Presented by Melene Kabadege
MCH Regional Technical Advisor, World Relief
December 9, 2010
Rwanda Health System Structure
Evolution of CHWs in Rwanda
2010
2008
1995
Beginning of CHW program
•The program was initiated in 1995with the objective to be the firstlevel of entry to the health systemat to the smallest administrative unitof the country (villages) with aminimum package of activitiesfocusing on primary health care
Evolution
•The selection and training of CHWscountrywide was linked with adiversification of strategies to reducechild and maternal mortality andcommunity case management
Present CHW Composition at village level
4CHWs/village
2 CHWs forCCM
(binome: male-female pair)
1 CHW forMaternalHealth
1 CHW forHealth andSocial Affairs
Plan to add two additional CHWs
A fourth package of activities will beadded soon and will focus onrehabilitative services (palliativecare)
A set of 2 CHWs might be added pervillage turning to 6 the number ofCHWs per village and bringing thenational number from 60,000 toabout 88,000
2010
2014
60,000
2010
88,000
2014
CHWs per village
Total CHWs
Future activities
CHW election process
Community is informed by MOH about the CCMprogram and the characteristics needed for CHWs.
The community elects one man and one woman forCCM and one woman for Maternal health.
CHW in charge of Health and social affairs iselected during local leader elections.
CCM Binome Community Health Worker Functions
Preventive Services
•Community sensitization onprevention of common:Malaria, Diarrhoea, etc.
•Community mobilizationtowards healthy lifestylesespecially during nationalhealth campaign:immunization, hygiene andsanitation
•Educate communities onuse of water treatmentsolutions and distribute them
Curative Services
•Community CaseManagement of malaria,pneumonia, diarrhoea,others (e.g. CommunityIntegrated Management ofChildhoodIllnesses/Community IMCI)
•Provision of family planningservices including FPproducts
•Engage in community DOTsfor tuberculosis
Promotive Services
•Nutrition education tocommunities
•Growth monitoringparticularly among childrenunder five years old
•Nutrition surveillance
CHW CCM training
CCM Training is done by MOH/HC trainers after TOT
Training lasts 4 days
MOH relies on NGO partners to support implementation
CHW CCM Supervision and Follow-up
Monthly meetings at the health center for datacollection and medicine resupply. Somesupervisors do mini trainings at this time.
Each CHW should be visited by a Supervisorfrom the health center quarterly and by a PeerCHW Coordinator monthly.
CHW in charge of Community basedMaternal & Newborn Care
Identify in the community and register women ofreproductive age, pregnant women
Encourage ANC, birth preparedness , facility baseddeliveries, and FP
Accompany women in labor to health facilities
Encourage early postnatal facility checks for both newbornsand the mothers.
Identify women and newborns with danger signs and referthem to health facility for care
Community Health InformationManagement System
A list of community health indicators has been establishedto feed into the national HMIS.
Phones for CHWs have been distributed in some districts
Some community health workers have been tested on useof mobile phones to capture and send health informationby Rapid SMS.
CHW Incentives
CHWs belong to acooperative at the level ofthe health center.
Funds from CommunityPerformance BasedFinancing are used by thecooperative to fund incomegenerating activities by themembers.
CHW make basket for sale
Policy environment
National Community Health Policy has
improved coordination of CHWs’ activities
Community Health policy supports CCMfor malaria, pneumonia and diarrhea.
Community mobilization for behaviorchange is less developed.
RWANDA EXPANDED IMPACT
CHILD SURVIVAL PROGRAM
A Partnership of Concern Worldwide, InternationalRescue Committee and World Relief
6 Program Districts
Nyamagabe
Ngoma
Map of Rwanda
Major EIP Strategies
CCM: build capacity of MOH for training and supervisionof CHWs doing integrated CCM of malaria, pneumonia,diarrhea and malnutrition.
EIP Strategies (cont.)
BCC: community mobilization for behaviorchange using modified Care Groups comprisedof CHWs and Community Health Volunteers.
M&E: support CHWs and HCs to collect andanalyze community health data.
District
Population
CHWs
Gisagara
300,736
1,048
Kirehe
307,391
1,250
Ngoma
284,343
946
Nyamagabe
334,002
1,072
Nyamasheke
357,034
1,206
Nyaruguru
280,065
664
TOTAL
1,863,571
6,186
CHWs trained on CCM by EIP
6,1186 CHWs Trained & Equipped by EIP
8 CHWs + 2-3 Volunteers forevery 2 villages form oneCare Group
serving
100-250 Total Households(fewer HH have children U5)
Volunteers complement 13,000CHWs for BCC in650 Modified Care Groups
Challenges
Integration of Community Healthdata in National HIS
Budget for replacement of CHWtools and materials
Drug management
Challenges
Ongoing Supervision of CHWs byHealth center, transport & allowances
Sustainability of CCM Quality of Carepost project
Inclusion of modified Care Groupsinto official CHW strategy
Integration of Health Volunteers intoCHW cooperatives
Lessons Learned
Well-trained CHWs are capable ofimplementing integrated CCM.
Peer Supervision for CHWs can help tocompensate for HC staff limitations withsupervision.
Policy combined with strong political willfor CHWs contributes to program success.
Lessons Learned (cont.)
Increasing the number of CHWs & BCCvolunteers per village helps to balance theworkload.
CHWs working as a team at the village levelimproves motivation and impact.
Presently this only happens where EIP hasincorporated the CHWs into modified CareGroups with complementary volunteers for BCC.
Murakoze cyane!THANK YOU!
