Post on 22-Feb-2016
description
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!