“We are no longer overwhelmed by sick patients coming to the health center. The cases of fever are treated at the community level, and we are delighted to have found work for our community health workers.”

Health providers at Masaka Health Center breathed a collective sigh of relief last year when they did not see a deluge of malaria patients straining the capacity of their health facility. Sister Scholastic, a nurse in charge of childhood illness, credits health workers from the Home-Based Management (HBM) of Fever Program for considerably reducing the number of serious malaria cases registered at the center. Malaria is the leading cause of morbidity and mortality in Rwanda, contributing to almost half of health facility visits.

Introduced by IntraHealth International’s Twubakane Program last year, the HBM initiative trains community volunteers to identify and manage malaria outbreaks in their districts. When appropriate, they provide timely referral of severe cases to district health facilities. Working in close collaboration with health centers, community health workers provide information on malaria prevention, support early management and detection of malaria and distribute anti-malarial medications. They also detect other illnesses in children under five and counsel caretakers of children on good health practices.

Therese M. is 54 years old and a community health worker in Kicukiro District. She is one of the 85 volunteers supervised by the Masaka Health Center. Without fail, Therese can be seen making the 15-kilometer trip to the center to obtain medical supplies for her community. She also provides health center authorities with a regular report of malaria cases in her area. Despite the long journey, Therese travels to Masaka Health Center at least twice a month. She and other workers in Kicukiro are well-known for their contributions to the community. “If we could find a partner to give us bicycles to facilitate transport, we would be very content,” she says.

Verena M., a 30-year-old mother of four, praises Muganga, another health worker assigned to the Masaka Health Center. Muganga treated two of Verena’s children in the community. “Before our neighbor began giving medicine to our children in the home,” says Verena, “I always had trouble finding the money I needed for consultation fees to bring [them] to the health center. I was forced to drive to the hospital, where I had to pay so much that I was forced to sell my goats. Thanks to Muganga I’ve taken my two young children to her, and I paid only 50 Rwandan Francs [nine cents] per child [for medicine], and they have all been cured.” Verena and other parents are proud to see their children treated by their neighbors at a cost aff ordable to everyone.

Therese, Muganga and other workers in Kicukiro District have treated a total of 337 children under the age of five and have referred about 100 children to health facilities. There have been no cases of death among children treated at the community level, and those that were not treated but referred to the health center were all cured.

Since March 2006, the Twubakane Program has worked to orient district authorities and community leaders to HBM and to identify and train qualified volunteers to serve in their communities. To date, the Program has introduced health care providers in ten health centers in three districts to HBM and trained 42 providers to act as HBM trainers and supervisors. The Twubakane Program raised public awareness of HBM through a public information campaign and currently supports 700 community-elected health workers.

Communities have quickly seen the results of the program. In the three districts of Kigali, almost 7,500 children under the age of five were treated through HBM over six months following training. An average of 86% who received care were treated for malaria fever in less than 24 hours; 19% of children had symptoms in addition to fever and were referred on a timely basis to health centers for additional diagnosis and treatment. Providers have reported receiving cases referred by the trained community health workers. Between August 2006 and January 2007, health centers reported a 45% decline in simple malaria cases and a 66% decline in severe cases.

The Twubakane Decentralization and Health Program is funded by the U.S. Agency for International Development (USAID) and collaborates with Rwanda’s Ministry of Health, Ministry of Local Administration, Ministry of Finance and Economic Planning and Ministry of Gender and Family Promotion. Led by IntraHealth International, Twubakane’s partners are RTI International, Tulane University, EngenderHealth and VNG (Netherlands International Cooperation Agency). Local partners include RALGA (the Rwanda Association of Local Government Authorities) and Pro-Femmes.