Abstract
BackgroundCommunity health workers (CHWs) can play important roles in primary health care delivery, particularly in settings of health workforce shortages. However, little is known about CHWs’ perceptions of barriers and motivations, as well as those of the beneficiaries of CHWs. In Rwanda, which faces a significant gap in human resources for health, the Ministry of Health expanded its community health programme beginning in 2007, eventually placing 4 trained CHWs in every village in the country by 2009. The aim of this study was to assess the capacity of CHWs and the factors affecting the efficiency and effectiveness of the CHW programme, as perceived by the CHWs and their beneficiaries.MethodsAs part of a larger report assessing CHWs in Rwanda, a cross-sectional descriptive study was conducted using focus group discussions (FGDs) to collect qualitative information regarding educational background, knowledge and practices of CHWs, and the benefits of community-based care as perceived by CHWs and household beneficiaries. A random sample of 108 CHWs and 36 beneficiaries was selected in 3 districts according to their food security level (low, middle and high). Qualitative and demographic data were analyzed.ResultsCHWs were found to be closely involved in the community, and widely respected by the beneficiaries. Rwanda’s community performance-based financing (cPBF) was an important incentive, but CHWs were also strongly motivated by community respect. The key challenges identified were an overwhelming workload, irregular trainings, and lack of sufficient supervision.ConclusionsThis study highlights the challenges and areas in need of improvement as perceived by CHWs and beneficiaries, in regards to a nationwide scale-up of CHW interventions in a resource-challenged country. Identifying and understanding these barriers, and addressing them accordingly, particularly within the context of performance-based financing, will serve to strengthen the current CHW system and provide key guidance for the continuing evolution of the CHW system in Rwanda.
Highlights
Community health workers (CHWs) can play important roles in primary health care delivery, in settings of health workforce shortages
When health centres offer the minimum package of services, CHWs' services can support the continuum of care and provide valuable referral health services [5,6]
These data were collected as part of a larger assessment of CHW capacity relating to community-based nutrition (CBN) programmes, as commissioned by the Rwanda Ministry of Health (MoH) with the support from World Bank and UNICEF Rwanda
Summary
Community health workers (CHWs) can play important roles in primary health care delivery, in settings of health workforce shortages. Little is known about CHWs’ perceptions of barriers and motivations, as well as those of the beneficiaries of CHWs. In Rwanda, which faces a significant gap in human resources for health, the Ministry of Health expanded its community health programme beginning in 2007, eventually placing 4 trained CHWs in every village in the country by 2009. Shortages of qualified human resources for health are acute in low-income countries, which face significant burdens of disease and mortality. CHWs are increasingly being utilized to alleviate the shortage of human resources for health, in the delivery of interventions for maternal and child health [3]. Can reduce effectiveness of CHW service delivery, including inadequate training, supervision, and remuneration, as well as insufficient assimilation of CHWs into the health system [12,13]
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