Equipping community health workers in Rwanda to deliver a gender transformative parenting program to prevent violence against women and children at scale

Kate Doyle^1,2*Isha Bhatnagar¹Emmanuel Karamage³Jean Paul Tuyisingize³Chantal Muhimpundu³Ange Marie Yvette Nyiransabimana³François Regis Cyiza⁴Fidèle Rutayisire³Silas Ngayaboshya⁵Webster Mavhu^6,7

• ¹Equimundo Center for Masculinities and Social Justicce, Washington, United States
• ²Department for Public Health and Primary Care, Ghent University, Ghent, East Flanders, Belgium
• ³Rwanda Men's Resource Center, Kigali, Rwanda
• ⁴Division of Maternal Child and Community Health, Rwanda Biomedical Center, Kigali, Rwanda
• ⁵Ministry of Gender and Family Promotion (Rwanda), Kigali, Rwanda
• ⁶Centre for Sexual Health and HIV AIDS Research, Harare, Zimbabwe
• ⁷Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom

IntroductionIn Rwanda, the Bandebereho program has demonstrated long-term reductions in intimate partner violence (IPV) and violence against children. Since 2019, the program has partnered with government to train community health workers (CHWs) to deliver at scale. Evidence on how to equip CHWs to deliver Bandebereho, or similar programs, with quality and fidelity is needed to support scaling. This study sought to assess the impact of training on CHWs and their capacity to deliver Bandebereho during scale up. MethodsA pre/post, follow-up study was conducted with 573 CHWs in Burera district. Data were collected at three time points over 20 months using self-administered questionnaires (pre/post) and a follow-up phone survey. Questionnaires gathered data on CHW attitudes about gender roles and violence, self-reported skills, knowledge and confidence to implement Bandebereho, and training impacts on partner relations and community work. Informed consent was obtained from all study participants. ResultsThe pre-survey was completed by 562 CHWs and 564 CHWs completed the post-survey after six to nine months. At 17 month follow-up, 506 CHWs completed the phone survey. Analysis of changes between pre- and post-surveys found CHWs had more equitable gender attitudes after training. Linear regression analysis found that CHWs with some secondary education (coefficient: -2.15, p<0.01) and more than three years’ experience (coefficient: -2.27, p<0.001) were less likely to hold inequitable attitudes. At post-survey, CHWs reported a high level of preparedness to implement, regardless of gender. A majority reported improved partner relations, including greater partner support for their community work. At follow-up, a majority of CHWs reported a high degree of comfort and confidence implementing Bandebereho, and benefits to their work and personal relationships. ConclusionsThe findings highlight the importance of investing in high-quality facilitator training, which allows sufficient time for facilitators’ own transformation, to maintain quality and fidelity at scale. The findings underscore the importance of a slow and steady approach, with sufficient time to adapt, test, and refine IPV programs for scale, which can also support a progressive handover to government. The findings may support program originators who seek to scale proven IPV prevention programs with government in other settings.