Community Health Workers Play a Key Role in Therapeutic Efficacy Study in Rwanda

This piece originally ran on the Impact Malaria blog.

Bonaventure Siborurema has been a community health worker for twelve years. People in his village put their trust in him and affectionately call him “Muganga” or health worker in ikinyarwanda. While he is helping his community stay healthy during his daily work to provide essential prevention and treatment services, he is also serving his community by participating in the ongoing therapeutic efficacy study (TES) at Ngoma Health Center in the Nyaruguru District of Rwanda.

Community health worker Bonaventure Siborurema (left) with Iradukunda Ildivine (right) sleeping peacefully in the arms of her mother, Angelique Ntawushirintimba Ildivine, outside the Ngoma Health Center, where the study is ongoing. Photo credit: PMI Impact Malaria Rwanda

This therapeutic efficacy study is analyzing the use of two antimalarial drugs to treat malaria among children from 6 months-14 years old to determine which is more effective. Growing resistance to antimalarial drugs used to prevent and treat malaria is a major obstacle to global efforts to reach elimination. These efficacy studies assess and evaluate the effectiveness of treatments and drugs in various combinations to understand how well they combat malaria. This ultimately contributes to comprehensive malaria case management efforts and the global monitoring of antimalarial drug resistance. Bonaventure recently took three sick children to the Ngoma Health Center to participate, including 2-year-old Iradukunda pictured above.

Community health workers, or mugangas, are fundamental to the national workforce for delivering quality malaria services and reaching communities beyond brick-and-mortar health facilities. They contribute to reducing the shortage of health personnel and to improving access to maternal and child health services delivery, including malaria case management at the community level. They are trusted by their communities to provide essential health services. Equipping them with knowledge about the ongoing study and access to bring patients to participate supports a successful outcome. 

There are 128 community health workers across 32 villages that support Ngoma Health Center. All of them were trained about the goal of the study, the importance of their role, and the inclusion criteria for patients. Gathering at Ngoma Health Center, they meet monthly to discuss progress and strategize to enroll more patients. So far, 53 children have participated in the study according to Valens Ntaganira, Head of the Ngoma Health Center, who shared “community health workers do an excellent job. More than 90% of enrolled study participants are sent by them.” 

Salua Tuyisenge (standing, center), Community environment and health officer at Ngoma Health Center, talks to community health workers during their monthly meeting. Photo credit: PMI Impact Malaria Rwanda

The results of therapeutic efficacy studies may be used by Ministries of Health to develop or update national malaria treatment strategies and policies. The World Health Organization recommends that all countries establish and maintain a routine, regular monitoring practice such as a therapeutic efficacy study to track the effectiveness of their primary antimalarial treatment and monitor resistance.

In the last year, PMI Impact Malaria and partners have been providing support to national malaria programs in Burkina Faso, Cameroon, Côte d’Ivoire, DRC, Kenya, Mali, Niger, Rwanda, and Sierra Leone to better understand drug resistance and contribute to global knowledge to combat resistance and work towards elimination. “[Ending malaria] is a humanitarian responsibility,” said Bonaventure, “and [by supporting this study] I am proud to be of service to my community.”  

PMI Impact Malaria is funded and technically assisted by the U.S. President’s Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with JhpiegoMCD Global Health, and the Malaria Elimination Initiative (MEI) at the University of California, San Francisco. 

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