Chw scale presentation jenn weiss


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  • ADD: 19% of total country communicate scale
  • Emphasize that expansion of CCM was overwhelming emphasis of project and BCC activities were only rolled in all target areas in earnest in last 18 months of project
  • How many health facilities per district?multiple cells per health facilityCell contains 150-300 CHWs that meet on a quarterly basis for supervision and cooperative meetingsFocus of today’s presentation on health facility level and below
  • Most sectors just have one cell and therefore one cell coordinator, but some have two. Each cell has approximately 150-300 CHWs, representing 35-75 villages.Supervision: Each binome is to be supervised by either In-Charge of Community Health or Cell Coordinator on quarterly basis. Reporting: Cell coordinator compiles all reports from CHWs and submits to In-Charge of Community Health on quarterly basis.
  • Each ‘type’ of CHW is expected to general ‘mobilization’ at community level on their specialty area, but not expected to do BCC through home visits
  • Addition of ‘CHW Peer Group Supervision’ who coordinates reporting for CHW Group and liaises with cell coordinatorEach CHW is responsible for visiting ?? households
  • Jean Capps?
  • From final evaluation and monitoring data – emphasize that efforts were really on CCM, and yet we were able to make some significant gains in behavior change
  • CHW peer support model brought CHWs together on regular basis to plan and coordinate BCC and community mobilization activities at village level
  • Anecdotally that smaller group cooperatives may be scaled-up for IGAs that look like “peer support groups”
  • Chw scale presentation jenn weiss

    1. 1. Community Health Workers – Overcoming Scalability ChallengesThe Rwanda Expanded Impact Child Survival Project Experience<br />Presented by:<br />Jennifer Weiss, MPH<br />Health Advisor, Concern Worldwide<br />CORE Fall Meeting 2011<br />
    2. 2. Project Overview<br />Implemented from 2007 – 2011 in six districts in Rwanda<br />Target population: 300,000 children under five<br />Technical interventions: malaria, diarrhea, pneumonia<br />
    3. 3. Project Overview<br />Goal: Reduce child mortality in six districts in Rwanda<br />Objective 1: Increase access to first line treatment<br />Objective 2: Increase coverage of preventative interventions<br />Objective 3: Increase adoption of key family health practices<br />Illustrative Activities:<br /><ul><li>Support health communication campaigns and National Health days</li></ul>Illustrative Activities:<br /><ul><li>Community mobilization
    4. 4. Adapted Care Group model</li></ul>Illustrative Activities:<br /><ul><li>Expand CCM
    5. 5. Strengthen service delivery (QI)</li></ul>Integrated Nutrition - CMAM<br />
    6. 6. Rwanda MOH Community Health Structure<br />District Hospital: Community Health Supervisor<br />Health Facility: In-Charge of Community Health<br />CHW Cooperative and Cell-Coordinators<br />Village Level: 2 ‘binomes’ for c-IMI; 1 CHW for Maternal Health, and 1 Social Affairs Officer <br />
    7. 7. Existing Supervision and Reporting Structures <br />Sector<br />In-charge Community Health<br />Cell<br />Cell coordinator<br />1 hour to 1 day walk<br /> 40-80 Villages<br />
    8. 8. Opportunities for Improvement<br />MOH has clearly defined Community Health structure that includes CHWs <br />CHWs are officially recognized in the community, motivated, and provided incentives (Cooperatives)<br />But …<br />Not well geared towards effective behavior change<br />Challenging reporting and supervision structures <br />
    9. 9. Rwanda EIP Response (as it evolved) <br />World Relief CSP (2001-2006) used Care Group Model<br />WR began to incorporate Care Groups into EIP (2007) under Community Mobilization activities <br />15-20 member “Peer Support and Collaboration Groups” formed with 4 CHWs from each village (2009 – 2011) <br />Rwanda MOH requirements on limited number of CHWs per village<br />(2008)<br />CHW peer support groups no longer fit Care Group criteria but still maintains group solidarity, and responsibility for HH visits and behavior change<br />
    10. 10. EIP Community Health Structure <br />In-Charge Community Health <br />Cell Coordinator<br />CHW Group<br />CHW Group<br />CHW Group<br />CHW Group<br />
    11. 11. Outputs<br />660 peer support groups formed with 13,166 CHWs in 6 districts<br />Average of 163,000 households visited on a monthly basis with key prevention messages<br />
    12. 12. Results<br />CHW Peer Support Group activities associated with:<br />Four-fold increase in the number of households with kitchen gardens<br />Twenty-five fold increase in the number of households with hand washing stations <br />
    13. 13. Results<br />Statistically significant increases in key behavior change indicators:<br />Hand washing <br />Point of use water treatment<br />Care seeking for and access to malaria and pneumonia treatment<br />Immunization, and Vitamin A<br />Even with main project focus on CMM! <br />
    14. 14. Outcomes – Supervision and Reporting <br />Peer supervision helped to compensate for health facility staff challenges (HR, transport)<br />Monthly meetings provided opportunity for facilitated supervision from In-Charge Community Health or Cell Coordinator <br />Reporting burden on Cell Coordinator greatly reduced<br />
    15. 15. Outcomes – CHW Activities <br />Provided CHWs with greater social support (small groups vs. large cooperatives)<br />Groups perceived as motivating factor<br />IGAs <br />Home visits provided mechanism for BCC that previously did not exist<br />Home visits also increased contact with families and provided opportunities for referrals and follow-up CCM care<br />
    16. 16. Outcomes – Integration with MOH<br /><ul><li>MOH stakeholders, CHWs, and beneficiaries viewed CHW peer support model as part of MOH-endorsed, cell-level CHW Cooperative structure at a smaller scale</li></li></ul><li>Conclusions<br />CHWs working as group:<br />Provide greater peer support through social cohesion<br />Encourage joint problem solving<br />(In Rwanda), provide mechanism for BCC and home visits that would not exist otherwise<br />Scale – working at district level first, in collaboration with TWGs <br />Decentralization – districts chose to adopt<br />Transition to country ownership <br />Sub-group cooperatives for IGAs that look very similar to “CHW peer support groups”?<br />
    17. 17. Conclusions<br />The CHW Peer Supervision Model provides a scalable model for meaningful engagement of CHWs at the village level - where it counts!<br />