In 2025, Denyse Murekatete noticed that a man in her community was becoming increasingly weak. His feet were swollen, his health was deteriorating, and he had been seeking help from traditional healers because he believed his condition had been caused by witchcraft.

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Concerned, the community health worker from Mukamira Sector&039;s Rubaya cell checked his blood pressure and blood sugar levels and found both were dangerously high.

She advised him to visit a health centre, where he was diagnosed with diabetes and hypertension and immediately started on treatment. Since then, Murekatete has continued to monitor him to ensure he adheres to his medication.

Today, she says, his health has improved significantly. He no longer relies on traditional healers and has quit both alcohol and smoking.

Murekatete, who has served as a community health worker for 17 years, said the programme has evolved considerably over time.

"In the past, we had to move from one household to another across several villages to identify people who needed support," she said.

Today, each village has four community health workers, allowing each of them to focus on a smaller number of households and provide more consistent follow-up.

Record-keeping has also improved. Where they once relied entirely on paper records, most patient information is now stored digitally, making it easier to track patients and plan follow-up care.

"Having a WhatsApp group has made communication much easier. During disease outbreaks, we use it to coordinate community sensitisation and advise people on how to prevent the spread of disease. Before WhatsApp, communication was much slower," Murekatete said.

She added that support from the Ministry of Health, including airtime and data, enables community health workers to quickly contact health professionals whenever urgent medical attention is needed.

"We can call for an ambulance or seek guidance on what to do. We also work closely with doctors to ensure patients receive timely care and support."

Rwanda's community health worker programme was established in 1995 with about 12,000 volunteers whose primary role was to educate communities and encourage people to seek care at health facilities.

Three decades later, it has grown into a nationwide network of more than 58,500 community health workers delivering services ranging from maternal and child healthcare to disease prevention, treatment and referrals at the community level.

According to Dr. Aline Uwimana, Maternal, Child and Community Health Division Manager at the Rwanda Biomedical Centre (RBC), community health workers begin supporting women even before childbirth.

They register women of reproductive age, identify pregnancies using urine pregnancy tests, conduct antenatal home visits, and refer or accompany pregnant women with danger signs to health facilities.

"They mobilise communities for vaccination at health facilities and encourage mothers to complete routine immunisation schedules, contributing to Rwanda's consistently high vaccination coverage. They also provide health education, behaviour change communication and counselling for pregnant women," Uwimana said.

Their support continues after childbirth through home visits, where they provide guidance on maternal and newborn care while educating families on hygiene, sanitation, nutrition and disease prevention.

At the community level, they also screen pregnant women, breastfeeding mothers and children under five for malnutrition using the mid-upper arm circumference (MUAC) method.

They provide nutrition counselling, promote exclusive breastfeeding and appropriate complementary feeding, and refer malnourished children to health facilities for treatment.

Uwimana said community health workers also manage uncomplicated cases of malaria, pneumonia and diarrhoea among children under five and refer severe cases for further treatment. They additionally provide community-based family planning services and treat uncomplicated malaria among adults.

"Their responsibilities have expanded beyond routine healthcare, especially during public health emergencies. Community health workers supported responses to outbreaks, including COVID-19, Marburg, Ebola and Mpox, by raising community awareness, reporting suspected cases and notifying authorities about maternal and child deaths," she said.

She noted that reporting has become more efficient with the introduction of the Community Electronic Medical Records (cEMR) system, which enables community health workers to capture and submit health data using mobile technology, replacing more than 15 paper registers previously used in primary healthcare.

The impact of the programme is reflected in Rwanda's latest health indicators.

According to the 2025 Rwanda Demographic and Health Survey (RDHS) by the National Institute of Statistics of Rwanda (NISR), the maternal mortality ratio fell from 203 to 149 deaths per 100,000 live births.

Under-five mortality declined from 45 to 36 deaths per 1,000 live births, while stunting among children under five dropped from 33 per cent to 27 per cent.

Uwimana attributed the programme's success to sustained government commitment, supportive policies and the integration of community health workers into the country's primary healthcare system.

She said competency-based training, performance-based financing, performance contracts, the formation of community health worker cooperatives, access to essential medicines, government and partner funding, and regular mentorship and supervision have all strengthened the programme.

She added that community trust remains one of its greatest strengths, as community health workers live among the families they serve.

Challenges remain

Despite the progress, Uwimana said community health workers continue to face challenges, including limited incentives, inadequate equipment and increasing workloads.

To help address some of these challenges, the Rwanda Biomedical Centre is supporting community health workers to join Muganga SACCO, enabling them to access loans and other financial services.

She said sustaining the programme will require continued domestic and external investment, regular mentorship and stronger collaboration across sectors.