Online Program

Supporting Rwanda's national community health program: Insights from a community partner organization

Monday, November 4, 2013

Didi Bertrand Farmer, MA, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Elias Ngizwenayo, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Peter Niyigena, BA, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Claire Mazin, MA, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Leslie Berman, MPH, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Grace Ryan, BA, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Tisha Mitsunaga, ScM, Department of International Health, Johns Hopkins University Bloomberg School of Public Health; Inshuti Mu Buzima/Partners In Health, Kigali, Rwanda
Daniel Palazuelos, MD, MPH, Partners in Health, Boston, MA
Michael L. Rich, MPH, MD, Partners In Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
Background: For the past 25 years, Partners In Health (PIH) has delivered care in resource-limited settings through health delivery platforms linking community-based care to health facilities. Since 2005, PIH and sister organization, Inshuti Mu Buzima (IMB), have worked in partnership with the Government of Rwanda to restructure and strengthen the national community health worker (CHW) system. We share our experience supporting the CHW program to meet its goals, adapting to challenges, and learning lessons from program delivery.

Methods: Each village in Rwanda elects a pair of CHWs who specialize in Integrated Management of Childhood Illness and lead education campaigns to encourage health-promoting behaviors. A second cadre of CHWs are responsible for maternal and neonatal health. Currently, 45,000 CHWs deliver preventive, curative and health promoting services throughout Rwanda. To strengthen the national system, PIH-IMB advocates for a CHW framework informed by six key elements: (1) geographical distribution of an adequate number of CHWs; (2) standardized training; (3) a management system for supportive supervision; (4) adequate compensation; (5) strong monitoring, evaluation and reporting; and (6) community involvement.

Results and Conclusions: Over the past decade, the national program has evolved substantially, incorporating innovations identified by the Ministry of Health, as well as those developed in collaboration with PIH-IMB and other partners. The program has adapted to challenges in order to increase CHW motivation, reduce turnover, and create a sustainable program. PIH-IMB has developed systems for working collaboratively within a strong national program, adapting elements of our framework while advocating for system strengthening innovations.

Learning Areas:

Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Program planning

Learning Objectives:
Describe the Partners In Health framework for community health Identify how Partners In Health supports the national community health worker system in Rwanda Discuss the process of supporting a national community health worker system to ensure sustainability, including challenges, adaptations, and lessons learned

Keyword(s): Community Health Programs, Community-Based Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a medical anthropologist who has been working for the last 15 years as a community organizer, activist for the rights of women and girls, and researcher in Paris, Haiti and Rwanda. Since 2006 I have served as Director of the Community Health Program for Partners In Health Rwanda-Inshuti Mu Buzima, where I am the Principle Investigator on several cross-site studies focusing on community health, reproductive health, and traditional healing.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.