Community Health Workers: Advancing health progress at grass root level

Access to timely health services remains a challenge to many countries especially in the developing world and in Rwanda’s case the reality of having very hilly terrain and a road network system which is still developing may pause a problem but the government decided to develop a unique system of utilizing Community Health Workers (CHWs) to advance health care. CHWs are respectable people in society that are elected in all villages across Rwanda to deliver basic health care. They are responsible for sensitizing the population on priority health issues in a bid to advance health progress and assist in attainment of Millennium Development Goals. Today, there are 60,000 community health workers across the country with about four in every village (umudugudu). Two are in charge of general health and community integrated management for childhood illness, one in charge of mothers and babies below nine months while the other is responsible for hygiene and sanitation in communities. The system was introduced in 2009 with an aim of having about 80 percent of health issues solved in communities. Today the CHWs have played a key role in saving the lives of mothers (pregnant and lactating), improving the state of health of children in Rwanda through educating the public on how to give children the right diet to eliminate malnutrition and the workers also offer advice on hygiene related issues. Rwanda has about 420 health centres, 42 district hospitals and four referral hospitals but the need for more health facilities still remains. The Community Health Workers therefore act as the strong link that facilitates quick access to medical care. The Ministry of Health through its capacity building efforts ensures that the CHWs acquire training before they can deliver health services. Today, most malaria cases are diagnosed and treated scientifically by CHWs at home through the continuous supervision efforts done by the health professionals who also do this work at sector level voluntarily. With an aim of further facilitating their work, the government introduced a phones-for-health system where each community worker was given a mobile phone that enables them to call officials at health facilities for guidance, call for ambulances in case of emergencies in the community and send monthly reports regarding health progress at the community level and other MDG indicators. The Minister of Health, Dr. Agnes Binagwaho concurs that CHWs play a significant role in saving lives. “The Government of Rwanda through the Health Ministry introduced the Community Health Workers’ approach to reduce morbidity of health related illnesses at community level by prevention so that we curb mortality among Rwandans especially for mothers and children under five,” she explained. “Rwanda has succeeded in increasing life expectancy and these are results of CHWs. Our children are now quickly tested and treated for malaria, most mothers now go for antenatal care deliver at health facilities as a result of being educated on the benefits. The population is always sensitized about HIV and services like PMTCT. It is indeed the goal of the government to do whatever it takes to deliver healthcare at grassroot level and we are glad that this approach is working,” Dr. Binagwaho explained. Catherine Mugeni, the Coordinator of the Community Health desk in the Ministry of Health also notes that without community health workers, it would have been so hard to reach some priority health goals such as having women deliver at health facilities. “Reduction of maternal and child mortality means that there should be a sure way of having the mother deliver her baby at health facilities. What CHWs do is make sure that if a woman is in an inaccessible area, they carry her to the road side where an ambulance can quickly rush her to the nearest health centre or hospital,” Mugeni said. Mugeni adds that to motivate these CHWs, the ministry of health through its performance based financing system avails for the services rendered by sending funds to the workers’ cooperatives to enable them develop economically and live with integrity in their communities. This process has led to economic growth at community level by providing health care services. The progress is clear but this is only part of a wider process to ensure quick and quality health care for all Rwandans. It is indeed impressive that this system is working and as a result many countries seek to pick lessons from Rwanda. Binagwaho adds that efforts to improve healthcare are ongoing, malaria must be eliminated, the goal of ensuring that women attend the four antenatal care sessions and deliver at health facilities can be reached and malnutrition must be a case of history. The author is the Communications Officer in RBC/ Rwanda Health Communication Centrevirenam@gmail.com