Community health workers: Facilitating the growth of Rwanda’s health sector

Community health workers (CHWs) have played an important role when it comes to primary health care delivery. Community health workers are members of a community chosen by members or organisations to provide basic medical care, and are capable of providing preventive and rehabilitation care. It is because of their efforts that 83 per cent of health conditions in Rwanda are treated at the primary healthcare level. Last month, Dr Diane Gashumba, the Minister of Health, commended the excellent work showcased by community health workers amongst their respective communities across the country. “Our community health workers are not only so good in saving lives but also in welcoming partners to witness what a good collaboration can do in transforming lives,” the Minister said in a statement. During the Connect Challenge (a campaign that focused on driving Rwanda’s smartphone penetration by donating phones to vulnerable households), the Ministry of Health pledged 1000 Mara phones for CHWs in a bid to equip and empower them. HOW IT STARTED Data from the Ministry of Health shows that this initiative started with 12,000 CHWs as a pilot programme in 1995. However, after positive results, it was scaled up to 58,445 CHWs today, of whom 65% are women. Gashumba said that this was a measure to bring back the trust lost by citizens to the health system because during the 1994 Genocide against the Tutsi, people were killed by those who were supposed to save them (nurses and doctors). “The country was devastated by the Genocide; there was no preventive system and people died from preventable and treatable illnesses, such as diarrhoea. As such, the Rwandan Government then decided on an unconventional programme, a system that would align with the vision of the new leadership and it had to centre services on the people of Rwanda,” she said. “We needed people who had the community’s trust and live close to them. However, geographic accessibility was an issue to address,” Gashumba said. SAVING LIVES In the previous Umushyikirano, Florence Mukantaganda, a community health worker in Jabana sector, highlighted their roles as primary health care providers. “We do screening/ testing and treat moderate cases of illnesses such as malaria, pneumonia, diarrhoea. We provide family planning services, deal with malnutrition cases and we refer patients to health centres [if need be],” Mukantaganda said. She also highlighted that they mind about quality and timely service delivery, that is; they do not wait for patients to find them but instead reach out to them. In terms of maternal-child health care, they make a follow up on the life of the mother and new-born to tackle preventable deaths. Community health workers are, hence, behind the elimination of malaria and reduction of child mortality. They are also charged with the responsibility to register information with RapidSMS, a system mainly intended to track children under-5 to prevent unnecessary deaths. The commitment of community health workers (CHW) has also contributed a great deal to achieving noteworthy immunisation coverage in Rwanda, the Ministry of Health declares. IMPACT MADE According to the Rwanda Demographic and Health Survey 2014-15 report released in 2016 by National Institute of Statistics of Rwanda, under-5 mortality declined during from 152 deaths per 1,000 live births in 2005 to 103 per 1,000 live births in 2007-08, 76 per 1,000 live births in 2010, and 50 per 1,000 live births in 2014-15. The survey says that the decrease in infant and under-5 mortality are likely due to the implementation of integrated management of childhood illnesses in all health facilities and community health services, and the introduction of new vaccines, among others. Djuma Murisho, the head of Gisenyi Health Centre, commends the role of community health workers in the fight against malaria. “Thanks to their regular home-based malaria management, today we don’t have any severe cases of malaria; cerebral malaria was eradicated in Rwanda because people get treatment at the community level. The awareness campaigns they carry out on a daily basis enable people to get timely treatment and access vaccines,” Murisho says. The CHWs on the other hand say their role has impacted their lives too. They have managed to form cooperatives from which they raise money, and this helps them earn a living. 43-year old Mathias Nkeranya, a resident of Kareba Village, Nyarubuye Cell in Musanze District, wanted to become a doctor but because he lacked means, he wasn’t able to achieve his dream. He is nonetheless happy to be impacting people’s lives as a community health worker. “I wanted to be a medic, but I did not manage to go through with education. Despite that, however, what makes me very happy now is that since I became a CHW, I gained many benefits both for myself and for others, as I help them prevent diseases. But, what makes me proud above all is how society calls me a medic,” he says. Christine Uruvugundi, a CHW in Karwasa Health Centre in Musanze District, says she is proud of her job and honoured to be saving lives. “My duties are to follow up on pregnant mothers from the time of pregnancy until delivery. I also make follow-ups on malaria cases and other community cases for management. I am always proud when I see a healthy baby, just because I have taken care of the mother,” she says.

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Community health workers: Facilitating the growth of Rwanda’s health sector