Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

Langston, Anne; Weiss, Jennifer; Landegger, Justine; Pullum, Thomas W.; Morrow, Melanie; Kabadege, Melene; Mugeni, Catherine; Sarriot, Eric

doi:10.9745/ghsp-d-14-00067

Cited by 33 publications

(30 citation statements)

References 9 publications

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“…One of the reasons suggested is lack of sufficient information about ANC services, and partners who directly or indirectly through threats or actual violence stop them from going to ANC clinics 42 43. This may not be true in Rwandan settings where there is a highly successful sensitisation and education effort by CHWs to support the community on health-related issues such as ANC services attendance 44. Each village of ∼100–150 households in Rwanda has about four CHWs for this purpose 45.…”

Section: Discussionmentioning

confidence: 99%

Intimate partner violence among pregnant women in Rwanda, its associated risk factors and relationship to ANC services attendance: a population-based study

et al. 2017

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ObjectivesTo investigate the prevalence of four forms of intimate partner violence during pregnancy in Rwandan women, associated sociodemographic and psychosocial factors and relationship to antenatal care service usage.DesignThis was a cross-sectional population-based study conducted in the Northern province of Rwanda and in Kigali city.Participants and settingsA total of 921 women who gave birth within the past 13 months were included. Villages in the study area were selected using a multistage random sampling technique and community health workers helped in identifying eligible participants. Clinical psychologists, nurses or midwives carried out face-to-face interviews using a structured questionnaire. Bivariable and multivariable logistic regression were used to assess associations.ResultsThe prevalence rates of physical, sexual, psychological violence and controlling behaviour during pregnancy were 10.2% (95% CI 8.3 to 12.2), 9.7% (95% CI 7.8 to 11.6), 17.0% (95% CI 14.6 to 19.4) and 20.0% (95% CI 17.4 to 22.6), respectively. Usage of antenatal care services was less common among women who reported controlling behaviour (OR) 1.93 (95% CI 1.34 to 2.79). No statistically significant associations between physical, psychological and sexual violence and antenatal care usage were found. Low socioeconomic status was associated with physical violence exposure (OR) 2.27 (95% CI 1.29 to 3.98). Also, young age, living in urban areas and poor social support were statistically significant in their associations with violence exposure during pregnancy.ConclusionsIntimate partner violence inquiry should be included in the standard antenatal care services package and professionals should be trained in giving support, advice and care to those exposed. Gender-based violence is criminalised behaviour in Rwanda; existing policies and laws must be followed and awareness raised in society for preventive purposes.

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Section: Discussionmentioning

confidence: 99%

Intimate partner violence among pregnant women in Rwanda, its associated risk factors and relationship to ANC services attendance: a population-based study

et al. 2017

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“…NGOs can disseminate proven community-focused MNCH interventions by sharing innovative community health strategies with other NGOs [27], other health actors, and national Ministries of Health [28, 29] to improve service delivery and child nutrition. This requires fiscal and operational flexibility to dedicate sufficient resources to develop the capacity of key stakeholders and organizations to address complex MNCH challenges.…”

Section: Conceptual Frameworkmentioning

confidence: 99%

Institutionalizing community-focused maternal, newborn, and child health strategies to strengthen health systems: A new framework for the Sustainable Development Goal era

Story

LeBan²,

Altobelli

et al. 2017

Global Health

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BackgroundStronger health systems, with an emphasis on community-based primary health care, are required to help accelerate the pace of ending preventable maternal and child deaths as well as contribute to the achievement of the Sustainable Development Goals (SDGs). The success of the SDGs will require unprecedented coordination across sectors, including partnerships between public, private, and non-governmental organizations (NGOs). To date, little attention has been paid to the distinct ways in which NGOs (both international and local) can partner with existing national government health systems to institutionalize community health strategies.DiscussionIn this paper, we propose a new conceptual framework that depicts three primary pathways through which NGOs can contribute to the institutionalization of community-focused maternal, newborn, and child health (MNCH) strategies to strengthen health systems at the district, national or global level. To illustrate the practical application of these three pathways, we present six illustrative cases from multiple NGOs and discuss the primary drivers of institutional change. In the first pathway, “learning for leverage,” NGOs demonstrate the effectiveness of new innovations that can stimulate changes in the health system through adaptation of research into policy and practice. In the second pathway, “thought leadership,” NGOs disseminate lessons learned to public and private partners through training, information sharing and collaborative learning. In the third pathway, “joint venturing,” NGOs work in partnership with the government health system to demonstrate the efficacy of a project and use their collective voice to help guide decision-makers. In addition to these pathways, we present six key drivers that are critical for successful institutionalization: strategic responsiveness to national health priorities, partnership with policymakers and other stakeholders, community ownership and involvement, monitoring and use of data, diversification of financial resources, and longevity of efforts.ConclusionWith additional research, we propose that this framework can contribute to program planning and policy making of donors, governments, and the NGO community in the institutionalization of community health strategies.

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“…Four international experts on supportive supervision in Sub-Saharan Africa who had published on the matter [13,27,43,44], assessed the relevance of items. We knew of these experts only through their publications, which we considered important points of reference for supportive supervision in Africa.…”

Section: Methodsmentioning

confidence: 99%

Development and validation of the ExPRESS instrument for primary health care providers’ evaluation of external supervision

Schriver

Cubaka

Vedsted

et al. 2018

Global Health Action

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Background: External supervision of primary health care facilities to monitor and improve services is common in low-income countries. Currently there are no tools to measure the quality of support in external supervision in these countries. Aim: To develop a provider-reported instrument to assess the support delivered through external supervision in Rwanda and other countries. Methods: “External supervision: Provider Evaluation of Supervisor Support” (ExPRESS) was developed in 18 steps, primarily in Rwanda. Content validity was optimised using systematic search for related instruments, interviews, translations, and relevance assessments by international supervision experts as well as local experts in Nigeria, Kenya, Uganda and Rwanda. Construct validity and reliability were examined in two separate field tests, the first using exploratory factor analysis and a test–retest design, the second for confirmatory factor analysis. Results: We included 16 items in section A (‘The most recent experience with an external supervisor’), and 13 items in section B (‘The overall experience with external supervisors’). Item-content validity index was acceptable. In field test I, test–retest had acceptable kappa values and exploratory factor analysis suggested relevant factors in sections A and B used for model hypotheses. In field test II, models were tested by confirmatory factor analysis fitting a 4-factor model for section A, and a 3-factor model for section B. Conclusions: ExPRESS is a promising tool for evaluation of the quality of support of primary health care providers in external supervision of primary health care facilities in resource-constrained settings. ExPRESS may be used as specific feedback to external supervisors to help identify and address gaps in the supervision they provide. Further studies should determine optimal interpretation of scores and the number of respondents needed per supervisor to obtain precise results, as well as test the functionality of section B.

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Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation

Cited by 33 publications

References 9 publications

Intimate partner violence among pregnant women in Rwanda, its associated risk factors and relationship to ANC services attendance: a population-based study

Intimate partner violence among pregnant women in Rwanda, its associated risk factors and relationship to ANC services attendance: a population-based study

Institutionalizing community-focused maternal, newborn, and child health strategies to strengthen health systems: A new framework for the Sustainable Development Goal era

Development and validation of the ExPRESS instrument for primary health care providers’ evaluation of external supervision

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