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This 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
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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.
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The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda’s 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In p
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roject districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.
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Health Systems for Outcomes Publication | This report summarizes the findings of a qualitative study on health workers’ performance and career in Rwanda to identify bottlenecks, strengths and shortcomings for human resources in the health sector, as perceived by both health workers and users of he
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alth services.
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Health Systems for Outcomes Publication | Using qualitative data from Rwanda, this study focuses on four institutional factors that affect health worker performance and career choice: incentives, monitoring arrangements, professional norms and health workers’ intrinsic motivation. It also provides
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illustrations of three institutional innovations that work, at least in the context of Rwanda: performance pay, the establishment of community health workers and increased attention to the training of health workers.
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Health Systems for Outcomes Publication | The government of Rwanda has identified human resources for health as one of its policy priorities. This study aims to contribute to building a better understanding of health worker choice and behaviour, and to improve evidence based polcies.
This study examines the ability of political, legal, health, and communities to respond to gender-based violence in Kigali, Rwanda.
This article reexamines a set of study findings that directly relate to the influence of gender on workplace violence, synthesizes these findings with other research from Rwanda, and examines the subsequent impact of the study on Rwanda’s policy environment.
Through public-private partnerships, the government of Rwanda can make more efficient use of public resources by targeting and meeting the needs of specific populations and thus help ensure family planning services and products will be available to all Rwandans in the long term. This report aims to
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inform stakeholders working to strengthen family planning through multisectoral partnerships about Rwanda’s family market.
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The survey was conducted in early 2015. Respondents were 347 people living with HIV in seven (7) towns/districts of five (5) departments of the Republic of the Congo.
The purpose of the situation assessment was to execute a situation analysis for Autism and Neurodevelopment Disorder (NDD) in Bangladesh. The situation assessment covers the following areas: a review of the scale and prevalence of NDD with trends of the disorder in the recent past in Bangladesh (see
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page 17); estimation of likely disease burden in the near future (see page 27); assessment of the social response to NDD in Bangladesh (see page 67); overview of the support and services required by persons with NDD (see page 79); an inventory of service providers working with NDD in Bangladesh (see page 85); an assessment of the adequacy of the existing services and support available for addressing NDD in country (see page 97); an overview of the role and preparedness of MOHFW and other stakeholders in addressing NDD in Bangladesh (see page 108); recommendations for monitoring, supervision and reporting mechanisms for NDD services at the national level (see page 167); and recommended key activities that should be undertaken by the Health and other relevant ministries in the short and medium term (see page 167).
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Lesotho’s predominantly rural population faces significant health challenges within a setting of inadequate human resources for health. It is essential that nurses and nurse-midwives, who together make up the largest health workforce in the country, be adequately prepared to address Lesotho’s He
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alth Priorities according to the Poverty Reduction Strategy Paper (PRSP) in the settings where they work. Under the HRAA project, Jhpiego conducted a task analysis study to obtain data on job duties or tasks performed by these cadres, as well as information about how often the tasks are performed, if and where tasks were learned, and the self-perceived level of competence in performing the tasks.
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R4D conducted a thorough desk review and qualitative fiscal space analysis, 19 interviews about financing for the three diseases and the extent of alignment between public financial management systems and health policy objectives, and a validation workshop with government officials.
Tanzania’ ... s disease response faces a triple transition challenge: replacing donor funding, closing the resource gap that would exist even with donor funding, and more efficiently delivering on disease response objectives. more
Tanzania’ ... s disease response faces a triple transition challenge: replacing donor funding, closing the resource gap that would exist even with donor funding, and more efficiently delivering on disease response objectives. more
Plos Current Outbreaks
An outbreak of Lassa Fever (LF) reported and confirmed in Ondo state, Southwest Nigeria in January 2016 was investigated. This paper provides the epidemiology of the LF and lessons learnt from the investigation of the outbreak.
Results: We identified 90 suspected LF case ... s of which 19 were confirmed by the laboratory. More than half (52.6%) of the confirmed cases were females with majority (73.7%) in the age group ≥ 15 years. The Case Fatality Rate (CFR) of 63.2% among the laboratory-confirmed positive cases where 9 of 19 cases died, was significantly higher compared to the laboratory confirmed negative cases where 6 of the 65 cases died ( CFR; 8.5%) p ≤ 0.05. Two hundred and eighty-seven contacts of the confirmed cases were identified, out of which 267(93.0%) completed the follow-up without developing any symptoms and 2 (0.7%) developed symptoms consistent with LF and were confirmed by the laboratory. More than half of the contacts were females (64.5%) with most of them (89.2%) in the age group ≥ 25 years. more
Results: We identified 90 suspected LF case ... s of which 19 were confirmed by the laboratory. More than half (52.6%) of the confirmed cases were females with majority (73.7%) in the age group ≥ 15 years. The Case Fatality Rate (CFR) of 63.2% among the laboratory-confirmed positive cases where 9 of 19 cases died, was significantly higher compared to the laboratory confirmed negative cases where 6 of the 65 cases died ( CFR; 8.5%) p ≤ 0.05. Two hundred and eighty-seven contacts of the confirmed cases were identified, out of which 267(93.0%) completed the follow-up without developing any symptoms and 2 (0.7%) developed symptoms consistent with LF and were confirmed by the laboratory. More than half of the contacts were females (64.5%) with most of them (89.2%) in the age group ≥ 25 years. more
An attempt has been made to map the incidence of uni-dimensional and multi-dimensional poverty simultaneously arguably for the first time in Pakistan. While multi-dimensional poverty map is calculated using PSLM 2010-11; small area estimation technique is utilized to map uni-dimensional poverty usin
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g both nationally representative HIES (Household Integrated Economic Survey) and district-level representative PSLM (Pakistan Standard of Living Measurement) for the same year of 2010-11. The result indicates the existence of spatial distribution of poverty pockets in each of the four provinces of Pakistan. Furthermore, it is also observed that these pockets of poverty are more concentrated in the desert and mountains regions of the country.
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Ethiopia met the MDG target for drinking water access with a unique and high degree of success. The magnitude of the country’s success in providing improved drinking water to nearly half of its population in 25 years despite its diversity, size, and challenges cannot be overstated. This case study
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documents the progress of the Ethiopian WASH sector from 1990 to 2015, and analyzes the impact of local systems created in Ethiopia to respond to water and sanitation challenges.
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Nationally, Senegal met the MDG target for water supply access. It did this by engaging the public and private sectors to effectively invest and report on investments. It focused on larger population centers, less on remote regions of the country. Its achievements set the stage for more equitable an
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d widespread service provision as the country now works to achieve the SDGs, requiring sustainable management of universal access. This case study documents the progression of the sector between 1990 and 2015, and analyzes the impact of local systems created in Senegal to respond to the water and sanitation challenge.
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Democratic dispensation in 1994 created a political and social platform that reshaped life in South Africa. There was a surge in common belief that the inequity and wrong of Apartheid should and could be rectified. Equity of access to water and sanitation were obvious targets for improvement. In 199
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4, an estimated 14–15 million South Africans were without access to an improved water supply, while close to 21 million - more than half of the population at that time - did not have access to improved sanitation facilities. These problems were most severe in poorer rural areas. The water and sanitation sector became unified by the vision of universal access for all South Africans. This case study documents the progression of the sector between 1994 and 2016, and analyzes the impact of local systems created in South Africa to respond to the water and sanitation challenge.
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This external performance evaluation of the Malawi Girls’ Empowerment through Education and Health Activity (ASPIRE), conducted 2.5 years after ASPIRE began, establishes the activity’s progress against its objectives, proposes adaptations for the final year, and captures lessons for application
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in future girls’ empowerment, health, and education programming in Malawi.
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WASH Ex-Post Evaluation Series - Water Communications and Knowledge Management (CKM) Project
This evaluation examines the sustainability of selected components of the USAID/Indonesia Environmental Services Program (ESP), which was implemented from 2004–2010. Among other objectives, this activ ... ity sought to improve health and livelihoods of Indonesians through enhanced and expanded access to key environmental services.
Following up on the program seven years after it ended, this evaluation addresses the sustainability of ESP’s capacity-building efforts with Indonesian municipal water utilities, known as Perusahaan Daerah Air Minum (PDAM), and financial mechanisms to improve utility management and expanded water access in urban areas. more
This evaluation examines the sustainability of selected components of the USAID/Indonesia Environmental Services Program (ESP), which was implemented from 2004–2010. Among other objectives, this activ ... ity sought to improve health and livelihoods of Indonesians through enhanced and expanded access to key environmental services.
Following up on the program seven years after it ended, this evaluation addresses the sustainability of ESP’s capacity-building efforts with Indonesian municipal water utilities, known as Perusahaan Daerah Air Minum (PDAM), and financial mechanisms to improve utility management and expanded water access in urban areas. more
