Complementary Evaluation for EIP
and Documentation of scale of
Integrated Community Case
Management in
Rwanda
- Key Findings -
Presentation Outline
I.
II.
III.
IV.
V.
VI.
Background
Objectives
Methodology
Results
Lessons Learned
Next Steps
2
Background
EIP CSHGP
Program:
Contributions to
Scale:
Cross-District
Comparisons:
•Focused on iCCM,
CHW training,
supervision and
supply chain
•What was
Rwanda’s planned
versus actual
pathway to scale for
iCCM?
•How does the
Care Group model
compare with the
existing default
model of C-IMCI in
Rwanda? And what
lessons can be
learned from its
experience?
•Encouraging peer
support through
CHW Care Groups
•How did EIP
contribute to
pathway?
Menu of Key Strategic Tasks by Timeline
Pre-introduction
from unaware/
uninterested to
building
consensus
 convene
interested
partners
 begin change
process
 characterize
problem/consider
possible solutions
 test/ refine
approaches
(pilot)
 cultivate
champions
Definitive
decisions
consensus
building to
motivating
 secure official
policy
endorsement/
approval
Introduction
motivating to
implementing
 do detailed
implementation
planning
 develop an M&E
 secure financial plan
commitments
 formalize
permanent
working group
 develop
-
MCHIP
Early
implementation
implementing
 conduct
orientations &
training
Mature
implementation
implementing to
sustaining
 maintain
oversight
 monitor fidelity
 ensure availability
 monitor and
of drugs & supplies
evaluate outcomes
at point of service
and impact
training curricula monitor inputs,  expand
processes and
& plans
geographically
quality
 procure
 institutionalize
 address barriers
needed drugs,
 adapt as needed
supplies
 address
 address capacity
issues
unintended
consequences
4
Objectives of Complementary Study
Scale Study:
To test the following Hypotheses
•NGO supported actions around
HBM (2004) and iCCM (2007)
were essential in leveraging MOH
support for scale
•Strong leadership and political
will in Rwanda were key in
moving CCM to scale
Comparative Study:
 To assess Care Group
attribution to CCM status
5
Methodology
The Complementary Study
comprised of 3 different tasks.
 Document Review (20012011)
 Qualitative elicitation of
narratives by key informants
(central level stakeholders) to
“tell the story” of iCCM in
Rwanda over time (2001-2011)
 Qualitative assessment of
CCM status in one non-EIP
district (Ruhango)
6
Focus Group
Interviews
Interviews and FGDs Conducted
Target
Done
Central MOH & Central Partners
(USAID, UNICEF, WHO, PNILP,
NGOs)
Technical persons
5
District Health Officer
1
Health professionals (Titulaire,
CSC)
CHWs
2
Mothers /
Caretakers
Cooperative Officials
1 MOH
11 NGO/Bilaterals
FGDs
FGDs
FGDs
RESULTS 1: CCM Timeline in Rwanda
HBM Strategic
Plan 2004
Expansion of HBM
to 12 of 19
“endemic” Districts
2006
HBM Evaluations
2006 and 2007
using ACT
Expansion of iCCM
to 30 Districts
2009-2010
iCCM Tool
Development and
revision 2008-2010
2009-Introduction
of RDT at
community level
iCCM Pilot in
Kirehe 2007
Rwanda CCM Timeline
POLICY
PHC
HBM
TWG
HBM
Strategic
Plan
CHW
CCM
Cadre
mooted
IMCI
TWG
CH Policy +
Community
Health
Desk
C-PBF to
incentivize
CHWs
MCH CH
TWG takes
over from
IMCI TWG.
Homebased fluid,
ORS & Zinc
in Kirehe
DIARRHEA
Pilot AQ
at village
level in 6
districts
MALARIA
Oct 07:
Bukora HC
1st ACT Tx
by CHW
RDT
Policy
Change
Feb 08: 1st
Pneumonia case
treated by a CHW
in Kirehe
PNEUMONIA
HBM in 6
Districts
EXPANSION
1990’s
2003
2004
HBM in
all 19
endemic
Districts
2005
2006
Expansion of
iCCM to 16
Districts 2008
(Phase 1)
2007
2008
Expansion
of iCCM to
30 Districts
2009-2010
2009
2010
Other Important Critical Events for CCM
in Rwanda
 Vision 2020 Umurenge of
2000 and
Decentralization Policy of
2001
 Global Fund Round 3, 5,
8, RCC
 WHO TA for HBM 2004
 Senegal Visit - 2006
 BASICS TA for ICCM
2007
 CHW Recognition by the
Presidency - 2008
 New Staff Cadre for CHW
Supervision - 2010
 HBM NGO pilot CORE/PMI support 2004
10
RESULTS 2: CHWs and Care Groups

The EIP intervened at
critical points in the
pathway to iCCM scale.

CHW Services are
appreciated by both users
and MOH.

Care Groups at the CHW
level provide a natural
peer support group and
help with Community
mobilization and BCC.
12
Potential CCM Challenges that Care
Groups could help alleviate
Key CCM Factors
EIP Districts
Non-EIP Districts
(with CHW Peer
(without CHW Peer
Support Groups) Support Groups)
Improving Task Competency for
CCM e.g. use of timer, MUAC,
RDT (Supervision/QA)
+
-
Minimizing stock-outs by sharing
inventory (Motivation)
+
-
Technical Supervision by Peers
+
-
Pooling/ Sharing Cases among
CHWs to maintain CCM
proficiency
+
-
13
Lessons Learned: MCHIP’s
Considerations
MCHIP validated the
hypotheses it was
testing. Now to consider

- co-opting peer support
group formation and
networking module in
CHW training;

- testing different CHW
restocking models/
supervision models
14
Next Steps
 Compare DHS
clusters from EIP and
non-EIP areas from
the recent DHS
(2010)
 Convene a face to
face meeting for
mutual agreement of
CCM events timeline
15
ANY QUESTIONS?
Thank you!
wwww.mchip.net
Follow us on: