Christine Uruvugundi is animatedly engaged with her mobile phone under a tree outside Karwasa Health Centre in Musanze District. She is also looking through a handful of documents on her lap. She is a community health worker (CHW). Her task is to keep tabs on pregnant mothers from the time the pregnancy is announced until delivery. She also makes follow-ups on malaria cases and other community case management. And she follows up the life of a child after birth in the outskirts of Musanze. This, Uruvugundi says, was difficult to do until she started using the Rapid SMS programme to convey all the messages related to the state of pregnant mothers, and people with community management cases, to the concerned institutions, mainly those under the Ministry of Health. As Rwanda is highly pacing in technology, the health sector is not left behind. In 2009, the Rwandan health sector realised that the number of women giving birth in hospitals was low, and infant mortality rate was high. Health officials also say traditional birth attendants, who lacked expertise to handle infections or complications, performed most of the deliveries before the programme was implemented. This made Rwanda come up with a technology initiative to curb the narrative. The adoption of the technology kicked off with the sensitisation of local community health workers, hospital staff and the general public. 10 years later, the results are impressive. The programme had purposes of tracking all pregnant women, hence, reach every pregnancy, promote and monitor antenatal care through CHWs, increase communication between CHWs and health centres, identify and refer to women at risk and prompt death audit. “A lot of parents were having little or no knowledge at all about their pregnancies and their kids’ health. Therefore, we realised technology as a tool that can curb the narrative”, says Dr David Ndayishimiye, the rapid SMS project manager. He also explains that in the case of an emergency, rapid SMS helps in decreasing transit time from arrival to hospital to entering theatres, thus, it reduces the rate of maternal deaths and other unexpected deaths caused by avoidable conditions. The project was first modelled in Musanze District in 2009 and after its trial, it started the regional operation in 2012. It works in a way that when a person has a problem, the community health worker approaches and helps. They use USSD network patterns that do not require internet or fee charges. They are installed in all 60,000 community health workers’ phones in Rwanda. Many expectant and new parents bear witness to the improvement in health service delivery as a result of this technology. They commend CHWs for helping them in various ways when they were pregnant until delivery, and working closely with them to raise their new-borns through counselling. After analysing its impact, The Ministry of Health through RBC added the section of community case management which comprises of three common diseases: malaria, diarrhoea and pneumonia as another section of diseases that were rising drastically also. The messages transferred are in form of codes that can only be decoded by community health workers. For example, ‘LA’ means labour at home, ‘WUM’ means fainting and ‘RVM’ means the patient is vomiting. All these messages are sent to the Ministry of Health’s server to receive data. Dr Jean-Louis Mangala, the malaria case management officer under Rapid SMS, says that hospitals are now shifting in telephones as everything is modernised. “CHWs are giving out reports on patient follow-ups without taking longer distances to the hospitals. They use very simple phones and that brings the hospital to the patient’s home,” says Jean Louis Mangala. THE IMPACT SO FAR In the malaria section, 1167 people have been helped through the service, says Jean Louis Ndikumana, the malaria case management officer under Rapid SMS. The last findings from Rwanda Demographic and Health Survey 2014-2015 show that infant mortality has fallen from 50/1000 births in 2010 to 35/1000 births in 2014-2015. Under-five mortality rate has fallen from 76/1000 births in 2010 to 50/1000 births in 2014-2015. Mothers giving birth at hospitals rose from 69% to 91%. Dr Ndayishimiye says that in their system, six million mothers have been helped, their pregnancy period was monitored and assisted in all ways possible. This technology has also been introduced by UNICEF in Nigeria, Malawi and Zambia to collect and analyse data. Globally, about six million children still die before their fifth birthday each year. Initiatives like the Rapid SMS, which is currently being managed by over 60,000 community health workers across the country, are responsible for such achievements in the health sector. But there is need to commit more investment in the sector while the support of every Rwandan and well-wisher is also paramount.
