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. 2014 Aug 31;2(3):342-54.
doi: 10.9745/GHSP-D-14-00067. eCollection 2014 Aug.

Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

Anne Langston  1 , Jennifer Weiss  2 , Justine Landegger  1 , Thomas Pullum  3 , Melanie Morrow  3 , Melene Kabadege  4 , Catherine Mugeni  5 , Eric Sarriot  6
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Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

Anne Langston et al. Glob Health Sci Pract. .

Abstract

Background: The Kabeho Mwana project (2006-2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems.

Methods: The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes.

Results: While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital.

Conclusions: The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.

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Figures

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The Bahomwana CHW Peer Support Group meets in Gasambu village, Rwanda, to exchange ideas and challenges in order to accomplish and improve their work.
Figure.
Figure.
Care-Seeking From CHWs and Facilities for All iCCM Conditions in Children 0–59 Months, Kabeho Mwana Project vs. Non-Project Districts Abbreviations: CHWs, community health workers; iCCM, integrated community case management.
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A community health worker and member of a Peer Support Group on a routine home visit.
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