Taking Advice from Rwanda: Why the U.S. Should Adopt a Community Based Health Care Model
Over the past 15 years, Rwanda has made remarkable progress in improving health indicators and health equity. From 2000 to 2015, maternal and under-five children mortality rates dropped roughly 75% — a monumental decrease in a very short period of time.
A core group of people is at the center of this success: Community Health Workers (CHWs). Over 45,000 CHWs volunteers work in 14,873 villages across Rwanda, and are responsible for huge components of Rwanda’s health care achievements.
Given that a large portion of Rwanda’s population lives in rural areas, access to health care is often challenging and time consuming. Going to a health center or hospital can require walking hours to receive needed treatment or preventative care.
CHWs address this issue of access by serving as an intermediary between the community and formal health system, bringing primary health care to patients’ homes, in every village. They also fill a large human resource gap in the Rwandan health system by providing services where there are often no nurses or doctors available.
Every village in Rwanda (each made up of roughly 50 to 150 households) has three CHWs, two female and one male. One female CHW is dedicated specifically to maternal and child health. They are responsible for a wide variety of tasks including:
· Administering ARV medication to HIV positive people at home.
· Screening pregnant and lactating women, and children for malnutrition.
· Leading nutrition education sessions in villages.
· Conducting fever screenings for malaria and TB at home.
· Home-based provision of contraceptives.
Even in rural settings, through mobile technology (see below), CHWs are also connected to the Rwandan national health system to guarantee good care, as well as advanced, centralized data collection.
The ability of CHWs, who work primarily as volunteers, is an impressive testament to Rwanda’s ability to make progress at such a fast rate. CHWs’ respected status within their community makes them effective at disseminating health messages and ensuring the health of their community; this is a role that is often lacking within Western countries.
For those living in the United States, an integrated community-based model rarely exists. Current events, with an ongoing influx of refugees from all over the globe into the U.S., and growing health and economic inequity, are only stronger evidence of the growing need for a community health care model.
The American health care system can be complicated and hard to understand for anyone, but especially for those who are new to the country, and do not speak English. There are thousands of immigrants and refugees streaming into the U.S.; all must adjust to new health care systems in unfamiliar places, and find new ways to get needed medications and treatment. It is overwhelming, and scary.
Just as in Rwanda, where CHWs fill a needed gap, CHWs can be a solution to many of the problems immigrants can have adjusting to a new life in the United States. They can help community members find primary care physicians, get the medications they need, and even stop by their homes regularly to make sure diabetics take their diabetes medication. These services can be especially helpful when CHWs speak the languages that members of their communities speak, allowing everyone to communicate most effectively.
Further, for American-born citizens, there continues to be a need for a community based health care model. By providing preventative health care services in communities, CHWs can help improve health, and reduce expensive treatments in the long-term.
In both urban and rural settings, CHWs can also provide counseling at local community centers, educate on issues like good nutrition and disease prevention, and ensure that elderly have access to the food they need. They can be a resource to accompany someone to the emergency room, or help someone find for health insurance.
The services CHWs could provide for Americans would strengthen our health care system and help provide quality health care for all. Yet in the U.S., this sort of community health care model, with an organized CHW system, does not exist.
Luckily, there are movements now to make CHWs a stronger part of our health system. The Affordable Care Act allows for non-licensed providers (i.e. CHWS) to provide preventative services, though states must develop their own training services and a structured and defined CHW role.
States such as Massachusetts have begun making these strides, but are nowhere near the level of Rwanda’s system. Nonprofits have also worked to fill this gap, but at a smaller scale.
As one of the world’s most powerful countries, it’s time that the U.S. follows the progress of Rwanda and addresses the huge health inequities within its borders at the national level. A system of CHWs is a sustainable way to address many of the gaps in the American health system, for both immigrants and rural and urban American-born citizens, while working to achieve health equity for all.
Mimi Frisch is a 2015–2016 Global Health Corps fellow at the Ministry of Health in Rwanda. All GHC fellows, partners and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. Join the movement today.
