Rwanda has started a process of reforming the current community health program (CHP) to optimize existing services provided by community health workers (CHW), a move that will equip, and enable digitalization, and improvement in primary health care service delivery.
This process, to start increasing CHW’s skills, and work scope, digitize their health services, and recruit young ones (age 21-45), was announced during a policy dialogue on Rwanda community health sustainability and resilience held on July 7, 2022,
The dialogue considered three CHP studies that were conducted to understand the gaps, challenges, and way forward in improving the existing community healthcare program whose backbone has been CHWs.
The three studies include; the community health program evaluation (2016) by Liverpool school of tropical medicine (supported by UNICEF), Rwanda CHP reform: polyvalent model design (2020) by RBC (supported by World Bank), and Community Health program investment case (2021) by RBC (supported by UNICEF).
The studies highlighted an important contribution made by CHWs in the reduction of maternal and child mortality and in improving health status in Rwanda but highlighted gaps that need to be addressed if the healthcare system is to remain sustainable.
For instance, the 2016 study showed a need to consider reducing the number of CHWs, rethink the model vis a vis changing socio-economic scenarios and expanding health infrastructures, and recommended recruiting new generations of CHWs to replace aging ones- which will require a package of motivation, retention and development policies.
The polyvalent model design (2020) aimed at increasing access to services to the public by enabling all CHWs to deliver the full community health integrated package also showed an unequal distribution of tasks in which CHWs were limited in their reach (packages of services)- limited to maternal health, malaria treatment and prevention, and early childhood growth and health monitoring and promotion.
At the policy dialogue meeting stakeholders and the government agreed on taking on the polyvalent model design which will be reviewed and submitted to the cabinet for approval and implementation- at least before the year ends.
“The whole goal is to enhance universal health care service and it goes with the training of human resources and gradually put in place competent resources and improved service delivery,” said Dr. Daniel Ngamije, the Minister of Health.
CHP investment gaps
Despite the effectiveness of the CHWs activities in the health program, the studies also showed that most of the CHP funding (80%) is donor-based and even when investments earn 10 times higher returns, there is a need to pool local resources to make this system sustainable.
The studies showed a funding gap in 2020 of rwf20.3 billion which is expected to keep increasing to rwf23.6billion by 2030.
As of 2020 statistics, the CHP funding has reached Rwf16.3billion yet the estimated cost stood at Rwf36.7billion. By 2030, this funding is expected to reach Rwf22.6billion with an estimated cost of Rwf46.2billion.
United States Agency for International Development (USAID) mission director, Jonathan Kamin said that they have committed an additional $3.5billion into digitization of Rwanda’s community health program and this funding will continue based on the fact that the country is currently doing a good job in improving health care services.
Prof. Jean Bosco Harelimana, the Director-General of Rwanda Cooperatives Agency said that they will help in shifting from specialized to polyvalent models by building needed cooperatives and functions therein.