Lucy Akoli, a community health extension worker (CHEW), spends her days checking on the sick in her village, referring patients to health facilities, and following up with HIV drug defaulters. But until recently, mobility was her greatest challenge.
“I used to walk for hours; three to the Health Centre III, and one to the Centre II. That meant I could only visit one or two people in a day,” she recalls.
On foot, she could cover only five households per week.
That changed a year and a half ago when she received a heavy-duty bicycle designed for rural terrain.
Now, she says, “What used to take me two days, I now do in one morning. We call it the village ambulance.”
Her work has not only become more efficient but also more respected. The bicycle, which she lends to fellow village health team members when needed, has enabled her to run errands, pick up her children from school, and use money she previously spent on transport for better family meals.
“I can feed my family meat, now that I do not have to spend on transport to health facilities and patients’ homes,” she says with a smile.
Akoli is one of hundreds of health workers in Lira and Mayuge districts who received bicycles through a mobility programme supporting CHEWs in rural Uganda. The initiative, developed in collaboration with the Ministry of Health, is designed to bridge the gap between underserved communities and essential health services.
Data that speaks volumes
A recent assessment shared at the Pedal for Change Forum in Kampala highlights the bicycle’s transformative impact. Community health workers have more than doubled their weekly household reach, travel time to facilities has nearly halved, and transport costs have dropped significantly. Many now use bicycles to transport sick patients, particularly in emergencies where ambulances are not available.
For CHEWs such as Akoli, many of whom are women working in physically demanding environments, these bicycles are more than tools of transport. They represent empowerment. Workers now spend more time with each household, improving care quality for chronic conditions and maternal health.
Addressing the mobility blind spot
Specioza Namakula, a monitoring and evaluation expert in the programme, notes that transportation remains an overlooked aspect of healthcare planning.
“For community workers, having a reliable means of movement is the difference between reaching a handful of households or an entire community,” she explains.
As Uganda scales up its national CHEWs programme, the issue of mobility is gaining attention. Dr Diana Atwine, the Permanent Secretary of the Ministry of Health, emphasises that tools enabling healthcare workers to reach those in need are essential to improving national health outcomes. So far, about 3,000 of the 21,000 intended CHEWs have been trained, and bicycles have been distributed to 331 workers in Lira and Mayuge.
Dr Atwine notes that the programme is already showing results, with notable declines in both communicable and non-communicable diseases in areas served by mobile CHEWs.
“When you invest one dollar in a community health worker, you get 10 dollars in return,” she says, underscoring the value of low-cost interventions.
What happens without bicycles?
Yet, many CHEWs across the country still struggle with mobility.
Caroline Namukasa, a CHEW from Kyotera, says her work is hampered by distance and unreliable boda boda riders, which she occasionally hires with personal funds.
“Sometimes you make an appointment and the boda comes 30 minutes late. That delays everything,” she says. Bushy paths and long treks back home also pose security concerns.
To promote sustainability, the programme includes training local bicycle mechanics in every community that receives bikes. With one mechanic assigned for every 50 to 100 bicycles, health workers have access to timely, affordable maintenance. The bicycles are also assembled locally, further boosting employment and local economies.
The integration of bicycles into Uganda’s healthcare strategy is quietly proving its worth. While challenges remain, especially for health workers yet to receive bikes, the story unfolding in villages like Akoli’s suggests that something as simple as a bicycle can steer a country closer to universal health coverage-one pedal at a time.