Community Health Workers Program
The Rwanda CHW Program was established in 1995, aiming at increasing uptake of essential maternal and child clinical services.
Historical Background
The Rwandan Community Health Workers program was initiated in 1995 through the assist of the Ministry of Health. After the atrocious 1994 Genocide against the Tutsi, the country was left ravaged by diseases and pregnancies out of genocidal rape. The purpose of CHW program was to provide maternal and child services to the underprivileged communities.
Progress Thus Far
Launched
1995
44999
CHWs Operating
at the Village Level (2010)
Village of 100–150 households, have one maternal health CHW
0
%
Decline of the percentage of
children who were underweight
0
%
2005
0
%
2010
In the past 23 years, the program’s mission has succeeded exponentially with the decreasing maternal mortality and childhood illness like pneumonia, malaria, and diarrhea. CHWs started as volunteers with about 12,000 and expanded to 45,000 by 2005 with their services being available in all the villages in Rwanda.
Meet some of the Community Health Workers
Arlene
Umurerwa
27
Age
Kicukiro
Sector
Kicukiro
District
Anastase
Twizeyumuremyi
37
Age
Masaka
Sector
Kicukiro
District
Bernadine
Kabisama
43
Age
Gatenga
Sector
Kicukiro
District
Challenges
Community Health Worker cooperatives operate income-generation activities, but some cooperatives have not been able to make a profit. There is keen interest in expanding income generation and improving efficiencies, but cooperative members and administrative council still lack business and management skills to fully support their cooperatives.
The loss of CHWs with skills and experience is undesirable while bringing in new ones because it requires to train newly, and requires resources.It was also noted that supervision of CHWs activities is not always conducted as provided for in the national guidelines. In some cases, supervision was reported to be more evaluative than formative. 16% of CHWs received no supervision during the 12 months preceding the survey. Forty percent (40%) of CHWs received 4 or more supervision visits during the 12 months preceding the survey.
Despite the fact that the Ministry of Health (MoH) provides CHWs equipment, some CHWs reported a lack of those and a few even reported stock out of medicines which compromises CHWs.
Theodète Nduwayo
Beneficiary
31
Age
Gatenga
Sector
Kicukiro
District
Kabisama Bernadine who has been in the program for 10 years, lives in the Gatenga sector and Jyambere village. She explains that if a person wishes to become a community health worker they should have a good behavior and be an upstanding figure in their community. She adds that they must also be comfortable to work with people and be available anytime they are needed for their job. “ In our job, we are three community health workers. Among the three, two have the same duties, they are called partners, and they are in charge of following up on the health of children aged 2 to 59 months. The third community health worker is in charge of mothers and infants, as well as women aged between 15 and 49 years old who can get pregnant .
At 15, a woman can get pregnant and give birth, after she has gotten pregnant the community health worker has to follow up on her health. In Kinyarwanda, she is called “umuherekeza w’ababyeyi” and Animatrice de Santé Maternelle(ASM) in French. So, the maternal health worker follows up on the mother’s health, and puts her records in the report. This report is sent to the ministry, health centers, and the hospital of our district. After having given birth, the maternal health worker keeps following up on the baby’s health and the mother, this is in line with the prevention of the mortality of infants or mothers when giving birth.
I started working in the Community Health Worker Program in 2008, in the month of September. It had been one year that I had finished my studies at the Kigali Health Institute, in the department of Public Health.
I am in charge of coordinating activities of community health workers, first, we give them trainings, we help them get some skills. None of their activities are carried out without our contribution; we train them, then do follow up on their activities and check if they perform them well, and help them solve any problem they may have.
Community health workers have helped us a lot. They are contributing to the country’s quick development, by fighting diseases. There are always a long queue at hospitals, so community health workers provide some health care at home; they treat kids with malaria, pneumonia, and diarrhea, and treat adults with malaria.
I started this job in 2013; it’s been five years now. I work in Bethsaida Health Center located in Kicukiro. As a person who did my studies in the Public Health field, my role towards people is through the community health workers training program. By giving community health workers trainings, we transmit the skills we were also given. When they feel confused, we give them some instructions about their job and stay close day to day.
Apart from working with community health workers, our other daily duty is to incite people to have cleanliness. When cleanliness is not given value, people can get sick, and it is said that 90% of diseases that people catch can be avoided through proper hygiene. There are some lessons we do, about the fact that when people don’t wash their hands with clean water and soap, they can catch diseases caused by poor hygiene. While they can prevent them by just washing their hands. We encourage people to do that practice in order to make the kids or the house maids understand that that’s an important thing in life, and that they have to do it to prevent those diseases.
Social Impact
Community Health Workers are very interested in contributing to social change, in terms of tackling issues about diseases. CHWs accept the increasing responsibility with honour and pride entrusted in them to implement government programs for the betterment of their community. They enjoy their interaction with the friendly community. They are motivated by the recognition of their work and the new skills acquired in the process.
Economic Impact
Community Health Workers are volunteers and do not receive payment for their work. To support their livelihood MoH and its partners set them up with associations in which they are encouraged to carry out income generating activities (IGA). The associations grew into cooperatives which serve as economic benefit for CHWs. CHWs reported being involved in various types of IGAs depending on what was available in their location.
Governance Impact
The community’s ability to relay and interact with CHW about feedback and requests is important to the Community Health Program. CHW engage with citizens and their local leaders through gatherings such as umuganda, ubudehe, umugoroba w’ababyeyi. The advantages of these meetings are that CHWs can talk to citizens about multiple messages such as mutuelles (health insurance).
About us
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Contact us
Please talk to us at
Hello@hgs.rgb.rw