1. The Rwanda Expanded Impact
Child Survival Program
2006 – 2011
A partnership between Concern Worldwide,
the International Rescue Committee, and World Relief
2012 CORE Spring Meeting
Wilmington, DE
Jennifer Weiss, MPH; Concern Worldwide

2. Overview of Presentation
• Background and Context
• Summary of Main Project
Activities
• Lessons Learned in the Scale-
up of CCM
• Conclusions

3. Background: Project Overview
•Implemented from 2006 – 2011 in six
districts of Rwanda
•Target population: 318,000 children under
five (~18% of country)
•Objectives:
– Increase access to first line treatment for
malaria, pneumonia, and diarrhea [through
scale-up of CCM]
– Increase coverage of prevention
interventions
– Increase adoption of key family health
practices

6. Context for Scale-Up
National Strategic Health Objectives in 2006:
• Creation of Community Health Desk
• Finalization of National c-IMCI Strategy
• National election of CHWs (2 per community)
Leadership from the Highest Levels:
• Performance-based Financing
• CHW Cooperatives
• Other CHW incentives
Commitment to Learning:
• Community Child Health Technical Working Group
• CHW Performance Evaluation (2010)

7. Pathway to Scale
2004 2006 2007 2008 2009 2010 2011
Rwanda Ministry of Health
HBM Expansion • HBM • Kirehe iCCM • Rapid • Expansion • MOH
Strategic of HBM to evaluation pilot study evaluation of of iCCM to Workshop
Plan 12 of 19 • Creation of • National ToT CHW all 30 to revise
endemic Community for iCCM performance districts CHW
districts Health Desk of CCM supervision
• National • Introduction structure
iCCM of RDTs at
Strategy community
level
Kabeho Mwana Expanded Impact Child Survival Project (6 districts)
• Kabeho • CHW training • District level • CHW training • CHW • Kabeho
Mwana on CCM for ToT on iCCM in iCCM refresher Mwana ends
begins malaria and • First case of • Training of training on
diarrhea pneumonia health center iCCM
• First case of treated by data managers • RDT training
malaria treated CHW and for CHWs
with ACT by supervisors
CHW

8. Role of Partnership in Scale-Up
MoH Partnerships EIP Partnership Model
•Whole greater than the sum of it’s
• Strong collaboration with MoH
parts
Community Health Desk, Nutrition
•Working in consortium provided
Desk, and PNILP (malaria program)
opportunities to not only reach high
at highest levels
numbers of beneficiaries, but also
• Greater coordination and
facilitate program synergies and cross-
collaboration as MOH only has to
learning
liaise with one partner instead of
•Expanded Impact Program model
three
combined with consortium approach
• Stronger voice for advocacy,
maximizes potential for scale and
evidence-building through
program impact
representation at TWGs

9. Results: Expanding CCM
+ --
• EIP adjusted plans and strategies • Working within MoH timelines
to align with and support national resulted in initial project delays
strategy • RDT effect on CHW utilization(?)
• Strong partnership with districts and • Supervision is sub-optimal
health centers due to substantial • LOE of CHWs
field presence
• High CHW utilization: CHWs
became first option of caretakers
with sick child
• Ever use = 69%; within last 2
weeks = 40%)
• High levels of CHW retention

10. Conclusions
• The EIP made major contribution to national health improvements over the
last five years
• Helped to launch and scale-up CCM: 183,000 treatments in the last year
alone
• Alignment and harmonization with GOR priorities
• The coalition “worked”, internally and for the GOR
• Community-based scale-up: Role at central level came from partnering
presence in the field (district and below down to community)
• Established critical building blocks for quality monitoring and performance
improvement

11. Murakuze Cyane!!