Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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
Affiliations

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.

PubMed Disclaimer

Figures

None
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.
None
A community health worker and member of a Peer Support Group on a routine home visit.
See this image and copyright information in PMC

References

    1. Marsh DR, Hamer DH, Pagnoni F, Peterson S. Introduction to a special supplement: evidence for the implementation, effects, and impact of the integrated community case management strategy to treat childhood infection. Am J Trop Med Hyg. 2012;87(5 Suppl): 2–5 10.4269/ajtmh.2012.12-0504 - DOI - PMC - PubMed
    1. Ministry of Health (MOH) [Rwanda]. Community health workers trainers guide: “community integrated management of child illness.” Kigali (Rwanda): MOH; 2011
    1. Mugeni C, Ngabo F, Humuza J. Community performance-based financing in health: incentivizing mothers and community health workers to improve maternal health outcomes in Rwanda. Draft background paper for the World Conference on Social Determinants of Health. Geneva: World Health Organization; 2011. Available from: http://www.who.int/sdhconference/resources/draft_background_paper20_rwan...
    1. National Institute of Statistics of Rwanda (NISR) [Rwanda]; Ministry of Health (MOH) [Rwanda]; ICF International. Rwanda demographic and health survey 2010. Calverton (MD): NISR; 2012. Co-published by the MOH and ICF International. Available from: http://dhsprogram.com/pubs/pdf/FR259/FR259.pdf
    1. World Health Organization (WHO); Organization for Economic Cooperation and Development (OECD). Official development assistance for health to Rwanda. Geneva: WHO; 2012. Available from: http://www.who.int/gho/governance_aid_effectiveness/countries/rwa.pdf

Publication types