title: Plausible role for CHW peer support groups in increasing care-seeking in an integrated community case management project in Rwanda: a mixed methods evaluation.
abstract: BACKGROUND
  The Kabeho Mwana project (2006-2011) supported the Rwanda Ministry of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda's 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems.
  
  
  METHODS
  The 2005 and 2010 Demographic and Health Surveys were re-analyzed to evaluate how project and non-project districts differed in terms of care-seeking for fever, diarrhea, and acute respiratory infection symptoms and related indicators. We developed a logit regression model, controlling for the timing of the first CHW training, with the district included as a fixed categorical effect. We also analyzed qualitative data from the final evaluation to examine factors that may have contributed to improved outcomes.
  
  
  RESULTS
  While there was notable improvement in care-seeking across all districts, care-seeking from any provider for each of the 3 conditions, and for all 3 combined, increased significantly more in the project districts. CHWs contributed a larger percentage of consultations in project districts (27%) than in non-project districts (12%). Qualitative data suggested that the PSG model was a valuable sub-level of CHW organization associated with improved CHW performance, supervision, and social capital.
  
  
  CONCLUSIONS
  The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.
authors.affiliation: International Rescue Committee , New York, NY. , USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Langston
authors.affiliation: Concern Worldwide , New York, NY. , USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Weiss
authors.affiliation: International Rescue Committee , New York, NY. , USA.
authors.forename: Justine
authors.initials: J
authors.lastname: Landegger
authors.affiliation: ICF International, The Demographic and Health Surveys Program , Rockville, MD. , USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Pullum
authors.affiliation: ICF International, The Demographic and Health Surveys Program , Rockville, MD. , USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Morrow
authors.affiliation: World Relief , Baltimore, MD. , USA.
authors.forename: Melene
authors.initials: M
authors.lastname: Kabadege
authors.affiliation: Rwanda Ministry of Health , Kigali. , Rwanda.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mugeni
authors.affiliation: ICF International, Center for Design and Research on Sustainability , Calverton, MD. , USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Sarriot
mesh_terms: D019090:Case Management / Q000458:organization & administration; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D019058:Community Networks; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003967:Diarrhea / Q000628:therapy; D005260:Female; D005334:Fever / Q000628:therapy; D006293:Health Promotion / Q000458:organization & administration*; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010379:Peer Group; D012120:Respiration Disorders / Q000628:therapy; D012432:Rwanda; D012944:Social Support