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ObjectiveDuring the COVID-19 pandemic, community health workers (CHWs) served as front-line workers in the COVID-19 response while maintaining community health services. We aimed to understand challenges faced by Rwanda’s CHWs during a nationwide COVID-19 lockdown that occurred between March and May 2020 by assessing the availability of trainings, supplies and supervision while exploring perceived needs and challenges.Design and settingThis study was a mixed-method study conducted in three Rwandan districts: Burera, Kirehe and Kayonza.Main outcome and measureUsing data collected via telephone, we assessed the availability of trainings, supplies and supervision during the first national lockdown, while exploring perceived needs and challenges of CHWs who were engaged in COVID-19 response, in addition to their existing duties of delivering health services in the community.ResultsAmong the 292 quantitative survey participants, CHWs were responsible for a median of 55 households (IQR: 42–79) and visited a median of 30 households (IQR: 11–52) in the month prior to the survey (July 2020). In the previous 12 months, only 164 (56.2%) CHWs reported being trained on any health topic. Gaps in supply availability, particularly for commodities, existed at the start of the lockdown and worsened over the course of the lockdown. Supervision during the lockdown was low, with nearly 10% of CHWs never receiving supervision and only 24% receiving at least three supervision visits during the 3-month lockdown. In qualitative interviews, CHWs additionally described increases in workload, lack of personal protective equipment and COVID-specific training, fear of COVID-19, and difficult working conditions.ConclusionMany challenges faced by CHWs during the lockdown predated COVID-19 and persisted or were exacerbated during the pandemic. To promote the resilience of Rwanda’s CHW system, we recommend increased access to PPE; investment in training, supervision and supply chain management; and financial compensation for CHWs.

ObjectiveTo evaluate the use of antigen-based rapid diagnostic tests (Ag-RDTs) alongside a digital tool to deliver household-level COVID-19 testing by community health workers (CHWs), in line with Rwanda’s ambition to decentralise COVID-19 testing.DesignThis was an operational pilot study to evaluate the impact and operational characteristics of using the digital e-ASCov tool combined with Ag-RDTs to support COVID-19 symptom screening and rapid testing by CHWs across eight districts in Rwanda. A total of 800 CHWs selected from both rural and urban areas were trained in delivering Ag-RDTs for COVID-19 testing and using the e-ASCOV application for data capture on a smartphone. Laboratory technicians repeated a subset of Ag-RDTs to assess the concordance of results obtained by CHWs. The study also assessed CHWs’ experience of the intervention using a mixed-methods approach.SettingEight rural, urban and semiurban districts in Rwanda.ParticipantsA total of 19 544 individuals were enrolled and screened for signs and symptoms of COVID-19.InterventionsCommunity-based screening for COVID-19 by CHWs using the digital tool e-ASCov combined with rapid testing using Ag-RDTs.Main outcome measuresNumber of participants screened and tested; concordance of Ag-RDT results between CHWs and laboratory technicians; feasibility of study procedures by CHWs and CHWs perceptions of the digital tool and Ag-RDT testing.ResultsFrom February to May 2022, CHWs screened 19 544 participants, of whom 4575 (23.4%) had COVID-19-related symptoms or a history of exposure to the infection. Among them, 86 (1.9%) were positive on Ag-RDTs. Concordance of Ag-RDT results between CHWs and laboratory technicians was 100%. Of the 800 trained CHWs, 746 (93.3%) were independently able to conduct household-based COVID-19 screening, perform the Ag-RDTs and send data to the central server. Most CHWs (>80%) found Ag-RDTs and e-ASCOV easy to use.ConclusionsThis study demonstrated the feasibility of deploying a digital tool and Ag-RDTs for household-level SARS-CoV-2 detection in Rwanda. The findings support a broader roll-out of digitally supported rapid testing by CHWs to broaden access to testing for priority diseases.

Background In Rwanda, community health workers (CHWs) serve a crucial function in providing community‐based maternal and neonatal health (CBMNH) services. However, limited access to continuous training affects their confidence and ability to execute their roles effectively. This study aimed at evaluating the impact of eLearning on enhancing and maintaining CHWs’ knowledge of CBMNH. Methods This cohort study, conducted from April to October 2021 in two Rwandan districts, evaluated knowledge acquisition and retention among 36 CHWs participating in an eLearning course. Knowledge scores were measured using a structured questionnaire administered pre‐training, post‐training and at a 6‐month follow‐up. Descriptive analysis and paired t‐tests were used to assess mean score differences. Results There was improvement in CHWs’ performance scores following eLearning training, with an average increase from 86.5% to 98.2%. The improvement was sustained at a 6‐month follow‐up. Statistical significance was found between age category and CHWs’ pre‐ and post‐test performance (p = 0.01, p = 0.04 respectively), and between years of experience and pre‐test scores (p = 0.02). Conclusions The results of this study suggest that eLearning is an effective method for enhancing and retaining CHWs’ knowledge of CBMNH. The findings support the use of eLearning as a valuable strategy for strengthening the capacity of CHWs in Rwanda and other countries with similar contexts. The study showed a significant increase in average scores from 86.48% in the pre‐test to 98.20% post‐test and 97.75% at follow‐up, indicating effective knowledge acquisition and retention among ASMs. The mean score differences were 11.72 and 11.27, respectively (p < 0.001), with no significant changes between post‐test and follow‐up (−0.46; p = 0.376).