Community Health Workers dance with World Health Organisation Director General, Dr. Tedros Adhanom Ghebreyesus during a 2018 visit. File Photo.
As Rwanda prepares to celebrate the World Malaria Day, Rwanda Biomedical Centre (RBC) statistics show that the numbers of malaria cases (incidents) have reduced in the last nine years, with the Community Health Workers (CHW) playing a significant role in the reduction.
Rwanda aspires to be malaria free by 2030, and through various programs in prevention, treatment and behavioural change campaigns such as kick malaria out of Rwanda, Zero Malaria, fighting malaria starts with me, among others.
For instance, these efforts have seen malaria incidents (per 1,000 persons per year) drop from 321 cases to 47 and malaria related deaths reduced from 264 cases to 51 cases between the years 2018 to 2023.
RBC statistics show that the role of CHWs has been massive with the proportion of malaria cases treated at community level rising from 7% (in 2014/15) to 59% in the fiscal years 2022/2023.
Most of this work has been done by trained CHWs across the country, who voluntarily deliver without a known salary, although they can receive monetary incentives as part of a Performance-Based Financing (PBF) scheme introduced in 2008 to reward both quantity and quality of services related to specific health indicators.
How did this happen?
The CHW program was initiated in 1995, as Rwanda’s Home Grown Solutions (HGS) with volunteers at cell level for mobilizing communities through health education to seek medical care in health facilities.
The voluntary program, where residents elect the CHW’s has grown to reach the village level with close to 60,000 volunteers across the country even when the CHWs get a meagar appreciation for their work through the Performance Based Financing (PBF)- which is provided by partners in the health sector.
Community Health Workers have played a pivotal role in the treatment and prevention of malaria.
Emmanuel Musabyimana is a CHW in Karongi district who never got a chance to be educated but thanks to the training in basics maralia treatment skills offered by RBC and its partners like Caritas Rwanda.
Musabyimana, one.of the four CHWs in Gitwa village, Mataba cell, Rubengera sector says that since 2008, he can effectively handle emergency cases in treating malaria and other common diseases like diarrhea and pneumonia, especially among children.
“We are well-equipped to diagnose, and provide appropriate treatment to malaria patients, thanks to the skills and training we received through Caritas Rwanda,” Musabyimana said.
“If the malaria case is severe or a patient has a disease we cannot treat here, we refer it immediately to the nearby health centre but also make a follow up on the patient’s progress,” Musabyimana said.
To ensure that these services are available to the community, Musabyimana spares three hours a day to handle cases from 5Am to 7AM and from 5PM to 6PM and spends the rest of the days farming and working at construction sites to earn a living.
Rwanda upped efforts to prevent malaria over the past three decades.
Since patients find him at home and they already know the timelines, Musabyimana has constructed a side room (reception) where I handle all these cases without interference with his family life.
“Many patients love to seek my services and they come from other villages. This means they trust me and appreciate my voluntary work which I now do effectively without disrupting my family life,” he said.
With 15 years of experience as a CHWs, Musabyimana wants to advance his skills to become a medical nurse but this is a dream which is still far-fetched for him, yet possible in another way.
“I am not sure I can become a nurse but at least my children will become medics because they love to do what I do,” he said.
Yvonne Uwitonze, a mother of four, who also appreciates CHW’s efforts and has refered her ill son to Musabyimana says that Community Health Workers are doing a good job in saving lives but also reducing the burden of traveling all day to a health centre or spending money on transport.
“These services are so close to the community in a way that we no longer spend 1,000 on a moto taxi per person to the health centre as before. In other words we no longer have patients bedridden or killed by Malaria,” Uwitonze said.
Jean Bosco Muhakane, a Community and Environment Health Officer at Rubengera Health Centre says that the work of CHWs has reduced the burden of health facilities handling many cases which results to delays in delivery of health services.
“At least 95 percent of the work on malaria prevention and treatment is done by CHWs, that means we only handle five percent of the cases-which are severe that is,” Mahatane said.
To ensure that efforts of CHWs are sustainable in eradicating malaria, residents like Uwitonze and Beatha Nyirakanani say that the community is engaged in clearing mosquito habitats (bushes, stagnant water), using mosquito nets and also following the advice of CHWs.
Narcisse Ngiruwonsanga, the Head of Malaria prevention program at Cartias Rwanda- Western Province, says that training more CHWs has created a level of trust among citizens to an extent that they do 60% of the preventive measures, but engaging all local leaders in the integrated vector management (IVM) program has played a major role in curbing malaria.
