Enabling Linkage Of Pregnant Women Into The Healthcare Ecosystem By Building Community Health Worker Programs Trusted By The Community

Authors

Ishimwe, Angele Bienvenue; Uwitonze. Annick Gloria; Nsubuga, Diana Nambatya, PhD; Leonard, Wendy, MD

Background

Despite numerous safe motherhood campaigns happening in Rwanda, only 47% of pregnant women complete the 4 standard Antenatal Care Visits (ANC), while 56% attend the first standard visit. This is a threat to the achievement of the 2030 Sustainable Development Goal (SDGs) agenda which is aiming to reduce maternal mortality while providing equitable access to maternal healthcare services. A strong bond between a nurse who is providing care to pregnant women brings a mother back to the Health Center  (HC) to seek her ongoing prenatal care. Due to social and cultural structure, nurses fail to create a trustful relationship as they only focus on treatment and clinical aspects. On the other hand, Community Health Workers (CHWs), establish a strong and trustful relationship with pregnant women due to the trust of their communities and knowledge of both the personal and medication history of pregnant women. Evidence showed that CHWs-led perinatal home visits improve pregnancy health behaviors, success in following ANC visits,  and led to improved pregnancy outcomes. Pregnant women in the community lose their trust in CHWs if they are not manifested as experts in their work and if they are not equipped or supported by the health system. This broken relationship mitigates any other linkage they could make in the health system.  

Purpose

Role of CHWs in optimizing maternal and child healthcare outcomes. 

Methodology

A phenomenal qualitative design was conducted to understand how CHWs play as a bridge  between pregnant women and nurses at the health facility. Focus groups and in-depth interviews were conducted with CHWs and with pregnant women. Meta-analysis and the Social-Ecological model were used for the analysis. 

Results

CHWs reported that compassion and kindness towards mothers create trust. This is facilitated by their reputation in the village and their skills.  However, they expressed a need to be valued and recognized by the system as it inspires them to be visionaries with proper skills. Pregnant women expressed that they are more open to CHW than nurses because they know and understand their life experiences and provide the day-to-day guidance and support they need. This mutual respect presented by mothers is mitigated by intimidation due to power dynamics when it comes to nurses. Nurses refer to CHWs’ observation to provide ongoing and personalized care to pregnant women. This not only increases the quality of healthcare at the HC but also decreases the burden on the health system. 

Conclusion/ Findings

Primary care is possible when the community is facilitated to access care at their nearest possible with a professionalized CHW. Health systems need to create a strong linkage in the healthcare ecosystem to facilitate the community to access each level of care without feeling overwhelmed by fear of superiority.  This is possible with a national will to assist CHWs in getting the support they need to provide high-quality care to mother and their children.

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