Community Health Workers Champion Postnatal Home Visits in Rwanda

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Rwanda DHS 2010 showed that the maternal mortality ratio is high at 476/100,000 live births, while neonatal mortality is 27/1000 live births. The post-natal period is a critical time for the survival of both mother and newborn.  Studies have shown that post-natal home visits (PNHVs) by community health workers (CHWs) contribute to the reduction of neonatal mortality. Rwanda has incorporated PNHV by maternal and newborn CHWs, Agent de Santé Maternelle (ASMs), into its strong CHW system. ASMs visit women during the antenatal period and support them to seek antenatal care (ANC) and delivery at a health facility. They also visit the mother and newborn during the postnatal visits. Women who deliver at home are visited immediately and supported to seek postnatal care (PNC) from the health facility.

Methodology: ASMs record all data related to their antenatal and postnatal home visits in their assigned registers. This is then entered into the Community Health Management Information System (CHMIS).  Data from the 2014 CHMIS was analyzed to assess the progress of the PNHVs.

Results: Approximately, 64% of all home deliveries, both mother and baby, were accompanied by ASMs to a health center for PNC. Over two thousand children less than 2 months of age were identified as sick based on observed danger signs and referred to health centers by ASMs.  Among 136,294 women who gave birth during the year 2014, 39% of couple mothers/new born received PNHV 1 and 36% received PNHV 2 by ASMs.

Conclusion: Rwanda has made significant progress to provide support to mothers and newborns during the critical postnatal period.  ASMs conducts PNHVs as part of a broader continuum of MCH services.  Key lessons learned would improve the current services and also assist other countries as they seek to introduce or expand their PNHV programs.