Data for Program Management: An Accuracy Assessment of Data Collected in Household Registers by Community Health Workers in Southern Kayonza, Rwanda.

Community health workers (CHWs) collect data for routine services, surveys and research in their communities. However, quality of these data is largely unknown. Utilizing poor quality data can result in inefficient resource use, misinformation about system gaps, and poor program management and effectiveness. This study aims to measure CHW data accuracy, defined as agreement between household registers compared to household member interview and client records in one district in Eastern province, Rwanda. We used cluster-lot quality assurance sampling to randomly sample six CHWs per cell and six households per CHW. We classified cells as having 'poor' or 'good' accuracy for household registers for five indicators, calculating point estimates of percent of households with accurate data by health center. We evaluated 204 CHW registers and 1,224 households for accuracy across 34 cells in southern Kayonza. Point estimates across health centers ranged from 79 to 100% for individual indicators and 61 to 72% for the composite indicator. Recording error appeared random for all but the widely under-reported number of women on modern family planning method. Overall, accuracy was largely 'good' across cells, with varying results by indicator. Program managers should identify optimum thresholds for 'good' data quality and interventions to reach them according to data use. Decreasing variability and improving quality will facilitate potential of these routinely-collected data to be more meaningful for community health program management. We encourage further studies assessing CHW data quality and the impact training, supervision and other strategies have on improving it.

Knowledge and practices surrounding outbreaks and COVID-19 among community health workers in rural Rwanda: a cross-sectional mixed-methods study.

Introduction: Community Health Workers (CHW) are a critical resource for outbreak preparedness and response. However, CHWs´ ability to respond to outbreaks depends on their accurate knowledge of the disease and proper adoption of disease prevention practices. We explored knowledge and practices related to outbreaks in general, and COVID-19 among CHWs in Rwanda. Methods: this cross-sectional multimethod study used stratified simple random sampling to recruit three cadres of CHWs (agents de santé maternelle, female Binomes, and male Binomes) from three rural Rwandan districts. We used telephone-based data collection to administer quantitative surveys (N=292) and qualitative interviews (N=24) in September 2020. We calculated descriptive statistics and conducted thematic analysis of qualitative data. We assessed for associations between general outbreak-related knowledge and receipt of training using Chi-square tests and between COVID-19 related knowledge and CHW characteristics and adoption of prevention methods using linear regression models. Results: only 56.2% of CHWs had received training on any health topic in 12 months prior to COVID-19 pandemic and only 19.2% had specifically received training on outbreak preparedness. Almost all CHWs reported preventing COVID-19 by wearing facemasks (98%), washing hands (95%), and social distancing in crowds (89%) with fewer reporting staying at home (50%), sneezing or coughing into an elbow (38%) or using hand sanitizer (18%). Almost all CHWs in our study knew that COVID-19 transmits through respiratory droplets (98%) and by infected surfaces (98%) and that asymptomatic spread is possible (91%). However, fewer than half of community health workers correctly affirmed that children were at low risk of becoming severely ill (48%) and only 32% correctly rejected the misconception that everyone with COVID-19 would become severely ill. There was no association between COVID-19-related knowledge and adoption of COVID-19 preventative practices. Qualitative findings suggested that while CHWs possessed lots of correct information about COVID-19 and reported good adherence to COVID-19 prevention practices, they also commonly held misconceptions that over-exaggerated the dangers of COVID-19. Conclusion: gaps in knowledge, training, and access to information point to a need for additional investment in supervision and credible informational systems to support CHWs.

Motivations and Constraints to Family Planning: A Qualitative Study in Rwanda's Southern Kayonza District.

BACKGROUND: While Rwanda has achieved impressive gains in contraceptive coverage, unmet need for family planning is high, and barriers to accessing quality reproductive health services remain. Few studies in Rwanda have qualitatively investigated factors that contribute to family planning use, barriers to care, and quality of services from the community perspective. METHODS: We undertook a qualitative study of community perceptions of reproductive health and family planning in Rwanda's southern Kayonza district, which has the country's highest total fertility rate. From October 2011 to December 2012, we conducted interviews with randomly selected male and female community members (n = 96), community health workers (n = 48), and health facility nurses (n = 15), representing all 8 health centers' catchment areas in the overall catchment area of the district's Rwinkwavu Hospital. We then carried out a directed content analysis to identify key themes and triangulate findings across methods and informant groups. RESULTS: Key themes emerged across interviews surrounding: (1) fertility beliefs: participants recognized the benefits of family planning but often desired larger families for cultural and historical reasons; (2) social pressures and gender roles: young and unmarried women faced significant stigma and husbands exerted decision-making power, but many husbands did not have a good understanding of family planning because they perceived it as a woman's matter; (3) barriers to accessing high-quality services: out-of-pocket costs, stock-outs, limited method choice, and long waiting times but short consultations at facilities were common complaints; (4) side effects: poor management and rumors and fears of side effects affected contraceptive use. These themes recurred throughout many participant narratives and influenced reproductive health decision making, including enrollment and retention in family planning programs. CONCLUSIONS: As Rwanda continues to refine its family planning policies and programs, it will be critical to address community perceptions around fertility and desired family size, health worker shortages, and stock-outs, as well as to engage men and boys, improve training and mentorship of health workers to provide quality services, and clarify and enforce national policies about payment for services at the local level.

Utilizing community health worker data for program management and evaluation: systems for data quality assessments and baseline results from Rwanda.

Community health workers (CHWs) have and continue to play a pivotal role in health services delivery in many resource-constrained environments. The data routinely generated through these programs are increasingly relied upon for providing information for program management, evaluation and quality assurance. However, there are few published results on the quality of CHW-generated data, and what information exists suggests quality is low. An ongoing challenge is the lack of routine systems for CHW data quality assessments (DQAs). In this paper, we describe a system developed for CHW DQAs and results of the first formal assessment in southern Kayonza, Rwanda, May-June 2011. We discuss considerations for other programs interested in adopting such systems. While the results identified gaps in the current data quality, the assessment also identified opportunities for strengthening the data to ensure suitable levels of quality for use in management and evaluation.