Statement of the Problem
Community health workers (CHWs) are
increasingly recognized as a critical link in improving access to services and
achieving the health-related Millennium Development Goals. Given the financial
and human resources constraints in developing countries, CHWs are expected to
do more without necessarily receiving the needed support to do their jobs well.
How much can be expected of CHWs before work overload and reduced
organizational support negatively affect their productivity, the quality of
services, and in turn the effectiveness of the community-based programs that
rely on them.
Even if the MOH provides different incentives like monthly top
up, Community PBF, Trainings, Provision of materials and equipment's to
Community Health Workers in order to improve the service they gave in maternal
and newborn health services, the objectives of MOH are not yet achieved:
According to the DHS (2010), report indicated the persistent
high maternal mortality rate where out of 100,000 women that gave birth 476
deaths occurred within 42 days. According to MDGs this indicator must be
reduced to 268/100,000 by 2015. Where the evolution of this indicator was:
· 2000:1071/100.00 lives birth (DHS 2000)
· 2005:785/100.000 lives birth (IDHS2005)
· 2008:540/100.000 lives birth (Rwanda HMIS 2008)
· 2010: 476/100.000 lives birth (RDHS2010)
· 2015: 210/100.000 lives birth (DHS 2014/2015)
In 2008, with the introduction of community based maternal
and newborn health implemented by motivated CHWs in charge of maternal and
newborn health up to now we are observing the improvement in maternal health
where the current statistics shows 210/100,000 lives birth (Rwanda, DHS
2014/2015) and our study is assessing if there a contribution of CHWs in charge
of MNH on improving maternal and newborn health services. Rwanda is observing
also an improvement in fertility ration where 6.1(DHS2005), 5.5(RIDHS200-2008),
4.6(DHS2010) and 4.2(DHS2014/2015) since the past ten years. Birth occurred in
health facilities by skilled provider have been improved in last fifteen years
from 27% in 2000 to 91% in 2015. The figures before 2008 and after 2008 with an
introduction of community based maternal and newborn health implemented by
motivated CHWs in charge of maternal and newborn health shows 27% (RDHS2000),
28% (RDHS2005), 45% (RIDHS2007-2008), 69% (RDHS2010) and currently 91%
(RDHS2014-2015).
By 2015, Millennium Development Goal 5 (MDG 5) sets a target
of 75 percent reduction in maternal mortality, from 400/100,000 live births to
100/100,000 between the 1990 baseline and 2015. Although progress has fallen
short of achieving this MDG by 2015, every region of the world has made
important gains, and globally, maternal mortality has fallen by 45 percent over
the past two decades (WHO, 2014).
In April 2014, the World Health Organization, Maternal Health
Task Force, United Nations Population Fund, USAID and the Maternal Child Health
Integrated Program, and representatives from 30 countries agreed on a global
target for a maternal mortality ratio (MMR) of less than 70/100,000 live births
by 2030, with no single country having an MMR greater than 140. This will
require that we collectively build on past efforts, accelerate progress and
ensure strong political commitment from all stakeholders (WHO, 2014).
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