Transcript Community health best practices in Rwanda
Overview
Community Health program in Rwanda: from Policy to Action
Cathy Mugeni, Community Health Desk, Ministry of Health January 25, 2011 First International Community Health Conference Kigali, Rwanda
1 Rwanda National Health Policy
(based on WHO’s seven building blocks health systems strengthening)
1 To improve accessibility to, quality of and demand for Maternal Health, Family Plan., Rep. Health, Nutrition services 2 3 To consolidate, expand and improve services for the prevention of disease and promotion of health To strengthen the sector’s institutional capacity To consolidate, expand and improve services for the treatment and control of disease 2 To increase the availability and quality of human resources for Health To ensure financial accessibility to health services for all 3 To ensure financial accessibility to health services for all & sustainable & equitable financing of the health sector 4 To ensure geographical accessibility to health services for all 5 To ensure (universal) availability & rational use at all levels of quality drugs, vaccines & consumables 6 To ensure the highest attainable quality of health services at all levels 7 To strengthen Specialised Services, National Referral Hospitals and research capacity Levels of Intervention
•
Family-oriented community based services
•
Population oriented schedulable services
•
Individual oriented clinical services
Community Health Structure
NATIONAL LEVEL MiniSante Community Health Desk DISTRICT ADMINISTRATION District Health Supervisor
• •
DISTRICT HOSPITAL District Hygiene and Sanitation Officer Community Health Coordinator HEALTH CENTER/COOPERATIVE Hygienist or Sociologue Chargé of Community Health Activities CELL LEVEL Binome Supervisor (1 per cell, elected from among the binomes)
• • • •
UMUDUGUDU (VILLAGE) LEVEL Community Health Workers Binomes (male & female worker in each umudugudu) CAS (1 per umudugudu) ASM (1 per umudugudu) Palliative Care (2 per umudugudu, not yet elected)
Evolution of CHWs
health
+11% p.a.
1995 BEGINNING OF CHW • • • Initiated : 1995 ( after Genocide ) Objective: first level of entry to the health system Operates at smallest administrative unit of the country (villages) Includes a minimum package of activities focusing on primary health care 2005 2011 Evolution • Selection and training of CHWs countrywide • Linkage to a diversification of strategies • to reduce child and maternal mortality • community case management
Community Health Workers
1 Female in charge of maternal Health 1 Binome female & male 1 CHSA (in charge of social affairs)
4 CHWs/ village
activities Preventive Services
• Community sensitization on prevention of common: diseases: malaria, diarrhoea, ARI, etc.
• Education for prevention of sexual transmitted infections • Community mobilization and sensitization, health campaign on hygiene and sanitation, immunization etc. • Educate communities on use of water treatment solutions and distribute them
Curative Services
• Community Case Management of malaria, ARI, diarrhoea, vaccination, malnutrition (e.g. Community Integrated Management of Childhood Illnesses/Community IMCI) • Provision of family planning services including FP products • Engage in community DOTs for tuberculosis, HIV
Promotive Services
• Nutrition education to communities • Growth monitoring particularly among children under five years old • Nutrition surveillance • Routine home visits for active case finding
Community-based prevention, screening and treatment of malnutrition
• • • • • Monthly growth monitoring &
promotion
Screening children for SAM using Middle Arm Circumference Measurement tape (MUAC) Treatment of SAM with RUTF
(Plumpynut)
Community demonstration kitchens to prevent malnutrition and reoccurrence Community level follow-up for treatment effectiveness
Community based Integrated Management of Child Illness (CB-IMCI)
• • Targets children less than 5 years for following health problems • fever • diarrhea • acute respiratory infections • malnutrition Medications provided include; • coartem • amoxicillin (pneumonia) • oral rehydration solution + zinc
Community-based maternal- neonatal care
• Identify and register women of reproductive age (encourage family planning) • Identify pregnant women and encourage ANC, birth preparedness and facility based deliveries • Identify women and newborns with danger signs and refer them to health facility for care • Accompany women in labor to health facilities • Encourage early postnatal facility checks for both newborns and the mothers • Use RapidSMS to support activities
Community based provision of family planning
• • Community health workers (CHW) provide: • condoms, • • • oral contraceptive pills, injectables, Standard Days Method Pilot In March and April, 2010, • 3068 CHWs were trained as trainers in CBP.
Community DOT HIV, TB and other chronic illnesses • •
Community DOTs for treatment and care of TB;
implemented in 30 districts 100% of the Rwandan population • •
Community DOTs for treatment and care
HIV NCD implemented by partners in 3 districts since 2005
Community behavior change and communication • • •
Sensitizing communities on disease preventive measures
• proper hygiene and sanitation, • use of Insecticide treated mosquito nets, • early health care seeking behaviors, • breast feeding, infant and young child feeding/nutrition
Disease surveillance Contact tracing
Community Environmental Health Interventions: Implementation of CBEHPP • • • • CHWs will be responsible for mobilizing the community to join CHC • CHWs will facilitate for the CHC during dialogue sessions The CHWs will list all CHC members in a registration book CHW signs membership cards for those attending sessions CHWs make household visits to check improved hygiene practices
Community health information systems and innovative technologies (m’ubuzima: Rapid SMS & P4H ) / • • • All CHWs received mobile phones; Phone4He being piloted for CHWs to report on HMIS indicators • CHW binome enters list of community health indicators that feeds into national HMIS; • • 22 indicators include CCM, MCH, deaths, Rapid SMS transmits information into computerized recording and response system • Improves referral system • Contact tracing, etc • Facilitates emergency services
Community-based health insurance
• • • • Health mutuelle: • Covers 85% of population • 1000Rwf annual fee, • payment per service Increases access to health facility services Reduction in illnesses Most vulnerable are covered by basket fund (risk-pooling)
Community-PBF/www.pbfrwanda.org/siscom
Improves performance
motivating them to raise agreed upon performance indicators of CHWs by Payments made when proof of the agreed level of performance
Community PBF guide
management at different levels details The Sector oversees the approves Steering payment to Committee implementation the and
CHW Cooperative
.
Indicators entered at district level into
web-based database
after quarterly approval by committee with feedback
CHWs COOPERATIVEs
All CHWs cooperatives organized to in ensure
income generation accountability
and of expected results
Community PBF payments
used for cooperative income generating projects including: poultry, rearing, cattle/goat/pig crop farming, basket making, etc.
Incentives and motivation for CHWs
• • • • • • Trust and respect from community members, leaders etc… Support from Supervisors and implementation partners help improve work; Regular trainings, meetings
supervision
In-country study tours to learn from peers in other districts Distance learning
Community performance-based financing (PBF);
• Membership in cooperatives for income generation
Monitoring and Evaluation
National
• M&E desk at MoH:
supervisors
• M&E
technical work group
with partners
District
• 41 & 5 NGOs Community health and M&E supervisors
Health center
• 380 In-charge of community health • 416 Sector-level comité de pilotage
Cell
• CHW supervisors