from care groups to chw peer support groups: scaling up in rwanda
TRANSCRIPT
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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
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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
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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
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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
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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)
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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
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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.
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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
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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
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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. )
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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
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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
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Thank You