Rwanda Expanded Impact Child Survival Program_Weiss_5.1.12


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  • what intervention(s) they took to scale, lessons learned in terms of modifying the intervention and leveraging partnerships for scale, and notable successes and challenges.”   Credit to Eric
  • Other CHW incentives = cell phones, trip to stadium with president, respect in community. Community Child Health Working Group helped to advocate for key policies, such as integration of CMAM into national c-IMCI protocol
  • Eric “The project influenced the national policy … there was a synergy between what the project was trying to achieve and a government that’s been trying to see some results.” Reference MCHIP study on role of EIP in CCM scale-up
  • CHW Utilization: In the six districts of EIP implementation, CHWs have become the first option of caretakers when a child has a fever, respiratory symptoms or diarrhea. They are also the first second opinion option, after a first consult with either a CHW or in a health center.
  • Rwanda Expanded Impact Child Survival Program_Weiss_5.1.12

    1. 1. The Rwanda Expanded Impact Child Survival Program 2006 – 2011 A partnership between Concern Worldwide,the International Rescue Committee, and World Relief 2012 CORE Spring Meeting Wilmington, DE Jennifer Weiss, MPH; Concern Worldwide
    2. 2. Overview of Presentation • Background and Context • Summary of Main Project Activities • Lessons Learned in the Scale- up of CCM • Conclusions
    3. 3. Background: Project Overview•Implemented from 2006 – 2011 in sixdistricts of Rwanda•Target population: 318,000 children underfive (~18% of country)•Objectives: – Increase access to first line treatment for malaria, pneumonia, and diarrhea [through scale-up of CCM] – Increase coverage of prevention interventions – Increase adoption of key family health practices
    4. 4. Context for Scale-UpNational Strategic Health Objectives in 2006:• Creation of Community Health Desk• Finalization of National c-IMCI Strategy• National election of CHWs (2 per community)Leadership from the Highest Levels:• Performance-based Financing• CHW Cooperatives• Other CHW incentivesCommitment to Learning:• Community Child Health Technical Working Group• CHW Performance Evaluation (2010)
    5. 5. Pathway to Scale 2004 2006 2007 2008 2009 2010 2011 Rwanda Ministry of HealthHBM Expansion • HBM • Kirehe iCCM • Rapid • Expansion • MOHStrategic of HBM to evaluation pilot study evaluation of of iCCM to WorkshopPlan 12 of 19 • Creation of • National ToT CHW all 30 to revise endemic Community for iCCM performance districts CHW districts Health Desk of CCM supervision • National • Introduction structure iCCM of RDTs at Strategy community level Kabeho Mwana Expanded Impact Child Survival Project (6 districts) • Kabeho • CHW training • District level • CHW training • CHW • Kabeho Mwana on CCM for ToT on iCCM in iCCM refresher Mwana ends begins malaria and • First case of • Training of training on diarrhea pneumonia health center iCCM • First case of treated by data managers • RDT training malaria treated CHW and for CHWs with ACT by supervisors CHW
    6. 6. Role of Partnership in Scale-UpMoH Partnerships EIP Partnership Model •Whole greater than the sum of it’s• Strong collaboration with MoH parts Community Health Desk, Nutrition •Working in consortium provided Desk, and PNILP (malaria program) opportunities to not only reach high at highest levels numbers of beneficiaries, but also• Greater coordination and facilitate program synergies and cross- collaboration as MOH only has to learning liaise with one partner instead of •Expanded Impact Program model three combined with consortium approach• Stronger voice for advocacy, maximizes potential for scale and evidence-building through program impact representation at TWGs
    7. 7. Results: Expanding CCM+ --• EIP adjusted plans and strategies • Working within MoH timelines to align with and support national resulted in initial project delays strategy • RDT effect on CHW utilization(?)• Strong partnership with districts and • Supervision is sub-optimal health centers due to substantial • LOE of CHWs field presence• High CHW utilization: CHWs became first option of caretakers with sick child • Ever use = 69%; within last 2 weeks = 40%)• High levels of CHW retention
    8. 8. Conclusions• The EIP made major contribution to national health improvements over the last five years • Helped to launch and scale-up CCM: 183,000 treatments in the last year alone • Alignment and harmonization with GOR priorities• The coalition “worked”, internally and for the GOR• Community-based scale-up: Role at central level came from partnering presence in the field (district and below down to community)• Established critical building blocks for quality monitoring and performance improvement
    9. 9. Murakuze Cyane!!