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Semelhante a Chw scale presentation jenn weiss
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Chw scale presentation jenn weiss
- 1. Community Health Workers – Overcoming Scalability ChallengesThe Rwanda Expanded Impact Child Survival Project Experience Presented by: Jennifer Weiss, MPH Health Advisor, Concern Worldwide CORE Fall Meeting 2011
- 2. Project Overview Implemented from 2007 – 2011 in six districts in Rwanda Target population: 300,000 children under five Technical interventions: malaria, diarrhea, pneumonia
- 5. Strengthen service delivery (QI)Integrated Nutrition - CMAM
- 6. Rwanda MOH Community Health Structure District Hospital: Community Health Supervisor Health Facility: In-Charge of Community Health CHW Cooperative and Cell-Coordinators Village Level: 2 ‘binomes’ for c-IMI; 1 CHW for Maternal Health, and 1 Social Affairs Officer
- 7. Existing Supervision and Reporting Structures Sector In-charge Community Health Cell Cell coordinator 1 hour to 1 day walk 40-80 Villages
- 8. Opportunities for Improvement MOH has clearly defined Community Health structure that includes CHWs CHWs are officially recognized in the community, motivated, and provided incentives (Cooperatives) But … Not well geared towards effective behavior change Challenging reporting and supervision structures
- 9. Rwanda EIP Response (as it evolved) World Relief CSP (2001-2006) used Care Group Model WR began to incorporate Care Groups into EIP (2007) under Community Mobilization activities 15-20 member “Peer Support and Collaboration Groups” formed with 4 CHWs from each village (2009 – 2011) Rwanda MOH requirements on limited number of CHWs per village (2008) CHW peer support groups no longer fit Care Group criteria but still maintains group solidarity, and responsibility for HH visits and behavior change
- 10. EIP Community Health Structure In-Charge Community Health Cell Coordinator CHW Group CHW Group CHW Group CHW Group
- 11. Outputs 660 peer support groups formed with 13,166 CHWs in 6 districts Average of 163,000 households visited on a monthly basis with key prevention messages
- 12. Results CHW Peer Support Group activities associated with: Four-fold increase in the number of households with kitchen gardens Twenty-five fold increase in the number of households with hand washing stations
- 13. Results Statistically significant increases in key behavior change indicators: Hand washing Point of use water treatment Care seeking for and access to malaria and pneumonia treatment Immunization, and Vitamin A Even with main project focus on CMM!
- 14. Outcomes – Supervision and Reporting Peer supervision helped to compensate for health facility staff challenges (HR, transport) Monthly meetings provided opportunity for facilitated supervision from In-Charge Community Health or Cell Coordinator Reporting burden on Cell Coordinator greatly reduced
- 15. Outcomes – CHW Activities Provided CHWs with greater social support (small groups vs. large cooperatives) Groups perceived as motivating factor IGAs Home visits provided mechanism for BCC that previously did not exist Home visits also increased contact with families and provided opportunities for referrals and follow-up CCM care
- 17. Conclusions The CHW Peer Supervision Model provides a scalable model for meaningful engagement of CHWs at the village level - where it counts!
Notas do Editor
- ADD: 19% of total country communicate scale
- Emphasize that expansion of CCM was overwhelming emphasis of project and BCC activities were only rolled in all target areas in earnest in last 18 months of project
- How many health facilities per district?multiple cells per health facilityCell contains 150-300 CHWs that meet on a quarterly basis for supervision and cooperative meetingsFocus of today’s presentation on health facility level and below
- Most sectors just have one cell and therefore one cell coordinator, but some have two. Each cell has approximately 150-300 CHWs, representing 35-75 villages.Supervision: Each binome is to be supervised by either In-Charge of Community Health or Cell Coordinator on quarterly basis. Reporting: Cell coordinator compiles all reports from CHWs and submits to In-Charge of Community Health on quarterly basis.
- Each ‘type’ of CHW is expected to general ‘mobilization’ at community level on their specialty area, but not expected to do BCC through home visits
- Addition of ‘CHW Peer Group Supervision’ who coordinates reporting for CHW Group and liaises with cell coordinatorEach CHW is responsible for visiting ?? households
- Jean Capps?
- From final evaluation and monitoring data – emphasize that efforts were really on CCM, and yet we were able to make some significant gains in behavior change
- CHW peer support model brought CHWs together on regular basis to plan and coordinate BCC and community mobilization activities at village level
- Anecdotally that smaller group cooperatives may be scaled-up for IGAs that look like “peer support groups”