Rwanda Community-based management of malaria

Rwanda has a strong community health worker (CHW) programme, with community case management provided through complementary programs of iCCM (an integrated approach for diseases including malaria, diarrhoea, and pneumonia among children under five years of age) and home-based management for malaria (HBM – management of only malaria among children at least five years of age and adults).[1] 

Currently, 57% of all malaria cases are diagnosed and treated by community health workers (CHWs) and the target is to increase this to 80% of cases being treated at community level supported by uninterrupted supply of rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACTs).[2] 

The countrywide cadre of 58,000 CHWs has two CHWs (binomes) per village trained to deliver malaria testing using RDTs and treatment at the community level. In FY 2020, 58 percent of all diagnosis and treatment of malaria in Rwanda occurred at the community level. The MOPDD uses RapidSMS (transitioning to RapidPro) a rapid, secure short message service (SMS) system introduced in late 2018 for coordination of severe malaria case referral from CHWs to health facilities and for commodities stock management.[1] 

The MOPDD conducts cascade training among CHWs at community level on malaria case management in line with the revised guidelines. Community and Environmental Health Officers (CEHOs) and CHWs are mentored on malaria case management, real time notification of severe malaria and malaria commodities stock management through RapidSMS, proper drug storage, availability of community health tools, and adherence to diagnostic and treatment algorithms. Supervisory visits are made routinely and at a minimum of every six months.