- World Relief's Umucyo CSP in Rwanda from 2001-2006 used care groups of 2800 volunteers in 202 groups to conduct home visits twice per month on topics like malaria, HIV/AIDS, nutrition and more. Results showed large increases in ITN use and an estimated annual reduction in under-5 mortality of 7 deaths per year. - The expanded Kabeho Mwana CSP from 2006-2011 worked with the Rwandan MOH and supported 13,166 government CHWs organized into 660 peer support groups to conduct integrated community case management and other behaviors. Analysis found under-5 mortality decreased more in project districts than non-project districts. - While care groups allowed closer supervision and more

1. Melene Kabadege, World Relief
Melanie Morrow, MCHIP/ ICF International
Care Group TAG; May 29, 2014
From Care Groups to
CHW Peer Support Groups:
Scaling up in Rwanda

2. World Relief’s Umucyo CSP (2001-2006)
• Location: Nyamasheke District,
Western Province, Rwanda (Former Kibogora Health District)
• Total Population: 152,981 people in 29,166 HH
• Care Groups:
>2800 Volunteers in
202 Care Groups;
HH visits 2x/mo
10 HH per Volunteer
Trained by project staff

3. Umucyo Major Activities
• C-IMCI for 6 Interventions:
– Malaria, HIV/AIDS, Nutrition
and BF, Diarrhea,
Immunization, and MNC;
• Piloted and scaled up Home
Based Management of Fever
(e.g. CCM for suspected
malaria)
• Also formed “Pastors Care
Groups” from 11 church
denominations

4. Umucyo Results – Malaria
Pregnant Women Who Slept Under an ITN Last Night
0%
20%
40%
60%
80%
100%
Baseline KPC Midterm KPC Final KPC Rwanda DHS
2001 2004 2006 2005

5. Umucyo Project Impact:
Estimated Annual Mortality Reduction using LiST
Using the Lives Saved Tool (LiST) to estimate mortality
impact of the project, the annual U5 mortality rate
decreased by 7 per year in the project area.
In contrast, sub-analysis of the DHS found that U5
mortality in the same region was getting worse – U5
Mortality increased by 3.4 per year.
Source: Community-based intervention packages facilitated by NGOs
demonstrate plausible evidence for child mortality impact. (Health Policy and
Planning, 2013: 1-13. Jim Ricca, Nazo Kureshy, Karen LeBan, Debra Prosnitz, and
Leo Ryan)

6. Kabeho Mwana Expanded Impact CSP
Concern Worldwide, IRC, World Relief (2006-2011)
Location: 6 districts in Southern
and Eastern Rwanda
Total Population: 1.67 Million
Project Focus:
• Support to MOH Scale up of
iCCM (Diarrhea, malaria, pneumonia)
• Promotion of Key Family
Practices – using Care Groups
(we thought)
MOH Mandate:
Work only with Government
CHWs

7. CHWs in Rwanda
4 CHWs per Village at time of project
2 CHWs (Male-female ‘binome’) for iCCM
1 CHW for Maternal Health (female)
1 CHW for Social Affairs (male or female)
Workload: Each CHW is responsible for the entire
village (60-80 HH), focused on their technical areas of
specialty. Emphasis on treatment over household
behaviors.
Supervision: The Community Health In-Charge at the
Health Center is responsible for supervision of CHWs.

8. Care Groups  CHW Peer Support Groups
• CHWs from 2-5 neighboring villages organized
into “Peer Support Groups” at cell level with up to
20 members, about half of whom were male.
• CHWs of all types were “cross-trained” in BCC,
while maintaining their specialized functions
• CHWs from the same village divided up
households (15-20 per CHW) to better support
monthly home visits for BCC.
• 3 Project Promoters per district built capacity of
CHW Cell Coordinators (elected by their peers) to
help with training and supervision of groups.
Violates Care Group Criteria  Peer Support Groups

9. CHW Peer Support Groups
CHW
Group
CHW
Group
CHW
Group
CHW
Group
Cell Coordinator
Health Facility-based
In-Charge of Community Health
Slide courtesy of Jennifer Weiss, Concern Worldwide

10. Outputs and Impact using
Peer Support Groups
• Trained 13,166 CHWS (all cadres) in 660 groups to
do BCC for C-IMCI during monthly home visits
and community mobilization.
• Trained over 6,100 CHWs and 88 health centers
to implement iCCM
Re-analysis of the Rwanda DHS (2005-2010) found
that U5 mortality rates decreased more in project
districts than non project districts.
(Data currently undergoing peer review for
publication. )

11. Benefits of Umucyo Care Groups
• Afforded closer supervision
• Better ratio of households per volunteer or
CHW (10 vs. 20)
• More frequent home visits (2/month vs.
1/month).
• Impact on household behavior was greater
but in a smaller population

12. Benefits of CHW Peer Support Groups in
Rwanda Context
• Directly supported and improved MOH CHW system;
scalable (but not nationally adopted)
• Impact was at greater scale –
– 18% of country; 1.6 Million population
– caveat: budget and interventions were different than
Umucyo
• Helped CHWs integrate and coordinate their
activities, including CCM
• Like Care Groups, contributed to CHW motivation,
improved supervision, and increased social capital.
• Gender balance strengthened male involvement

13. Thank You