Back in 2000, only about a quarter of mothers in Rwanda delivered their babies in health facilities. Instead, most women gave birth at home, with or without the help of trained birth attendants. And that same year, more than one-tenth of Rwandan babies died in infancy.¹

Today, though, almost 70% of Rwanda’s mothers are giving birth in health facilities. And infant mortality has dropped by half.² These are huge accomplishments that, according to Dr. Fidel Ngabo of Rwanda’s Ministry of Health, are largely thanks to Rwanda’s 54,000³ community health workers.

“CHWs [community health workers] have played a big role in the increase of this number, as they follow up and make sure that women don't give birth at home but in health facilities,” he told The New Times. “They have also been given phones, so they can call in case there's need for an ambulance or further medical assistance."

Community health workers are the first line of care in many African countries. And while these workers don’t receive the same extensive formal training as nurses or doctors, they are taking on more and more responsibilities in their regions. Millions of people worldwide depend on them for maternal and child health care, family planning, counseling and referrals for HIV and malaria, and various other services.

To keep up with the demands on their time, community health workers have to be highly productive and efficient. According to a new paper by IntraHealth’s Wanda Jaskiewicz and Kate Tulenko, workload and work environment can directly affect a worker’s performance.

Workers need regularly replenished supplies, medicines, and equipment to carry out their tasks efficiently—and keep the trust and respect of their communities, Jaskiewicz and Tulenko say. They also need high-quality supervision, often one of the weakest links in the community health worker program. Without these, the workers’ morale and productivity can quickly drop. (Jaskiewicz and Tulenko have several recommendations for improving work environment here.)

By establishing balanced, well-managed working environments, policy-makers and program managers can help community health workers do their best work. If the numbers are any indication, it’s working in Rwanda. 

Read more:

• Working Conditions for Community Health Workers
• IntraHealth’s work in Rwanda
• Family Planning in Rwanda: How a Taboo Topic Became Priority Number One [466 kb pdf]

1. http://www.measuredhs.com/pubs/pdf/FR215/FR215.pdf

2. http://www.measuredhs.com/pubs/pdf/PR7/PR7.pdf

3. http://www.hrh-observatory.afro.who.int/images/Document_Centre/rwanda_hrh_country_profile.pdf