RESUMEN
Community Health Workers (CHWs) play a vital role delivering health services to vulnerable populations in low resource settings. In Rwanda, CHWs provide village-level care focused on maternal/child health, control of infectious diseases, and health education, but do not receive salaries for these services. CHWs make up the largest single group involved in health delivery in the country; however, limited information is available regarding the socio-economic circumstances and satisfaction levels of this workforce. Such information can support governments aiming to control infectious diseases and alleviate poverty through enhanced healthcare delivery. The objectives of this study were to (1) evaluate CHW opportunity costs, (2) identify drivers for CHW motivation, job satisfaction and care provision, and (3) report CHW ideas for improving retention and service delivery. In this mixed-methods study, our team conducted in-depth interviews with 145 CHWs from three districts (Kirehe, Kayonza, Burera) to collect information on household economics and experiences in delivering healthcare. Across the three districts, CHWs contributed approximately four hours of volunteer work per day (range: 0-12 hrs/day), which translated to 127 684 RWF per year (range: 2 359-2 247 807 RWF/yr) in lost personal income. CHW out-of-pocket expenditures (e.g. patient transportation) were estimated at 36 228 RWF per year (range: 3 600-364 800 RWF/yr). Participants identified many benefits to being CHWs, including free healthcare training, improved social status, and the satisfaction of helping others. They also identified challenges, such as aging equipment, discrepancies in financial reimbursements, poverty, and lack of formal workspaces or working hours. Lastly, CHWs provided perspectives on reasonable and feasible improvements to village-level health programming that could improve conditions and equity for those providing and using the CHW system.
Asunto(s)
Agentes Comunitarios de Salud , Adulto , Agentes Comunitarios de Salud/economía , Agentes Comunitarios de Salud/educación , Agentes Comunitarios de Salud/psicología , Estudios Transversales , Atención a la Salud/economía , Femenino , Humanos , Renta , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Motivación , Rwanda , Adulto JovenRESUMEN
Infectious diseases of grave concern to human health are emerging from wildlife and livestock populations in multiple regions of the world. Responding effectively to these emerging pandemics requires engagement of multidisciplinary groups of professionals. Using a One Health approach, One Health Central and Eastern Africa (OHCEA), a network of seven schools of public health and seven veterinary schools, with the support of the United States Agency for International Development (USAID), has engaged in curriculum review with the aim of building the skills of multidisciplinary groups of professionals to improve their capacity to respond to emerging infectious diseases. Through stakeholder analysis and curriculum development workshops, the University of Rwanda's School of Veterinary Medicine, in association with Tufts University, revised its curriculum to incorporate One Health competencies to be better prepared to respond to any infectious disease outbreak in Africa. The revised curriculum aimed to build cross-sectoral skills and knowledge; transform students' ways of thinking about infectious disease outbreak response; link human, veterinary, and wildlife health training opportunities; and strengthen community frontline responder training. Eight different disciplines engaged in the curriculum review process: Veterinary Medicine, Livestock Production, Wildlife and Aquatic Resources, Environmental Health and Epidemiology, Communication Technology, Engineering, Agriculture, and Public Health. One Health competencies such as communication, collaboration, leadership, and advocacy were added to the new curriculum, helping ensure that each professional be appropriately equipped with skills to recognize and respond effectively to any emerging infections.