presented this project at the Global Network of Public Health Nursing International Conference 2019 in Nairobi, Kenya. Ministers of Health and Education in both Kenya and Uganda, nurses from the University of Nairobi School of Nursing, and public health nurse educators from Uganda and Kenya told me they have the same need for CHW training; the nurse educators said they would like to be involved as trainers. Nurse leaders in Zambia and Botswana also expressed a need and interest to be involved. From the U.S., nurse educators with backgrounds in health projects in Africa and in neighboring countries to Rwanda will also be part of the project at present.  See PROFILE MEDIA AFRICA Interview https://www.youtube.com/watch?v=BqRMVeD2pSc&feature=em-uploademail 

In Kigali in May 2019, I met with the Dean and faculty at the University of Rwanda School of Nursing. Their interest and commitment were reinforced in 2020. The beauty of collaborating with the faculty and graduates of the local school of nursing ensures capacity development and sustainability with local graduates who speak English and the local language of the villages. “The School of Nursing and Midwifery/University of Rwanda is ready to work and collaborate with you….it is a privilege for the school of Nursing and midwifery to work with you.” (Dean M. Mukeshimana and former Dean D. Mukamana, email, June 10, 2020).

In May 2019 the Executive Director of UNM and I met with the Rwanda Country Director of the U. S. Peace Corps. The Peace Corps (pre-pandemic) has offered us a third-year Health Volunteer for our project in Rwamagana, the village where the Peace Corps also has a presence. (Keith Hackett, personal communication, May 20, 2019).  (NB Due to COVID-19, the Peace Corps has suspended most of its programs; the Health Volunteer position is on hold at present.

The future

We will implement the Train the Trainer programs and develop the evaluation and outcome tools with the University of Rwanda School of Nursing and others. Based on data, training will be revised, and health needs will be re-assessed as they change and evolve. After data from evaluations and outcomes are analyzed, this model can be introduced to other villages throughout Rwanda, then to fragile societies in East Africa and other continents.

Lessons Learned to date

1. Advocacy. This is a grassroots project focusing on the health and education needs that are identified by women in their communities. This is not a program imposed by outsiders who determine the community needs; rather, it is a program that sought initial buy-in from schools/parents/teachers, community health workers, and local authorities.
2. Empowerment. The heart of the project is a focus on women and local community health workers (CHWs). There are not enough nurses and physicians in the country to provide adequate care for the health needs. Teaching CHWs to identify diseases and environmental problems, and alert professionals to emerging concerns (including to prevent epidemics and pandemics) is critical to an effective healthcare system.
3. Collaboration. Identifying partners is essential in assuring a successful project. Including the local NGO that has several community sites throughout Rwanda, establishing relationships with government officials, conducting community meetings with women, schools/parents/teachers, community health workers, and local authorities, and connecting with nurse education programs provides insights into what local villages and communities perceive as needs and keep solutions realistic.    

Financial to continue our project, "Grassroots Empowerment of Women as Gatekeepers of the Health of the Community".  

Partnering with a local NGO in Rwanda and the local School of Nursing, requires basic support of travel, lodging, meals.  As well as up-to-date technology in both the local NGO and the local School of Nursing.  

The United Nations Sustainable Development Goals 3 Good Health and Well-Being and 5 Gender Equity particularly relate to women, nursing, and primary health care. https://sdgs.un.org/#goal_section. The World Health Organization (WHO), Nursing Now and the International Council of Nurses (ICN) in 2020 are seeking new global models of health care delivery (https://www.who.int/hrh/news/2018/nursing_now_campaign/en/). The domain of nursing is health maintenance, promotion, and prevention of disease and disability, framed by a holistic approach to the human condition within a local, regional, national, global focus. Nursing offers a different perspective from the medical disease-focused model.  Presented here is a nursing holistic health model for the 21 Century that is forming now in Rwanda, Africa. 

A continuation of the Pilot Phase, in the village of Rwamagana, Rwanda, this project directly relates to Gates Foundation belief in gender equity and improving health, as well as WHO 2020 Year of the Nurse & Midwife, and UN Sustainable Development Goals 3 & 5 – ‘Women Empowered Good Health and Well-Being’. Through assessing from the women in their homes their identification of health needs of the village/community, validate with schools/parents/teachers, community health workers, and local authorities, then develop Train the Trainer programs for community health workers and nurses in Rwanda to learn how to supervise community health workers.

Through Train the Trainer Programs sustainability and capacity development can be achieved. This project empowers the most vulnerable in the community, the women, the voiceless, yet the ones with real knowledge and un-tapped power to know their own, children, families, and village/ community needs. This is a grassroots project focusing on the health and education needs that are identified by women and their communities; it is not a program told by outsiders what are the community needs, rather, by including schools/parents/teachers, community health workers, and local authorities, there is a buy-in from the grassroots.

The need originally validated by the then Minister of Health for training of community health workers, citing “Eighty percent of the population live in rural areas, and that is where 80% of the burden of disease is.” Yet noting “there is little to no training of the thousands of community health workers throughout the country.” We have the ‘buy-in’ from the nursing community, starting with the Chief Nursing Officer in the Ministry of Health, and the first president of the Rwandan Nurses and Midwives Association who said "we need well educated nurses and community health workers, you have my buy-in 100 percent, I would like to be involved in evaluation.  Now the Dean of the local School of Nursing and faculty are anxious to be participants. Faculty and graduates are fluent in English and the local language of Kinyarwanda.

The overall goal is to set in motion a global model to meet UN Sustainable Development Goals # 3 (Good Health and Well-Being) and #5 (Gender Equity), in other words, Women-Led and Inspired Good Health and Well-Being.) 

During the first year, we plan to further develop Assessment Data Tools and gather further data from women and what they see as the health needs of their villages, validate with schools/parents/teachers, and local authorities.  We will also develop Evaluation Tools, which will be ongoing as health needs evolve from time to time.

Then work with the local School of Nursing faculty and graduates to develop Train the Trainer programs for community health workers based on the health needs identified and validated. Implement Train the Trainer programs for community health workers and programs for local nurses to learn how to supervise these frontline health workers.

Once evaluation data is gathered and with Evaluation results, revise/update Train the Trainer programs as needed and indicated. Then take to other villages in Rwanda. 

Then begin to offer to other nearby East African countries, such as Kenya and Uganda that have expressed great interest and a need for Train the Trainer programs for community health workers. Nurse Educators in these countries have offered to be Trainers for community health workers. The University of Nairobi has expressed great interest in faculty expressly for this project.     

Essentially, this is a global model to improve health at the basic primary care community level. 

With the local NGO and staff of Uyisenga ni Imanzi (UNM), I visited the initial site for the project in Rwamagana, a rural village about 40 miles east of the capital. Along with the staff of UNM, we interviewed women in their homes, participated in community meetings, met with local authorities, and talked with staff of the Neighborhood Health Center. These discussions led to their identification of health needs of the village/community. A missing link was identified in the process of obtaining healthcare: lack of communication between local women and regional healthcare professionals and follow-through after health needs are identified. We also asked all what they wanted from professional nurses. Local nurses noted a lack of continuing education since graduation; they feared their practice was not up-to-date. This input from nurses identified a direct need for involvement with the local School of Nursing to provide ongoing continuing education to meet local nurses and community health workers ongoing village needs.

A gap and a model

Armed with anecdotal data, we began to develop a model of empowerment of women leaders in health. The model is twofold: 1) Train the Trainer programs to teach community health workers (CHWs) to recognize and report emerging diseases; and 2) Train the Trainer programs to teach local nurses how to supervise CHWs and provide for continuing education to upgrade CHWs knowledge and skills. We developed a specific program titled “Grassroots Empowerment of Women as Gatekeepers of the Health of the Community.”

Continued validation of needs identified from women in villages came from schools/parents/teachers, community health workers, and local authorities. We now have the new model of global health nursing for the 21st century – nurse-led Train the Trainer programs for community health workers that can be replicated in many countries around the world. This project empowers the most vulnerable in the community, the women, the voiceless. They are the ones with real knowledge and un-tapped power to know their own need and those of the children, families, and village/ community.

Expanding the network toward sustainability

In May 2019, I presented this project at the Global Network of Public Health Nursing International Conference 2019 in Nairobi, Kenya. Ministers of Health and Education in both Kenya and Uganda, nurses from the University of Nairobi School of Nursing, and public health nurse educators from Uganda and Kenya told me they have the same need for CHW training; the nurse educators said they would like to be involved as trainers. Nurse leaders in Zambia and Botswana also expressed a need and interest to be involved. From the U.S., nurse educators with backgrounds in health projects in Africa and in neighboring countries to Rwanda will also be part of the project at present.  See PROFILE MEDIA AFRICA Interview https://www.youtube.com/watch?v=BqRMVeD2pSc&feature=em-uploademail 

In Kigali in May 2019, I met with the Dean and faculty at the University of Rwanda School of Nursing. Their interest and commitment were reinforced in 2020. The beauty of collaborating with the faculty and graduates of the local school of nursing ensures capacity development and sustainability with local graduates who speak English and the local language of the villages. “The School of Nursing and Midwifery/University of Rwanda is ready to work and collaborate with you….it is a privilege for the school of Nursing and midwifery to work with you.” (Dean M. Mukeshimana and former Dean D. Mukamana, email, June 10, 2020).

In May 2019 the Executive Director of UNM and I met with the Rwanda Country Director of the U. S. Peace Corps. The Peace Corps has offered us a third year Health Volunteer for our project in Rwamagana, the village where the Peace Corps also has a presence. (Keith Hackett, personal communication, May 20, 2019).  (NB Due to COVID-19, the Peace Corps has suspended most of its programs; the Health Volunteer position is on hold at present.

The future

We will implement the Train the Trainer programs and develop the evaluation and outcome tools with the University of Rwanda School of Nursing and others. Based on data, training will be revised, and health needs will be re-assessed as they change and evolve. After data from evaluations and outcomes are analyzed, this model can be introduced to other villages throughout Rwanda, then to fragile societies in East Africa and other continents.

My Theory of Change is a grassroots empowerment of local individuals, families/support systems, communities – local, regional, national, global. Real change for the good must come from those living the reality of their lives.  Particularly In fragile societies, it is the locals who know what they need and want to survive and for quality of life.  In Rwanda in 2012, the need for Train the Trainer programs for community health workers was confirmed by the then Minister of Health, who said of the existing program and funding partnering with the Ministry of Health was only to "beef up hospital nursing", adding that 80 percent of the population live in rural areas where 80 percent of the burden of disease is."  This was the result of 'outsiders' musunga identifying a country's needs and problems for them. With the UN Sustainable Development Goals #3 (Good Health and Well-Being) and #5 (Gender Equity) equating to as I term it Women-Led Good Health and Well Being) we have a Theory of Change for "Grassroots Empowerment of Women As Gatekeepers of the Health of the Community". With women identifying health needs of their villages then validating with schools/parents/teachers, community health workers, and local authorities, we have a framework to develop Train the Trainer programs for community health workers and local nurses to learn how to supervise. In keeping with this model of Change, our project in partnering with a local NGO in Kigali with a vast network in Rwanda and the local School of Nursing, we have a Input from local resources and experts to keep the design and implementation in tune with health needs identified by women for the Goal of women-led good health and well-being.  

The local NGO Uyisenga Ni Imanzi (UNM) founded in 2002 with the original purpose to address needs of children and orphans from the genocide and those with HIV/Aids. I met the Executive Director of UNM at a fundraiser in New York in 2013. We agreed that to achieve UNM's goals women must be involved as leaders. In 2016, I visited the village of Rwamagana where UNM has a strong presence with local community leaders.  We began our pilot project then. In 2019, I presented this project at the Global Network of Public Health Nursing International Conference in Nairobi, Kenya. My website has further and ongoing progress in developing "Grassroots Empowerment of Women as Gatekeepers of the Health of the Community".  

The core power for solutions is based on the community meetings framework of the local NGO.  Held in community meeting spaces or schools, where women and men, parents and teachers are attending to identify solutions. The one-to-one data collection will often take place in the homes of the women hosting other village women (and men).  Through traditional technology and online meetings and enhanced electronic capabilities of UNM and the local School of Nursing, there is potential for enhanced use of technologies through local resources and designs.  

Partnering with the local School of Nursing, we have the buy-in of faculty and graduates to provide the grassroots assessment of data.  Providing an expanded model of nursing education and practice meeting the health needs in their local communities.  

Focus the project on the local people in the village and country.  Not some musunga wandering in and telling villagers and communities what they need. Rather ask from the local community what they see as needs.  In particular, we know globally, women are hidden and unsung resource of power and potential leadership in societies globally.  Women are also the fallout war and fragile societies.  In Rwanda, since the genocide where women suffered horrendous unimaginable rape and abuse, there is now a mandate that women hold 50 percent of government positions, indeed it is now 64 percent, more than any country in the world.  However, in rural villages where 80 percent of the population resides, and where the former Minister of Health Agnes Binagwaho described "80 percent of the burden of disease is" there is still a recognized need by local authorities that women must be included as leaders in health.  

Therefore, I am partnering with a local NGO in Rwanda with a long track record in programs and advocacy for vulnerable children and with HIV/AIDS, and trauma from the genocide.  Will also be including local nurse educators and graduates of the University of Rwanda School of Nursing.  

The model of "Grassroots Empowerment of Women as Gatekeepers of the Health of the Community" is essentially an education model with the intended impact of improving health in the community.  Health will be defined by the women of the villages and what they see as the pressing and ongoing needs of the community at any point in time.  Then needs identified by the women are validated by parents/teachers/schools, community health workers, and local authorities. Then, along with the expertise of faculty and graduates within the local School of Nursing, develop Train the Trainer programs for community health workers and local nurses to learn how to supervise community health workers.  With the School of Nursing faculty and graduates and other experts within Rwanda, develop Evaluation Tools for outcomes of the Train the Trainer programs.  Outcomes expected are improvement in Health and Well-Being (UN Sustainable Development Goal #3) and Gender Equity (Un Sustainable Development Goal #5).  In other words, Women-Led and Inspired Good Health and Well-Being.)  Women and local authorities throughout Rwanda, especially in villages where the NGO I am partnering with (Uyisenga ni Imanzi) have had a longstanding presence in the village of Rwamagana where the project has initially begun.  With evaluation data, we see bringing to other villages and communities in Rwanda and neighboring countries in East Africa.  Essentially, this is a global model to improve health at the basic primary care community level.      

The key 'customers and beneficiaries' are the villages measured through the Evaluation Tools to be developed, by improvements in the stated needs identified by the women.  

The impact is healthier children in schools where women have identified needs, women empowered leaders in their villages with and including local authorities, schools/parents/teachers, and knowledgeable community health workers to address needs identified and approaches developed and learned in Train the Trainer programs. healthier villages as measured by the ongoing Evaluation Tools.  For example, in recent years women have identified as health needs as defined broadly by quality of life and health, in areas such as childhood vaccinations, truancy, domestic abuse of young girls by relatives. 

Secondary beneficiaries are ongoing inservice for health workers serving villages, opportunities for women in villages to be exposed to potential entrepreneurial endeavors through expressing greater voice in their communities and more public awareness.   

Initially through Grants, such as this.  When presenting my project and model at the Global Network of Public Health Nursing International Conference 2019 in Nairobi, Kenya, there was and is great interest from Ministers of Health and Education, and nurse educators and leaders in Kenya, neighboring Uganda, Zambia, and Botswana.  This combines potential for "service contracts to governments".  As well, with Evaluation Data, to infiltrate into nursing education globally the necessity and value of grassroots Train the Trainer programs for community health workers for Gender Equity and Good Health and Well-Being - Women inspired good health and well-being.  As the former Minister of Health in Rwanda identified when I first met with them, the majority of health needs are in the community and that is a need here.  

We are looking for funding to continue our program, specifically to further gather assessment data from women in villages, validated by schools/parents/teachers, community health workers, and local authorities, and then develop Train the Trainer programs for community health workers and local nurses to learn how to supervise.  

As project director, I will be associating with three to four U.S. nurse educators with vast and in-depth experience in global health and work in villages and remote rural areas in Africa. Through onsite and online, we will serve as consultants and expert resources in local development of Evaluation Tools and Data Collection Tools. Funding would also help provide resources, such as transportation, administration, and office work with the local NGO.