Melene Kabadege, World ReliefMelanie Morrow, MCHIP/ ICF International
Care Group TAG; May 29, 2014
From Care Groups to CHW Peer Support Groups:
Scaling up in Rwanda
World Relief’s Umucyo CSP (2001-2006)
• Location: Nyamasheke District,
Western Province, Rwanda (Former Kibogora Health District)
• Total Population: 152,981 people in 29,166 HH
• Care Groups:
>2800 Volunteers in
202 Care Groups;
HH visits 2x/mo
10 HH per Volunteer
Trained by project staff
Umucyo Major Activities
• C-IMCI for 6 Interventions: – Malaria, HIV/AIDS, Nutrition and
BF, Diarrhea, Immunization, and MNC;
• Piloted and scaled up Home Based Management of Fever (e.g. CCM for suspected malaria)
• Also formed “Pastors Care Groups” from 11 church denominations
Umucyo Results – Malaria Pregnant Women Who Slept Under an ITN Last Night
0%
20%
40%
60%
80%
100%
Baseline KPC Midterm KPC Final KPC Rwanda DHS
2001 2004 2006 2005
Umucyo Project Impact: Estimated Annual Mortality Reduction using LiST
Using the Lives Saved Tool (LiST) to estimate mortality impact of the project, the annual U5 mortality rate decreased by 7 per year in the project area.
In contrast, sub-analysis of the DHS found that U5 mortality in the same region was getting worse – U5 Mortality increased by 3.4 per year.
Source: Community-based intervention packages facilitated by NGOs demonstrate plausible evidence for child mortality impact. (Health Policy and Planning, 2013: 1-13. Jim Ricca, Nazo Kureshy, Karen LeBan, Debra Prosnitz, and Leo Ryan)
Kabeho Mwana Expanded Impact CSP Concern Worldwide, IRC, World Relief (2006-2011)
Location: 6 districts in Southern and Eastern Rwanda
Total Population: 1.67 Million
Project Focus: • Support to MOH Scale up of iCCM
(Diarrhea, malaria, pneumonia)• Promotion of Key Family Practices
– using Care Groups (we thought) MOH Mandate: Work only with Government CHWs
CHWs in Rwanda4 CHWs per Village at time of project
2 CHWs (Male-female ‘binome’) for iCCM1 CHW for Maternal Health (female)1 CHW for Social Affairs (male or female)
Workload: Each CHW is responsible for the entire village (60-80 HH), focused on their technical areas of specialty. Emphasis on treatment over household behaviors. Supervision: The Community Health In-Charge at the Health Center is responsible for supervision of CHWs.
Care Groups CHW Peer Support Groups
• CHWs from 2-5 neighboring villages organized into “Peer Support Groups” at cell level with up to 20 members, about half of whom were male.
• CHWs of all types were “cross-trained” in BCC, while maintaining their specialized functions
• CHWs from the same village divided up households (15-20 per CHW) to better support monthly home visits for BCC.
• 3 Project Promoters per district built capacity of CHW Cell Coordinators (elected by their peers) to help with training and supervision of groups.
Violates Care Group Criteria Peer Support Groups
CHW Peer Support Groups
CHW Group
CHW Group
CHW Group
CHW Group
Cell Coordinator
Health Facility-based In-Charge of Community Health
Slide courtesy of Jennifer Weiss, Concern Worldwide
Outputs and Impact using Peer Support Groups
• Trained 13,166 CHWS (all cadres) in 660 groups to do BCC for C-IMCI during monthly home visits and community mobilization.
• Trained over 6,100 CHWs and 88 health centers to implement iCCM
Re-analysis of the Rwanda DHS (2005-2010) found that U5 mortality rates decreased more in project districts than non project districts. (Data currently undergoing peer review for publication. )
Benefits of Umucyo Care Groups
• Afforded closer supervision • Better ratio of households per volunteer or
CHW (10 vs. 20) • More frequent home visits (2/month vs.
1/month). • Impact on household behavior was greater
but in a smaller population
Benefits of CHW Peer Support Groups in Rwanda Context
• Directly supported and improved MOH CHW system; scalable (but not nationally adopted)
• Impact was at greater scale – – 18% of country; 1.6 Million population – caveat: budget and interventions were different than Umucyo
• Helped CHWs integrate and coordinate their activities, including CCM
• Like Care Groups, contributed to CHW motivation, improved supervision, and increased social capital.
• Gender balance strengthened male involvement
Thank You
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