From Care Groups to CHW Peer Support Groups: Scaling up in Rwanda
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From Care Groups to CHW Peer Support Groups: Scaling up in Rwanda

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  • World Relief introduced Care Groups to Rwanda in the Umucyo CSP, using the “traditional” model with great success.
  • This was characteristic of the project’s results – increasing from very low to high coverage. <br /> <br /> Final KPC Survey took place before the first national campaign for ITN distribution.
  • The annual mortality rate for the region (Cyangugu & West Province) increased according to sub-analysis of the DHS from 2000 to 2005, while decreasing in the project area from 2001 to 2006, the latter based on project intervention data modeled in LiST. <br /> <br /> <br /> According to the study authors: Baseline (2000 DHS) Regional U5MR in Cyangugu was 158.0; Endline (2005 DHS) Regional U5MR for West Province was 178. (The former Cyangugu Prefecture, where the project was located, became part of West Province in 2002, due to national changes in administrative structure.)
  • The project applied as many principles from Care Groups as possible, but was forced to violate many of the criteria, to fit with the MOH system. What started out as Care Groups became so heavily modified that we now refer to the approach in Rwanda as CHW Peer Support Groups.
  • In order to better facilitate CHW supervision, Kabeho Mwana created and mobilized CHW Peer Support Groups in 2007. Peer Support Groups consisted of 15-20 CHWs (binomes, ASM and Social Affairs) from two to three neighboring villages who met at least once a month for training on health topics, joint planning of health promotion activities, and to compile monthly reports related to their preventive and curative functions. A total of 660 Peer Support Groups were formed. <br /> <br /> NOTE: Each village had 4 CHWs (2 binome, 1 ASM, 1 for Social Affairs). There were 2-3 villages per Care Group; 1-2 Care Group per cell, depending on the number of villages per cell. <br /> <br /> Peer Support Group meetings were facilitated by CHW Cell Coordinators, under the supervision of the Health Facility In-Charge of Community Health. During the Peer Support Group meetings, the Cell Coordinator would facilitate a discussion on experiences or challenges in providing CCM in the previous month, and discuss any supervision issues raised by the In-Charge of Community Health. The Cell Coordinator would then review and compile CHW reports. To conclude, CHWs would plan and coordinate upcoming health promotion or community mobilization activities. <br />

From Care Groups to CHW Peer Support Groups: Scaling up in Rwanda From Care Groups to CHW Peer Support Groups: Scaling up in Rwanda Presentation Transcript

  • Melene Kabadege, World Relief Melanie Morrow, MCHIP/ ICF International Care Group TAG; May 29, 2014 From Care Groups to CHW Peer Support Groups: Scaling up in Rwanda
  • 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
  • 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
  • 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
  • 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)
  • 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
  • CHWs in Rwanda 4 CHWs per Village at time of project 2 CHWs (Male-female ‘binome’) for iCCM 1 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.
  • 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
  • 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
  • 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. )
  • 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
  • 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
  • Thank You