678 doctors. 11.92 million citizens. Those are the statistics in Rwanda. That’s one doctor for every 17, 581 people. Yet they manage to have 98% vaccination coverage for seven essential childhood vaccines. I have spent a year looking at this data, and every time I read this I am still blown away. The really interesting and important question is: how? How is a statistic like that even possible?
Our team has looked into a whole host of explanations, but the one I find most interesting is the immense presence of Community Health Workers (CHWs) in Rwanda. Since 2009, the Government of Rwanda has rolled out an extensive CHW program, with 45,000 operating around the country. These exceptional women and men:
- Monitor people living with HIV;
- Provide referrals to the various levels of clinic and hospital care;
- Rapidly diagnose malaria;
- Counsel their communities on nutrition, sanitation and hygiene, and HIV prevention;
- Monitor tuberculosis patients with their treatment routines;
- Teach family planning and provide condoms;
- Provide the full range of support required by pregnant women, new mothers, and newborns;
- And of course, educate their community about the importance of vaccinations while keeping track of which children need to be vaccinated.
Sounds like quite the job description!
In each community across Rwanda, there are three CHWs, ensuring that each of the above is managed for the 100-150 individuals they are personally responsible for. One female CHW specifically supports maternal and child health and a binome pair (one woman, one man) supports all of the other activities included above. As a team, these CHWs are truly at the frontline of healthcare. Their understanding of who is in their community is integral to identifying who should be vaccinated, and their educating role helps people understand exactly why vaccinating their children is so important. By empowering members of each community to manage the health of everyone (including those who are hard-to-reach), the Rwandan government has expanded their reach of vaccination services throughout this beautiful country. I am very much looking forward to meeting some of these incredible men and women.
By Heather McAlister