Presented by Melene KabadegeMCH Regional Technical Advisor, World

Relief

December 9, 2010

MOH

30 DISTRICTS : Unite Sante ,

District Hospitals

416 Sectors : Health Centres

2148 Cells : CHWscoordinators

14,837 Villages : 2 CHW binomes ,1 ASM /50 to 250 Households, 1 ASOC.

Evolution of CHWs in Rwanda60,000

45,000

12,000

201020081995

Beginning of CHW program

• The program was initiated in 1995 with the objective to be the first level of entry to the health system at to the smallest administrative unit of the country (villages) with a minimum package of activities focusing on primary health care

Evolution

• The selection and training of CHWs countrywide was linked with a diversification of strategies to reduce child and maternal mortality and community case management

Plan to add two additional CHWs

A fourth package of activities will be added soon and will focus on rehabilitative services (palliative care)

A set of 2 CHWs might be added per village turning to 6 the number of CHWs per village and bringing the national number from 60,000 to about 88,000

6

4

2010 2014

60,000

2010

88,000

2014

CHWs per village

Total CHWs

Future activities

CHW election processCommunity is informed by MOH about the CCM

program and the characteristics needed for CHWs.

The community elects one man and one woman for CCM and one woman for Maternal health.

CHW in charge of Health and social affairs is elected during local leader elections.

Preventive Services

• Community sensitization on prevention of common: Malaria, Diarrhoea, etc.

• Community mobilization towards healthy lifestyles especially during national health campaign: immunization, hygiene and sanitation

• Educate communities on use of water treatment solutions and distribute them

Curative Services

• Community Case Management of malaria, pneumonia, diarrhoea, others (e.g. Community Integrated Management of Childhood Illnesses/Community IMCI)

• Provision of family planning services including FP products

• Engage in community DOTs for tuberculosis

Promotive Services

• Nutrition education to communities

• Growth monitoring particularly among children under five years old

• Nutrition surveillance

CHW CCM trainingCCM Training is done by MOH/HC trainers after

TOTTraining lasts 4 daysMOH relies on NGO partners to support

implementation

CHW CCM Supervision and Follow-upMonthly meetings at the health center

for data collection and medicine resupply. Some supervisors do mini trainings at this time.

Each CHW should be visited by a Supervisor from the health center quarterly and by a Peer CHW Coordinator monthly.

CHW in charge of Community based Maternal & Newborn Care

Identify in the community and register women of reproductive age, pregnant women

Encourage ANC, birth preparedness , facility based deliveries, and FP

Accompany women in labor to health facilitiesEncourage early postnatal facility checks for both

newborns and the mothers.Identify women and newborns with danger signs

and refer them to health facility for care

Community Health Information Management System

A list of community health indicators has been established to feed into the national HMIS.

Phones for CHWs have been distributed in some districts

Some community health workers have been tested on use of mobile phones to capture and send health information by Rapid SMS.

CHW IncentivesCHWs belong to a

cooperative at the level of the health center.

Funds from Community Performance Based Financing are used by the cooperative to fund income generating activities by the members. CHW make basket for sale

Policy environmentNational Community Health Policy has

improved coordination of CHWs’ activities

Community Health policy supports CCM for malaria, pneumonia and diarrhea.

Community mobilization for behavior change is less developed.

RWANDA EXPANDED IMPACTCHILD SURVIVAL PROGRAM

A Partnership of Concern Worldwide, International Rescue Committee and World Relief

6 Program Districts

6

5

6

7

HC Zones

11,566681,734,925780,092TOTALS

172111258,088NyaruguruNew areaPHASE II

209612314,423GikongoroNew areaPHASE II

12

11

10

11

HC Zones

2392

1708

1689

1961

Number of CHWs

Nyamasheke

Kibungo

Kirehe

Gisagara

New District

358,775

256,267

253,290

294,082

Est 2006 population

174,000KibagoraPHASE I

278,742KibungoPHASE I

153,879KirehePHASE I

173,471KibiliziPHASE I

Est 2006 Population

Original CS Health DistrictPHASE

6

5

6

7

HC Zones

11,566681,734,925780,092TOTALS

172111258,088NyaruguruNew areaPHASE II

209612314,423GikongoroNew areaPHASE II

12

11

10

11

HC Zones

2392

1708

1689

1961

Number of CHWs

Nyamasheke

Kibungo

Kirehe

Gisagara

New District

358,775

256,267

253,290

294,082

Est 2006 population

174,000KibagoraPHASE I

278,742KibungoPHASE I

153,879KirehePHASE I

173,471KibiliziPHASE I

Est 2006 Population

Original CS Health DistrictPHASE

Kirehe

Kibungo

Nyamasheke

Gikongoro

Nyaruguru Gisagara

Kigali

Annex A

: Program

Map

Map of Rwanda with January 1, 2006 new districts. Data is based on preliminary figures available at time of application development and are subject to change.

Nyamagabe

Ngoma

Map of Rwanda

Major EIP StrategiesCCM: build capacity of MOH for training and supervision of CHWs doing integrated CCM of malaria, pneumonia, diarrhea and malnutrition.

EIP Strategies (cont.)BCC: community mobilization for behavior change using modified Care Groups comprised of CHWs and Community Health Volunteers.

M&E: support CHWs and HCs to collect and analyze 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

6,1186 CHWs Trained & Equipped by EIP

8 CHWs + 2-3 Volunteers for every 2 villages form one Care Group

serving

100-250 Total Households (fewer HH have children U5)

ChallengesIntegration of Community Health data in National HIS

Budget for replacement of CHW tools and materials

Drug management

ChallengesOngoing Supervision of CHWs by Health center, transport & allowances

Sustainability of CCM Quality of Care post project

Inclusion of modified Care Groups into official CHW strategy

Integration of Health Volunteers into CHW cooperatives

Lessons LearnedWell-trained CHWs are capable of implementing integrated CCM.

Peer Supervision for CHWs can help to compensate for HC staff limitations with supervision.

Policy combined with strong political will for CHWs contributes to program success.

Lessons Learned (cont.)Increasing the number of CHWs & BCC

volunteers per village helps to balance the workload.

CHWs working as a team at the village level improves motivation and impact. Presently this only happens where EIP has

incorporated the CHWs into modified Care Groups with complementary volunteers for BCC.

Murakoze cyane!THANK YOU!