Ninety percent (90%) of Rwandan children are immunized against preventable diseases according to the 2010 Demographic Health Survey.
Three major factors have contributed a great deal to this achievement. Political will and government commitment through the ministry of health, the role of Community health workers and the use of mobile technology are the main factors that have contributed to the success of immunization campaigns in Rwanda.
Jered Muhoza, the director of immunization and safety at the Expanded Program on Immunization in the ministry of health note that immunization programs have enabled Rwanda to reach the Millennium Development Goal 4 on reducing under-five mortality rates. He commended that Rwanda is on the right track when it comes to immunization compared to other Sub-Saharan African countries as child mortality has reduced from 156 deaths per 1,000 children to 54 deaths per 1000 children born annually according to a report by UNICEF. Note that the government of Rwanda spends $ 2 million on vaccines every year.
The program immunizes children aged 0 to 11 months but also adolescent girls and pregnant women against 11 preventable diseases. Apart from the vaccine against virus papilloma to adolescent girls and vaccine against Tetanos for pregnant women, other routine vaccines are used to immunize children under one year old. The program plan a supplement in Vitamin A for children aged 6 to 59 months and women in post-partum up to 6 weeks. Anti- Diarrhea (rotavirus vaccine) have also been launched by the government in partnership with Global Alliance for Vaccines and Immunization (GAVI) and will be part of the national vaccination program. Rwanda has also been the first sub-Saharan African country to roll out measles and rubella vaccination with the support of the GAVI Alliance, WHO, UNICEF and other partners.
Community health workers role
The coordination from the central level in the ministry of health to the low level in the villages has played a key role in this success. Community health workers ( CHW ) in villages have been praised for their contribution in the sensitization of the population in immunization campaigns. In Rwanda every village has at least three community health workers. “They are trustworthy members of the community that have been elected by the population to take care of issues concerning health at the community level”, said Cassien Havugimana the program manager at a local NGO Health Development Initiative.
Rwanda has 45011 community health workers that serve the population in health related issues in more than 460 health centers around the country. Each village (100 to 200 households) elects three volunteers to act as CHWs for the general population – a binome comprising of a man and a woman for general diseases and a woman as assistant to follow antenatal care, women after delivery and children below 9 months according to a blog post by the minister of health Dr Agnes Binagwaho. The minister note that once elected the CHWs are trained by the Ministry of Health throughout the country to deliver quality services and to monitor health at village level and to refer sick patients to the nearest health facility.
“During vaccination campaign, the role of community health workers is to make a list of children who need to be vaccinated “ remark Mme Catherine Mugeni the coordinator of CHWs in the ministry of health. She said that CHWs have a notebook where they write all the information about children under 5 years old in every village with vaccines that they must have. During campaigns that are held twice a year, they inform parents where the vaccination will take place. Before the campaign, community health workers go to health centers to receive explanations of the vaccine so that they can go in the villages to sensitize parents.
President Paul Kagame recognizes the role of CHWs and joined renowned global personalities at the beginning of this year to unveil “One Million Community Health Workers Campaign” in Davos, Switzerland. President Paul Kagame and Novartis CEO Joseph Jimenez joined Earth Institute Director Jeffrey Sachs to announce the campaign, which will be overseen by a steering committee at the Earth Institute and will be run through the United Nations Sustainable Development Solutions Network.
Mobile technology impact
Mobile technology directly connect community health workers at village level to the high level in the ministry of health. Mme Catherine Mugeni point out that the Government of Rwanda has established a Community Health Information System (CHIS) to support the national community health worker program that allows CHWs to report basic data about their program, such as the number of children to be vaccinated.
mUbuzima, is an application that builds on Rwanda’s mobile phone infrastructure and support Community Health Workers. It allows Community health workers to enter and transmit CHIS indicators in real time – even in remote parts of the country using only a mobile phone. Officials at the Ministry of Health, districts and health centers can log on to the mUbuzima website to access up-to-date data on many aspects of the CHW national program such as immunization. The Ministry of Health can also send educational messages to Community health workers that can guide them to reach out to parents to bring their children for vaccination.
RapidSMS is another mobile phone application that is used by the ministry of health to support the work of community health workers. It was designed specifically to support maternal, neonatal and early child health at the community level and to save mothers and newborn lives according to Royal Tropical Institute. The tools help community health workers (CHWs) to track pregnant women, monitor antenatal care, identify and refer women at risk, and improve communication with health facilities in the case of emergencies.