“Role of Community Health Workers in Improving and Sustaining the Health Care System in Rwanda”
The 1994
Genocide against the tutsi in Rwanda left devastated institutions and led to loss
of lives of skilled personnel including those that served the health sector.
The population then suffered preventable diseases and the health indicators
including child and maternal mortality where among the highest in the world.
The post
conflict recovery strategies prioritized the establishment of a solid health
care system which promotes and implements universal and quality of care
critical to affordable health care.
Over the
years, health demands increasingly grew, yet the country still faced a visible
gap on inadequate workforce in the health sector. This therefore called for the
introduction of the Community health workers, a national and strategic
homegrown initiative, a supported network of over 58,000 men and women trained
volunteers committed to promote health seeking behaviors and increased uptake
of essential maternal and child clinical services in the communities. Due to
the programme effectiveness, their scope later expanded to accommodate other health
services such as malaria treatment, identifying tuberculosis suspects and accompaniment,
sensitization on family planning programmes, monitoring and reporting on cases
of gender-based violence, among other duties.
CHW programme
have recorded successes of saving lives of children under five and pregnant
mothers who were at risk of death breaking record of reducing these two health
indicators in only 2 decades by far 100% during the implementation of Millennium
Development Goals and Sustainable Development Goals. As a result, today the
lifespan of Rwanda has increased from 47 years in 2000 to 67 years in 2023.
Death
resulting from Malaria in Rwanda is increasing becoming history and active
cases are treatable at village level. In 2018-19, CHW alone managed over 2
Million malaria cases in communities compared to 1 Million managed at health
facilities. The same was achieved for diseases such as Tuberculosis to mention
but a few. 98% of children in Rwanda receive basic vaccination and 98% of pregnant
mothers attend to antenatal care visits.
CHW is one
of the success stories of the effective national decentralization policy in
Rwanda and the programme remains the most significant health initiative that is
impactful, sustainable and replicable.
Key lessons learned from the study illustrates
that
CHW
succeeded because the government’s national health goals were clear and had the
programme fully integrated in the health sector policy and implementation plans
including budgeting. This gave the programme some level of legitimacy and
credibility. The homegrown solution is aspired by the approach of Rwanda’s government
to find localized solutions to their problems and that is why the aspect of
volunteerism is positive. Without this
programme, Rwanda would be so far away from realizing its health care goals and
development would have been slow to what we witness today.
CHW has been
and remains an essential contributor to improving and sustaining health care
systems in Rwanda. The programme is replicable and could be one of the
transfarable tool to close health care gaps in majority of the African
countries and globally.
“Development starts with life which
is our collective responsibility but the CHW have outcompeted us in fulfilling
this duty. We should all be proud of them” Francisca Mujawase
Thanks to
the wonderful team of the professors from whom I learned a lot during the
research process and for their encouragement that got my work feature in this
Important book.
I thank you!
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