The Bill & Melinda Gates Foundation have been quick to recognise the importance of monitoring and evaluating the scaling up of the CHC Approach in Rwanda, through the Presidential Initiative which has directed everyone of the 15,000 villages in the country to start CHCs, through the Community Based Environmental Health Promotion Programme (CBEHPP). The latest figures show that already over 12,000 CHCs have been registered, and 18% have started the training of the community.
When this programme was highlighted at a recent presentation given by the Directors of Africa AHEAD in Seattle at the Gates Foundation Campus, in October, 2011, there was an immediate response. Headed by Jeff Raikes, the man who invented Microsoft Office, the culture of innovation is strong at the Foundation. No messing around like so many of the complacent old Agencies have done for years in the face of the CHC opportunity. At Gates there is a genuine committment to find responses that work at scale. This was shown by a high powered Conference convened in November bringing together top experts to discuss ‘Impact at Scale’, idenfiying the use of Community Health Workers as a key strategy. Thanks to this participation Africa AHEAD was able to show case the CHC approach which enables Community Health workers to be so effective spreading their influence through the structure of a CHC. Within two months they had identified a highly experienced team to visit Rwanda and see for themselves if it the CHC approach is as good as it claims!
Between 11th – 16th November, 2011, the Environmental Health Department of the Ministry of Health made them welcome and a meeting of all stakeholders was convened in Kigali. A field visit to Rulindo District, appears to have convinced the Gates Team this is no scam… CHCs are indeed mushrooming across the country, and officials everywhere are responding to the challenge to scale up within the year.
Having verified the CHCs in the field to their satisfaction they are now planning how to evaluate the programme over the next four years, providing for the first time an objective research into the cost-effectiveness of the CHC approach at scale.
Africa AHEAD, will be back stopping the Ministry of Health, building capacity for the monitoring and quality control for the programme, and hope to be able to demonstrate how to optimise the methodologly and pave the way for a successfull process of scaling up throughout Rwanda.
There are already NGO partners identified for almost all the districts, with World Vision taking 12 districts, Unicef and WaterAid both doing 2 districts, and Unicef already implementing in 4 districts, with numerous smaller NGOs taking part at sector level. There is still much work to be done to coordinate this programme and ensure the CHC approach looses nothing by replication. It is important that CBEHPP is properly monitored and documented, but we are confident that with the expectation of the spot light that can be shone on the project by the Gates Foundation, it will progress. Rwanda, a tiny country in the heart of Africa is going to shine, when the MDG tally is made in 2015.