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.
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.
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.
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.
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.
From Care Groups to CHW Peer Support Groups: Scaling up in Rwanda
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
• Also formed “Pastors Care
Groups” from 11 church
Umucyo Results – Malaria
Pregnant Women Who Slept Under an ITN Last Night
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
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
• Support to MOH Scale up of
iCCM (Diarrhea, malaria, pneumonia)
• Promotion of Key Family
Practices – using Care Groups
Work only with Government
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
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
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
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.
• Impact on household behavior was greater
but in a smaller population
Benefits of CHW Peer Support Groups in
• 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
• 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