EXPANDED IMPACT EXPANDED IMPACT CHILD SURVIVAL PROGRAMCHILD SURVIVAL PROGRAMin six underserved districts in Rwandain six underserved districts in Rwanda

AA Partnership of Concern Worldwide, the Partnership of Concern Worldwide, the International Rescue Committee, and World ReliefInternational Rescue Committee, and World Relief

KABEHO MWANAKABEHO MWANA“Life for the Child”“Life for the Child”

““Land of a Thousand Hills”Land of a Thousand Hills”

° Small land-locked country in Central Africa Small land-locked country in Central Africa ° 8.5 million people8.5 million people° Most densely populated country in Africa, with few Most densely populated country in Africa, with few natural resources and minimal industrynatural resources and minimal industry

MTE-2009Kigali

Expanded Impact Child SurvivalExpanded Impact Child Survival

This 5 year program follows on from the earlier CSPs & pilot This 5 year program follows on from the earlier CSPs & pilot Home-based Management of Malaria within the CSPs. Home-based Management of Malaria within the CSPs.

Building on past accomplishments and the partnership to Building on past accomplishments and the partnership to implement an expanded impact child survival programimplement an expanded impact child survival program

The new program, the EIP, is significantly larger in The new program, the EIP, is significantly larger in approximately one fifth of the country (6 out of the 30 Districts approximately one fifth of the country (6 out of the 30 Districts of Rwanda with a population of approx. 1.8 million)of Rwanda with a population of approx. 1.8 million)

““contributing towards a common goal of child survival”contributing towards a common goal of child survival”

Level of Effort & Key InterventionsLevel of Effort & Key Interventions

Malaria35%

Pneumonia30%

Diarrhea35%

• ORT• Zinc• POU• Feeding practices• Hygiene practices • Prompt treatment

• Early referral of newborns • Vitamin A

• Prompt treatment • IPT• Bed nets

Strategic ObjectivesStrategic Objectives

GOALReduce child mortality in 6 districts

reaching >300,000 children under-five

OBJECTIVE 1. Increasing access

to first-line treatment

OBJECTIVE 2. Increasing coverage

of key preventive interventions

OJECTIVE 3. Increasing key family health

practices

• CCM• Reducing treatment

costs • Performance

contracting• Quality of referral

care

• District area targeting

• Essential drug management

• Strengthening outreach services

• Community mobilization & BCC

• Demonstration Care Groups

• Strengthen counseling

IMCI/QA Manager (Concern)

M&E Manager (IRC)

Mobilization Manager (World Relief)

Team Leader(Concern)

Districts

Key roles of the PVOsKey roles of the PVOs

PVO Key Responsibilities District Lead

Concern Worldwide

Overall management, external partnerships, Quality

Assurance

Gisagara

Nyaruguru

IRC Monitoring and evaluationKirehe

Ngoma

World Relief

Community Mobilization, including care groups and

behavior change

Nyamasheke

Nyamagabe

Community Mobilization & BCC (1)Community Mobilization & BCC (1)

BinomesBinomes for CCM; for CCM;

Other CHWs with specific rolesOther CHWs with specific roles

Only official CHWs can participate in Only official CHWs can participate in cooperatives organized at HCcooperatives organized at HC

Government CHW systemGovernment CHW system

Community Mobilization Community Mobilization & BCC (2)& BCC (2)

Combines additional volunteers with CHWs to assist with Combines additional volunteers with CHWs to assist with home visits and BCC home visits and BCC

Started in 2 HC areas per district, Started in 2 HC areas per district,

Now scaling up but limited to official CHWsNow scaling up but limited to official CHWs

Care GroupsCare Groups

Underlying Underlying PrinciplesPrinciples

Integrated training in management of three target diseases Integrated training in management of three target diseases

Manageable work load Manageable work load Peer support through participation in CHW Associations Peer support through participation in CHW Associations Frequent supportive supervision by health center staffFrequent supportive supervision by health center staff

Participated in tool development for CCM training, information Participated in tool development for CCM training, information management and supervisionmanagement and supervision

EIP Influence at EIP Influence at National LevelNational Level

BCC Key Messages and Job Aids for C-IMCI developed with BCC Key Messages and Job Aids for C-IMCI developed with MOH & Unicef MOH & Unicef

Successfully piloted CCM for pneumonia – EIP treated first child Successfully piloted CCM for pneumonia – EIP treated first child at community levelat community level

Scale up by population

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

Oct-04 Oct-05 Oct-06 Oct-07 Oct-08 Oct-09

Popu

latio

n w

ith C

CM

Total

Rwanda

DRC

Sierra Leone

South Sudan

Ethiopia

Uganda

Scale up by condition

24,245

0

5,000

10,000

15,000

20,000

25,000

30,000

Oct-04 Oct-05 Oct-06 Oct-07 Oct-08 Oct-09

Total Malaria Diarrhea Pneumonia

ChallengesChallenges

ExternalExternal Budget implicationsBudget implications TimingTiming

InternalInternal Harmonization of Harmonization of

organizational policiesorganizational policies Coordination of administrationCoordination of administration Reporting linesReporting lines

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