In Rwanda, MCHIP is expanding and strengthening interventions to ‘count malaria out’ among pregnant women and children under five. The Program will support Rwanda’s strategy for the prevention and treatment of malaria in pregnancy (MIP), including the change in the national intermittent preventive treatment policy for pregnant women, the new and increased involvement of community health workers, and community case management (CCM). By addressing malaria prevention and control comprehensively on a platform of maternal and child health services, the Program is helping Rwanda scale up services for pregnant women and young children. MCHIP’s support is directly contributing to improved human capacity development, strengthened service delivery, increased community awareness, and strengthened linkages between communities and facilities—all critical elements for ensuring healthy outcomes for women and their families.
These efforts build directly on the successful work to date through USAID’s Access to Maternal, Neonatal, and Women’s Health Services Project (ACCESS) and the Basic Support for Institutionalizing Child Survival Project (BASICS), as well as the national Twubakane Program. MCHIP will collaborate with the Rwanda Ministry of Health- Maternal Child Health desk and the National Program to Fight Against Malaria (PNILP) to accelerate successful strategies on an integrated maternal and child health platform that will improve the lives of women and their children.
Facility Level Care
MCHIP will strengthen MIP interventions with focused antenatal care (ANC) services at the district and national level. Recognizing that 94 % of pregnant women in Rwanda attend ANC, it is an ideal opportunity and platform to deliver comprehensive maternal health services to pregnant women—including counseling on sleeping under an insecticide treated bed net (ITN) and accessing prompt treatment when showing signs and symptoms of malaria. MCHIP will facilitate and support ongoing advocacy efforts targeting national and district level stakeholders, including policy makers, program managers, health workers and community leaders. These efforts will focus on maintaining continued support and empowering local leaders to implement a comprehensive platform of care for pregnant women to help prevent and control malaria. The Program will also train health providers and supervisors, and provide ongoing support to improve the quality of services using the standards based management and recognition approach.
Community Level Care
Community health workers (CHWs) and Animatrice de santé maternelle (ASM) play a central role in the provision of services in Rwanda. The Program will support ASM training and supervision to improve knowledge of the importance of ANC attendance and of sleeping under an ITN for both pregnant women and their children. In addition to strengthening ASM capacity, MCHIP will help to bridge the link between communities and health facilities to improve health outcomes for women and their children. MCHIP will also facilitate the training of CHWs to bolster CCM efforts, and print CHW tools, including registers and referral sheets that will be disseminated during refresher trainings. These efforts will help Rwanda accelerate the implementation of MIP and CCM within Rwanda’s integrated community health approach.
Information, Education, Communication (IEC) and Behavior Change Communication (BCC)
MCHIP’s support for IEC and BCC is a key component of programming efforts that will help reduce malaria incidence and ensure that MIP and infant mortality due to malaria is continuously controlled. Through work with the Rwanda MOH, the Program will finalize IEC/BCC materials targeting both MIP and CCM. To promote improved health behavior and support the implementation of the community outreach approach, MCHIP will print and disseminate these messages at the facility and community levels through trainings and supervision. These efforts will ensure:
a) Linkages between CHWs and ASMs with health facilities;
b) Correct and consistent LLINs use;
c) Early and regular ANC visits;
d) Integrated child health care and prevention at community and facility levels in Rwanda; and
e) Prompt treatment for children under 5 years.
 In 2008, Rwanda discontinued the use of IPTp based on studies that showed sulfadoxine-pyrimethamine therapeutic failures and increasing resistance.
 ASM’s are a cadre of health workers who were former traditional birth attendants but who now provide information to women concerning pregnancy and newborn health and who are responsible for encouraging women to seek ANC