Community nurses like Emilia Hayford are unsung heroes who bring care directly to women and families in the seaside villages of western Ghana.

They are often the only health providers a family in this coastal region will see. Award-winning photojournalist Kate Holt, on assignment with Jhpiego, a global health nonprofit, documents an average day in Emilia’s busy schedule.



Emilia Hayford, 27, begins the day in her room that adjoins the Akentenchie village clinic. As a Community Health Officer, Emilia is a salaried, trained nurse who is assigned to a specific community. She provides immunizations, conducts child welfare clinics and home visits and reports on the incidence of diseases throughout the community.



Emilia took part in a training through the STAR CHPS (Supportive Technical Assistance for Revitalizing Community-Based Health Planning and Services) project, which was designed to increase access to high-quality, basic health care for people in the coastal districts of western Ghana. Through the training—funded by the Jubilee Partners (Tullow Oil, Kosmos Energy, Anadarko Petroleum, Ghana National Petroleum Company and PetroSA)—Emilia learned to perform home visits, work with local health volunteers and encourage pregnant women to attend antenatal care classes and deliver at the local health facility.



“I have been in Akentenchie for four years,” Emilia says. “I do approximately 15 home visits a month.” She starts her day by identifying the families she needs to visit. “There are two types of home visits—the special and the routine,” she explains. “The special clients are pregnant women, the aged, children under five years, even twins. Routine visits are any other people in need…we look at people’s sanitation, how their children look, whether there are signs of malnutrition…” She also calls village leaders to prepare a place to host a child welfare clinic later in the day.



Fishing is a common occupation in Akentenchie, and Emilia will often observe fishing boats bustling with activity in the morning as she enters the village. Women and children in Akentenchie and many of the coastal villages throughout the region encounter common health problems like malaria, diarrhea and anemia, alongside complications of pregnancy and childbirth. “I like doing home visits because it helps us trace the people who are not coming to our workshops [or health facility],” Emilia says.



Emilia stops to talk with women washing and preparing fish in Akentenchie. Part of her job is to promote healthy behaviors throughout the community.



In her first home visit, Emilia talks with a woman who recently gave birth. She examines the new mom and baby to check their progress and offers information and advice on breastfeeding and immunizations to keep her baby healthy. “When women give birth here, they do not leave home for a week,” Emilia explains. “So it is important to go and see them, so we can see how they are doing. For example, the mother I saw today wasn’t breastfeeding correctly—I could tell her how to do it better.”



Next, Emilia meets Agnes Mensah, a mother of seven with another child on the way. She checks Agnes’ blood pressure to ensure the mother isn’t suffering from pregnancy-related hypertension, and discusses proper nutrition and the importance of attending prenatal care at the health facility. She also convinces Agnes to attend the child welfare clinic later that afternoon to ensure all of her children have been properly immunized against common diseases.



At the child welfare clinic, Emilia educates mothers about their children’s health and other topics, such as reproductive health. Mothers have the chance to ask questions and often bring their children to have their growth monitored.



After receiving new information from the child welfare clinic, Agnes Mensah feels empowered to discuss her reproductive health options with her husband.



“I love children, and I love having children around me, so I like working with them and helping their mothers look after them,” Emilia says. Weighing babies to monitor their growth is an important part of Emilia’s routine at the child welfare clinic, enabling her to spot malnutrition and other problems that might affect the child’s development.



Emilia records data on clients she has seen, which she later consolidates into monthly reports. These reports are critical for monitoring the impact of health services. After a hard day’s work, she returns to her room at the clinic to rest…before starting all over again the next day.