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The role of partnership in strengthening the community health system in rwanda :

The role of partnership in strengthening the community health system in rwanda :. THE MOH/PIH PARTNERSHIP AS AN EXAMPLE. Didi BERTRAND FARMER Kigali, January 25-28, 2011. INTRODUCTION. The MOH/PIH community health system. Background.

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The role of partnership in strengthening the community health system in rwanda :

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  1. The role of partnership in strengthening the community health system in rwanda: THE MOH/PIH PARTNERSHIP AS AN EXAMPLE Didi BERTRAND FARMER Kigali, January 25-28, 2011

  2. INTRODUCTION The MOH/PIH community health system

  3. Background • In 2006, in accordance with Rwanda’s MOH, Partners In Health (PIH) began initiating a number of health system strengthening (HSS) activities to enhance the national Community Health Worker (CHW) system. • MOH/PIH model is adapted from an established international model of community health in PIH Haiti. • Model is implemented in Burera and southern Kayonza Districts (550,000 persons).

  4. Principals of Community Health system KEY principals to build a system of CHWs : • Geographical distribution and Sufficient number of CHW (about 1 CHW per 40-50 households) • Standardized training with clear responsibilities (multidisciplinary roles) • Staffing for systematic support for strong supervision and coordination • Monitoring and Evaluation with feedback to the CHWs for program improvement • Adequate Compensation • CHW system feeds into a well-functioning health center • Community involvement

  5. Rwanda’s MOH Community Health System Overview of MOH system started in 2008: • Two CHWs per village (50 up to 250 households) for IMCI community health; • One CHW per village for Neonatal and maternal health; • One Health Center/sector based in charge of CHW program; • One District Hospital level program supervisor; • Reporting through PBF Report; • Financing 100% through cooperatives.

  6. Additional MOH Interventions C-IMCI, Community Cooperatives, & PBF

  7. MOH Intervention Achievements: 2009 • Implementation of c-IMCI (community integrated management of childhood illnesses) through introduction of Binomes • Implementation of income-generating CHW cooperatives to finance national CHW system • Implementation of Performance-Based Financing (PBF) Report to pair data collection with financing and supervision activities

  8. PIH INTERVENTIONS Key enhancement components to the National Community Health Program through a MOH/PIH Partnership

  9. Activity 1: Increase in number of multi-disciplinary CHWs (binomes) in each village to one per fifty households. Average (umudugudu) size: 40 to 250 households (or more)

  10. Activity 2: Monthly household visits by CHWs for early case detection, treatment and referral.

  11. Activity 3: Additional training for CHWin primary health specialties including HIV to improve performance of CHWs. Training for Health Center/sector based in charge of CHW program and Hospital level program supervisor on Program Management and data quality Improvement

  12. Activity 4: Supplemental Performance-Based Financing (PBF) to incentivize individual CHWs. • Performance-based compensation (10-20 USD/month) for: • Monthly home visits, daily accompaniment & key maternal health activities; • Timely completion of a monthly report form; • Participation at monthly training. • Additional support to Cooperatives: • 10% compensation directed to cooperatives; • Technical support for managing income-generating activities; • Added financial support to cooperatives based on number of CHWs.

  13. Activity 5-Staffing for systematic support and supervision 5a.Community health nurse at each health center working in collaboration with Charge of Community Health Program: • Supervise the CHWs and CHW supervisors • Organize trainings and meetings • Collect and prepare monthly reports, organize sensitization activities, and implement the PBF system. • Provide technical support for clinical components 5b.PIH funding CHW supervisor at cell level: • With higher level of education • Monitors all CHWs and their households • Hosts monthly meetings with all CHWs 5c. Supervision tools provided at all levels

  14. Activity 6-Monitoring, reporting and evaluation 6a. A supplemental monthly report: • Complements MoH PBF report • Monitors and supports supervision of non-PBF CHW activities 6b. A household chart: • Facilitates regular delivery of care • Captures socio-demographic data • Monitors target populations (pregnant women, women on family planning, chronic care patients, children under 5)

  15. Activity 7: Training of supervisors (cell and sector level) to improve CHW performance. • Daily accompaniment for chronic diseases to improve treatment adherence and outcomes. HIV patient on food supplements and accompaniment ( 18 months later)

  16. Activity 8: Enhanced Community Involvement • System works in close collaboration with existing societal structures: • Local leaders; • Traditional healers and birth attendants ; • Church representatives; • Local groups and associations, etc. • CHWs use community forums to conduct sensitization and advocacy activities, promoting active participation of the community in decisions regarding their health. • Builds solidarity and establishes a community link to the broader healthcare system.

  17. Costs of System: $3 US per capita Additional Components: • Community Health Nurse salaries; • Supervisors salaries; • Compensation for CHWs; • Trainings and meetings for CHWs, supervisors , and Community Health Nurses; • Training materials and tools; • Support training on MOH materials; • Sensitization activities with District collaboration; • Technical support and contributions to cooperatives.

  18. Results and Conclusions The role of partnership in strengthening community health systems

  19. Results • In the two districts: • 2,067 multi-disciplinary CHWs follow 110,000 households performing IMCI community protocols, family planning and maternal health interventions; • 1,741 CHWs accompany a total of 5,000 patients daily to aid in HIV, TB, and other chronic disease treatment; • The CHW attrition rate in southern Kayonza is < 3% and 98% of CHWs attend trainings and monthly meetings and complete reports on time.

  20. Conclusion • Nongovernmental partners can support and strengthen important components of public CHW programs through a number of different interventions. • In two districts in Rwanda, an innovative CHW model has been implemented quickly to reinforce the overall health system. • More research is needed to evaluated the impact of the added components

  21. Acknowledgments • MOH/CH DESK • Doris Duke Grant: Partnership for African Health Systems Strengthening • Clinton Health Access Initiative (CHAI) • University of Rwanda School of Public Health. • National Institute of Statistics, Rwanda

  22. . Thank youMURAKOZE

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