Evaluation of the community health programme in Rwanda

Community health worker handing a baby to her mother

This independent evaluation aims to document the Rwanda community health programme, assessing programmatic achievements and constraints. It will review the existing conceptual framework and overall system, including financial support, management structure, supervision mechanism and governance.

The objective of the evaluation is to understand whether the Community Health Programme has achieved its intended objectives, thus contributing to the overarching objectives of improving the health status of the population by ensuring universal accessibility of quality health services for all Rwandans.

The objectives of the Community Health Programme, as defined through the National Community Health Strategic Plan 2013-2018, are to:

  1. Strengthen the capacity of decentralised structures to allow community health service delivery.

  2. Strengthen the participation of community members in the community health activities.

  3. Strengthen Community Health Workers Motivation through Community-Performance-Based Financing to improve health service delivery

  4. Strengthen coordination of community health services at the central, districts, health centres and community levels.

LSTM-CMNH’s approach entails evaluating the community health strategy nationwide. To ensure robustness and representativeness of the findings, and taking into account the complexity of the intervention (multiple stakeholders, multiple inputs-resources, funding streams,) the evaluation will rely on mixed methods of data collection and analysis. To explore to what extent the community health programme has contributed to improve the health status of mothers, newborn and children, the LSTM-CMNH team will analyse secondary data, using a retrospective stepped-wedge analysis method. The “how” and “why” will be explored through a contribution analysis, which will be informed by literature review and primary quantitative and qualitative data. The LSTM-CMNH team will carry out a cross-sectional survey at health facility level and at Community Health Workers level, and will conduct Key Informant Interviews and Focus Group Discussions with main stakeholders and beneficiaries.

The proposed evaluation will provide an independent assessment of the Community Health Programme in Rwanda against the following criteria: impact, relevance (put impact first), effectiveness, efficiency and sustainability (including partnership). The dimension of human rights and equity will also be addressed, as this is of interest to UNICEF and to the Ministry of Health in Rwanda. It is envisaged that the evaluation findings will inform the improvement/refinement of the design and delivery of the intervention nationwide