Community Needs Assessment Final

Community Needs Assessment
Targeting Health
Deficits of a Rwandan
Community: A Needs
Assessment of Gituku
Village And Surrounding

Areas
Caroline M. Burns, BSN RN
ABSTRACT
Introduction
The purpose of this research is
to evaluate the health needs of
Gituku village and surrounding
areas and to utilize the results in
order to produce project
proposals.
Methods
Methods used in this study are
interviews, surveys,
INTRODUCTION
The village of Gituku and
surrounding areas have many
health deficits in their
communities. In order to aid the
attempt to rectify these deficits,
research was conducted from
August 2016-October 2016.
Many methods of evaluation
were used to do so. The purpose
of this research is to evaluate
the health needs of Gituku
village and surrounding areas
and to utilize the results to
produce project proposals.
observation, document analysis,

profiling, and home visits.
Results
area. The study also indicates

the need for action in areas that
do not have to do with health.
The results gathered by this

study lead to the conclusion that
more efficient processes are
needed in some areas of the
health center. It is also
concluded that respiratory
issues and malaria are the most
common health concerns in this
Discussion
Acronyms and Abbreviations

AIDS Acquired
Immunodeficiency
Syndrome
ANC Antenatal Care
BCG Bacillus Calmette
Guerin (vaccine)
CHW Community
Healthcare Worker
CNA Community Needs
Assessment
DTP Diphtheria Tetanus
Pertussis (vaccine)
GHC Gituku Health
Center
HEPB- Hepatitis B
(vaccine)
HIB - Haemophilus
Influenzae Type B
(vaccine)
HIV Human
Immunodeficiency Virus
HPV Human Papilloma
Virus (vaccine)
LLIN Long Lasting
Insecticidal Nets
MC Mass Campaigns
MR Mumps Rubella
(vaccine)
MUAC Mid Upper Arm
Circumference
In conclusion, there are many

things that can be done to help
solve some of the health and
non-health issues of this
community. In the discussion
section, project proposals are
explained.

PACA Participatory
Analysis for Community
Action
PC Peace Corps
PCV Peace Corps
Volunteer
RWF Rwandan Francs
STOMP Stomp Out
Malaria in Africa
TT Tetanus Toxoid
WASH Water,
Sanitation, and Hygiene
Location
GHC is located in Kibatsi cell,
Rukira sector, in Ngoma district
of the Eastern region of
Rwanda. The climate is around
75-80 degrees Fahrenheit
constantly with low humidity.
The dry season lasts from May
to September as well as the
month of March. The rainy
season is from September to
May with the exception of
March. Gituku village is located
on the top of a large hill. The
foliage includes mainly banana
trees. The main road is
comprised of dirt; though it is
not paved, the quality is goodwide and flat.
METHODS
One-on-One Interviews
A few individuals were verbally
interviewed during this study in
order to gain different
viewpoints of the communitys
health advantages and
disadvantages. These
individuals include:
Headmistress of Gituku
Inclusive Model School,
Executive Secretary of Kibatsi

Cell, and the Executive
Secretary of Buliba Cell. They
were ranked in English
language ability by these
categories: poor, moderate, and
high. Depending on the level of
English language ability, it is
assumed that some interviews
provide more reputable/in-depth
information than others.
Health Center Staff Surveys
Health center staff surveys were
distributed during this study.
They were utilized to gather
information and opinions
surrounding the general health
of the community. 24 surveys
were distributed and 18 were
returned complete. Responses
were translated into English
from Kinyarwanda.
See Figure 1
Maternity-Focused
Community Health Worker
Surveys
The maternity-focused
community health workers were
given a different survey than the
GHC staff survey. It provided
an alternate, more maternity1. The First 1,000
Days program is a
health program
focusing on the proper
nutrition and wellbeing
of pregnant mothers
and their children, ages
0-2. The program deals
with malnutrition
issues in communities
of Rwanda, attempting
to slow and eventually
cease the emergence
of physical and mental
growth defects due to
focused look at the needs of the

community as compared to the
generalized viewpoints the staff
survey provides. 42 surveys
were distributed and 41 were
returned complete. Responses
were translated into English
from Kinyarwanda.
See Figure 2
Service Observations
Several services GHC offers
were observed during this study
in order to gather information
about the health centers
functionality. Services observed
include: maternity,
nutrition/milk distribution,
vaccination distribution, and
prescription distribution.
Document Analysis
During this study, several
different documents were
reviewed to gather information.
Categories that were reviewed
include: childhood illnesses,
antenatal care, malaria,
deliveries, postnatal care,
vaccinations, nutrition
screenings, and bed net
distribution. Documents ranging
from January 2016 to July 2016
were analyzed and conclusions
drawn from the given
information.
Community Profiling
To profile the community, data
from the data manager was
utilized to collect information
on topics such as catchment
population and location.
Observation of the community
was also used to draw
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conclusions about its current
health status.
Home Visit Interviews
To gain a further understanding
of health issues and life in
Gituku village and surrounding
areas, visits to the homes of the
general population were
conducted. In Buliba cell,
interviews with the occupants of
the cell were completed. The
population focus was on
pregnant women and mothers of
children ages two years and
younger (target population of
The First 1,000 Days programSee Text Box 1).
PACA Tools
PACA tools were initially
considered to gather
information for this study. It
was later determined that,
because of the low literacy
levels of the population, it
would be more effective to
focus on collecting information
through different avenues.
RESULTS
One-on-One Interviews
Headmistress of Gituku
Inclusive Model School
(Moderate English language
ability):
She has held position for
seven years
27 teachers
One accountant
One Deputy of Studies
988 primary students
237 secondary students
More girls than boys in

general
Students come from
Kibungo and Kirehe
districts
Primary schedule
7:20am-11:40am and
12:40pm-5:00pm,
Monday through Friday
Secondary schedule
7:20am-11:50am and
1:00pm-4:20pm,
Monday through Friday
Three trimesters
School has: seven
computers, many books
from the old curriculum
but not enough for the
new curriculum, one
soccer ball, one basket
ball, one volleyball,
basketball and volleyball
infrastructures in
disrepair, utilizes field
behind market for soccer
School has: no existing
health club, no existing
English club, minor
lessons in nutrition in
Science and Technology
courses, soccer clubs for
boys and girls
Poor secondary students
receive free food once
per day
Tuition excluding
uniforms = 12,500RWF
for the current term
(price depends on
number of days in term,
which varies)
Requests: health and
English clubs
Executive Secretary of Kibatsi

Cell (Poor English language
ability):
Has held position for
five years
Duties- resolve issues,
project development
Biggest health issues in
cell are malaria and
malnutrition, SIDA is
no problem
Ongoing projects to help
solve biggest health
issues in cell- groups for
parents at the health
center
How can we work
together to help cell
issues: mobilize
population, teach
sanitation and balanced
diet lessons
Advice for working with
people in this cell: work
with local government
and CHWs, go into the
community to meet the
people
Executive Secretary of Buliba
Cell (Kinyarwanda translator
present):
Has held position for 12
years
Duties- communicate
from high to low levels
of government, manage
data and have
knowledge of cell
statistics, ensure safety
and security of the cell,
manage social injustice
in the cell, perform a
3
range of health
promotion activities
Biggest health issues in
cell are poor hygiene
and malnutrition, there
are many children in
families which she
believes leads to a
poorer overall living
condition, unsafe
drinking water
Ongoing projects to help
solve health issuesWASH project
completed recently
Challenges of WASHonly worked with 8/12
villages in the cell
Cell has no program that
deals with The First
1,000 Days program
Wants the volunteer to
facilitate water
sanitation and family
planning
Suggests volunteer to
work with local
government leaders like
herself, the water and
people of the
community
Advice for working with
the community- explain
After careful review of all 18

completed surveys, conclusions
were drawn from the data
provided. They are as follows.
Figure 1 The staff survey that was given to every staff member at Gituku Health Center.
motorcycle
cooperatives, and
CHWs
Challenge volunteer
may face- instilling the
importance and purpose
of the project to the
in detail the projects that

are carried out, organize
meetings with the
community, complete
the projects that are
begun
Health Center Staff Surveys
The participants in this survey

fell into these categories: one
supervisor, six nurses, one
secretary, one
community/environmental
health officer, two drivers, one
auxilliaire, one midwife, one
data manager, two laboratory
5

technicians, one accountant, and
one cashier. Eight of these
responses were from male staff
members and the other ten were
from female staff members.
Work experience and longevity
ranged from four months to 25
years.
On 18/18 surveys, a request to
build a new maternity ward was
requested. 16/18 requested
running water to be installed at
GHC. 12/18 requested good
nutrition to be taught in the
form of a lesson or club at
GHC. 5/18 requested English
lessons to be provided at GHC
for the staff members. 3/18
requested accommodations for
staff to be created at GHC. 1/18
requested computer skills to be
taught to staff at GHC.
The staff members rated what
they considered to be the most
serious health problems. They
compared malaria, AIDS,
malnutrition, women having too
many children, and parasites
against each other to display
which was the most serious
health problem. 2/18 people
think malaria is a serious health
problem. 7/18 people think
AIDS is a serious health
problem. 3/18 people think
malnutrition is a serious health
problem. 5/18 people think that
women having too many
children is a serious health
problem. 7/18 people think that
having a parasite is a serious
health problem.
10/18 surveys reported patients

traveling to GHC on foot. 2/18
reported patients travel to the
health center by motorcycle
taxi. 6/18 reported patients
travel to the health center by
both foot or motorcycle taxi. It
was also reported that the time
it took to travel to the health
center ranged from five minutes
or one to three hours depending
on mode of transportation.
18/18 surveys reported
plantains being a regular part of
the communitys diet. 12/18
surveys reported beans being a
regular part of the communitys
diet. 4/18 surveys reported corn
being a regular part of the
communitys diet. 8/18 surveys
reported cassava being a regular
part of the communitys diet.
3/18 surveys reported cabbage
being a regular part of the
reported spinach being a regular
2/18 surveys reported rice being
a regular part of the
reported tomato being a regular
1/18 surveys reported green
peppers being a regular part of
the communitys diet. 1/18
surveys reported nuts being a
regular part of the communitys
diet. 1/18 survteys reported
sweet potatoes being a regular
7/18 surveys reported Irish
potatoes being a regular part of
the communitys diet.
Maternity-Focused
Community
Health Worker Surveys
42 surveys were distributed and
41 were returned complete. The
answers were translated into
English from Kinyarwanda.
Fourteen questions were asked
including: How long the person
has been a CHW, what they do
everyday, what they know about
The First 1,000 Days program,
if the community uses family
planning and what type if they
do, how many women become
pregnant each month, the
average amount of ANC visits
women complete, if deliveries
occur at GHC, standard length
of stay at GHC after
uncomplicated vaginal
deliveries, if women return for
required post natal check ups,
obstacles pregnant women face
in the community, if pregnant
women and children under two
years of age have good
nutrition, how may children are
malnourished, and how can the
PCV help them in their work.
The work experience of these
CHWs ranged from one and a
half to ten years. Their average
duties consisted of:
Knowing women and
girls in the village that
are of childbearing age
Visiting women and
girls that become
pregnant and giving
them the proper health
advice needed
Accompanying parents
to the health center for
deliveries
Measuring children in
their villages
Encouraging delivery at
the health center or
hospital as apposed to at
home
Teach proper nutrition to

families
What the CHWs know about
Encouraging pregnant
the First 1,000 Days program is
Figure 2 The community health worker survey given to 41 maternity-focused CHWs at

Gituku Health Center.
women and girls to eat a
that it focuses on the nutrition
Report findings via text
balanced
diet
and
rest
of children from birth to two
messaging
properly
years of age. Two responses
Caring for pregnant
included that breastfeeding was
Teach
women
and
girls
women and newborns in
a focus of the First 1,000 Days
to utilize their bed nets
general
program. 15/41 responses said
Teach women and girls
Encouraging the
that they did not know what the
proper hygiene
community to use
First 1,000 Days program was.
family planning
One response said that the
7

target age range was from birth
to five years of age, which is
incorrect.
The types of family planning
used in the community that
were reported are: injections,
pills, and the natural way.
The average amount of women
that become pregnant each
month that the CHWs reported
is three women. Adding up all
responses and dividing by the
number of surveys completed
deduced this result.
The reported average amount of
ANC visits a woman completes
is between three and four (four
being the complete set of visits
provided by the health center).
It is reported that almost all
deliveries in this area occur at a
health center- whether it is
GHC or Rukira (sector) Health
Center. It is also reported that
women and families typically
remain at the health center for
24 hours after an uncomplicated
vaginal delivery.
13/41 surveys reported that
women do return for required
postnatal check ups. 28/41
surveys reported that women do
not return for postnatal check
ups. Of the 28 surveys that
reported women do not come
back for required postnatal
check ups, few did specify that
the mother may return for one
visit, but generally the women
do not return in the proper
way.
Some obstacles, CHWs

reported, that pregnant women
in this community face are:
Poverty
Not having a way to get
to the health center
Lack of health insurance
Misunderstandings with
spouse
Not keeping a good
schedule
Living far from the
health centers
pregnant women and children
under two years of age have
access to good nutrition and
clean water. 13/41 reported that
it depends on where they live
or that the families do not have
access to these resources.
Good nutrition for children two
years of age and younger was
reported by the CHWs.
It was reported that there are, in
total for Rukira sector, 17
malnourished children. 24
CHWs reported that their
communities have no
malnourished children.
On average, the CHWs
requested the PCV should offer:
Trainings on nutrition
for pregnant mothers,
infants, children, and
adults
Trainings on health of
pregnant women,
children, and mothers
Trainings on
malnutrition
Trainings concerning
breastfeeding
Trainings on helping
mothers during and after
delivery
Give them health care
advice and increase their
health knowledge
Service Observations
Maternity:
Three rooms comprise the
maternity unit. There is one
waiting room that has three
cots, one delivery room with
two gynecological tables, and
one post partum room with six
cots.
The delivery room requires the
most attention. It is a small
room with not enough
resources. The two
gynecological tables used for
delivery are next to each othertwo feet apart at the most. There
is one radiant heater located in
the delivery room, used to
prevent newborn hypothermia.
The materials that can be found
in the delivery room can be
used for simple, uncomplicated
vaginal deliveries only. All
complicated deliveries are
transferred to the regional
hospital in Kibungo.
The main problem in the
delivery room is the lack of
privacy the mothers have,
especially if two mothers are
delivering at once, which
happens often. There is a small
8

removable curtain divider that
can be put between the patients
if they are delivering at the
same time. There is also a small
curtain that shields the mothers
from being visible from people
walking into the room.
entire process of measuring 28

children and then distributing
supplements took roughly four
hours. Even on the days when
the children are not measured,
the process takes longer than
necessary.
A secondary problem is the

small size of the post partum
room, and the even smaller size
of the waiting room. The
midwife at GHC, Diocres, said,
Mothers know that Gituku has
a small maternity ward, so they
avoid coming here. This can
lead to potential issues for
mothers. The closest health
center, besides GHC, is Rukira
Health Center, which is a twohour walk away.
Vaccination Distribution:
While observing this service it
was determined that there are
more negatives than positives
involved in the process of
distributing vaccinations.
Nutrition/Milk Distribution:
During this observation it was
found many positives with few
negatives. The mothers
attending the distribution arrive
every week to receive the milk
(500ml to 1L xs 7 per week),
indicating their positive interest
in their childs health. Another
positive is the program itselfthe measurement of children
(height, weight, MUAC) to
indicate levels of malnutrition
and the government following
up those findings by supplying
milk and nutritional
supplements to children in need.
One negative that was observed
was the wait time the mothers
had to endure. During the
measurements (which happens,
at most, once a month) the
The main issue is time. It has

been deduced, through
observation, that there are three
main problems with this service
that are taking up much of the
patients and staffs time. The
first is the system of patient
arrival. The mothers (often 50+
women) of the children mostly
arrive on time for the
vaccinations to be given. Many
however, show up half an hour
late or more.
Another issue to discuss is the
documentation system. The
mothers arrive and then give
their vaccination booklets to the
nurse. The nurse then arranges
the booklets in piles by the
vaccination that the child needs.
The nurse documents the
vaccinations given in a
government logbook. This
documentation process takes
one to one and a half hours to
complete, many times longer
when mothers arrive late.
The third problem is the method

of administering the
medications. The mothers are
given their booklets and then
arrange themselves towards the
front of the room to receive the
medications. This entire process
takes a minimum of four hours
to complete each time.
Prescription Distribution:
This service operates effectively
and smoothly. The patient waits
in a fast-moving line outside of
the medicine room. When it is
their turn they come in and hand
the staff member their
prescription booklet and
insurance card. The nurse fills
the order and gives the patient
instructions on how to take the
medicine. The process takes
less than five minutes per
patient. No negatives were
observed in this service.
Document Analysis
During the study it was found
that only monthly reports were
catalogued at GHC, not yearly.
The information was compiled
for this study beginning in
January 2016 and concluding in
July 2016- seven months of
information. The data included
many different ages and
diagnoses. The most common
diagnoses and the most serious
diagnoses were then identified.
Childhood Illnesses:
Data was accumulated in the
following categories- bacterial
9

infection, conjunctivitis, eye
infection, diarrhea with and
without the co-occurring
dehydration, pneumonia,
cough/cold, simple and severe
malaria, febrile disease,
mastoiditis, ear infection,
anemia, skin infections,
intestinal parasites, teeth/gum
infection, fracture, and physical
trauma without co-occurring
fracture.
These categories were separated
into three different age groups:
1. Zero to seven days
2. Eight days to two
months
3. Two months to 59
months
It was found that the only
diagnoses for age group one
were bacterial infection (46
confirmed cases) and
conjunctivitis (eight confirmed
cases).
For age group two, the only
occurring diagnoses were eye
infections (16 confirmed cases)
and bacterial infections (nine
confirmed cases).
It was discovered that the most
common diagnosis for age
group three is cough/cold
with 1,401 confirmed cases so
far this year. The next most
common was confirmed simple
malaria with 449 confirmed
cases. The third most common
diagnosis was diarrhea with no
co-occurring dehydration at 251
cases.
Antenatal Care
In general, data supplied on the
subject of antenatal care
focused around these topics:
new registrations, standard
visits, high-risk pregnancies,
vaccination/medication
distribution, bed net
distribution, deworming,
MUAC screening, anemia, HIV
testing, and syphilis screening.
In 2016 so far there have been
446 new ANC registrations at
GHC. The following categories
had full participation (446): full
course of iron/folic acid
supplements given, MUAC
screened, and syphilis tested.
440 were screened for HIV and
2 were positive results. 372 new
registrations were tested for
anemia. Zero cases of moderate
or severe anemia were reported.
67 bed nets were distributed to
ANC new registrations.
Malaria in Pregnancy
In 2016 thus far, six confirmed
cases of simple malaria in
pregnancy were reported for
women ages 20 and younger.
101 confirmed cases were
reported for women 20 or older.
Deliveries
The total number of deliveries
at GHC from January to July
2016 is 226. Out of the 226, 225
were normal deliveries. There
was one reported dystocic
delivery.
Zero deliveries were reported

with mothers ages 15 and
younger. In the age range of 16
to 19, 21 deliveries have been
reported. In patients 35 and
older, 38 deliveries were
reported. The rest of the
deliveries fell in the 20-34 age
bracket that is considered lowrisk.
11 deliveries were reported with
infants weighing <2.5kg,
38>weeks, that were live. One
delivery was reported to fall in
the category of <2.5kg, within
22-37weeks, that were live. No
still births or infant death
occurring within 30 minutes of
birth have been reported so far
in 2016.
Postnatal Care
In the category of PNC, data
was split into two groups:
mother and baby. Items reported
included but are not limited to:
new registrations, standard
visits, vitamin distribution, and
mothers screened for MUAC.
There have been 237 new
registrations for mother and
child from January to July 2016.
In attendance for standard visit
one (one day to three days after
birth), 231 mothers and babies
were confirmed. In attendance
for standard visit two (four to
nine days after birth), 215
mothers and babies were
confirmed. In attendance for
standard visit three (10 days to
six weeks after birth), 73
10

mothers and babies were
confirmed.
Zero mothers were given
vitamin A supplements. 237
mothers were screened for
malnutrition using MUAC. Zero
mothers were confirmed to be
malnourished.
Vaccinations
The vaccinations supplied at
GHC for patients age 0-11
months include: BCG, Polio 03, DTP HEPB HIB 1-3,
Pneumococcus 1-3, Rotavirus
1-3, and MR. The vaccinations
supplied at GHC for patients
age 12 years and older are: HPV
1-3. Vaccinations supplied at
GHC for patients age 15 months
and older is solely the Measles
vaccination.
Accumulated sum of
vaccinations given in 2016 this
far:
BCG- 338
Polio 0- 339
Polio 1- 413
Polio 2- 433
Polio 3- 423
DTP HEPB HIB 1- 413
DTP HEPB HIB 2- 433
DTP HEPB HIB 3- 423
Pneumococcus 1- 413
Pneumococcus 2- 433
Pneumococcus 3- 423
Rotavirus 1- 413
Rotavirus 2- 433
Rotavirus 3- 423
MR- 433
HPV 1- 252
HPV 2- 0
HPV 3- 0
Measles (at 15 months
of age)- 346
Measles (at ages 16
months or older)- 7
Nutrition Screenings
Nutritional screenings using
MUAC were conducted in the
time frame of January to July
2016. The totals in the
following paragraph encompass
all ages of patients.
26 confirmed cases of acute
moderate malnutrition without
complications (stunting) were
reported in this time frame. 18
confirmed cases of acute severe
malnutrition without
complications were reported as
well. Two confirmed cases of
chronic moderate malnutrition
with stunting were also
reported.
Bed Net Distribution
Bed net distribution was
recorded and split into three
categories: LLIN for ANC,
LLIN for EPI, and LLIN from
mass campaigns. Quantity
received, quantity dispensed,
and the stock at the end of the
month was recorded from
January 2016 to July 2016.
Quantity received:
LLIN for ANC- 0
LLIN for EPI- 0
LLIN from MC- 0
Quantity dispensed:
LLIN for ANC- 60
LLIN for EPI- 207
LLIN from MC- 0
Stock as of July 2016:
LLIN for ANC- 4,626
LLIN for EPI- 1,946
LLIN from MC- 0
Community Profiling
1. Facility Name: Gituku
2. Catchment Area
Population: 27,484
3. Province: East
4. District: Ngoma
5. Sector: Rukira
6. Cell: Kibatsi
It has been observed that Gituku
village has a small population.
It includes many children.
Many of the population are thin
in appearance. Others appear to
have an adequate diet. Men are
most often seen fetching water
in the community than women.
Women most often remain in
the home. House helpers seem
to be mixed in both the male
and female genders. Families
seem to have many children.
Gituku has many farmers in its
community. The main crops
here are plantains. At the
market, tomatoes and onions are
in abundance. In the boutiques,
bottled water, rice, flour, sugar,
and salt are always available.
During school hours, a few
children can be seen not
attending for reasons unknown.
The landscape appears dry and
brown in color during the dry
11

season. During the rainy season,
the landscape becomes much
greener and more crops can be
seen growing. There are many
banana trees. There is no natural
source of water to be seen in the
village of Gituku. The artificial
water source is close to the only
restaurant in the village: a 30minute walk from the center of
town.
Religion plays a large part in
the general populations life.
Catholics seem to make up the
majority of the population while
there are also Muslim people
who live in Gituku. The
Catholic Church as well as the
Rwandan government fund
GHC. The person in charge of
GHC is a Catholic Sister.
A few home visits were
conducted during this study in
Buliba cell. The focus was
pregnant women and families
with children under the age of
two. They were asked an
assortment of questions. The
results for each cell were as
follows:
1. Woman with child under
two years of age: 27 years
old, married, has two
children, does not use
family planning, example of
balanced diet she gave
included
vegetables/beans/rice and
potatoes, family eats
vegetables and fruits five
times a week, family eats
twice daily, during the rainy

season they have a garden
where they grow plantains
and beans, they do not have
a garden in the dry season,
family uses Mutuelle health
insurance, common health
problems in the community
that the mother could think
of were malnutrition/
malaria/ and pneumonia in
children, the service her
family uses most often at
GHC is walking in for a
check up with the doctor or
nurse, family has visited
GHC three times so far this
year, family has two
mosquito nets, during the
dry season it takes family
one hour round trip to
collect water, they boil
water for drinking, they
wash their hands after using
the toilet/ after changing the
babys diaper or loin cloth/
and before they eat, they
live ten minutes by
motorcycle from GHC, her
husband is a CHW, she
breastfeeds one child who is
one month and ten days old
seven times per day
2. Pregnant woman: 26 years
old, married, no children,
does not use family
planning, example of
balanced diet she gave
included vegetables/ beans/
potatoes and plantains,
family eats fruits and
vegetables once a week,
family eats twice per day,
has a garden in the dry
season in which they grow

beans, family uses Mutuelle
health insurance, believes
malaria and head aches are
the most common health
problems in the community,
uses GHC for check ups,
has been to GHC three
times this year so far, family
has two mosquito nets,
during the dry season it
takes family one hour round
trip to collect water, they
boil water for drinking,
washes hands after using the
toilet, five minute
motorcycle from home to
GHC, CHW is her neighbor,
she is seven months
pregnant and has attended
three ANC visits
PACA Tools
PACA tools were not utilized in
this study.
DISCUSSION
Comments, Recommendations,
and Challenges
Maternity-Focused Community
Health Worker Surveys
There are a few comments I
would like to make on the
reported information from these
41 surveys. While comparing
the data from the surveys to the
data from the monthly reports,
some disparities were
unearthed.
The reported average amount of
ANC visits a woman completes
is three or four. Although
conflicting information is
12

reported in the monthly reports
the data manager keeps. In
those reports, it seems the
average would be around two
visits.
women do return for required
postnatal check ups. Although it
is stated in the record from the
data manager that the first
postnatal visit attendance so far
this year was 231, the second
visit was 215, and the third was
73. As you can see, over 30% of
the surveys do not match the
records from the data manager.
Another discrepancy found in
the results of the MaternityFocused Community Health
Worker surveys was the total
number of malnourished
children (17) and the total
number of malnourished
children as yielded by the
monthly reports (28). This
discrepancy leaves 11 children
unidentified.
The requests made by the
CHWs to the PCV coincide
with the purpose of the First
1,000 Days program. Hopefully,
all requests can be
implemented. Challenges to this
may be organization and
mobilization of participants and
finding the time to implement
every suggested training or
educational session.
The discrepancies between the
reported information from the
data manager and the
information given by the

CHWs is concerning. It brings
up the question of the reliability
of the information from both
sides. Is the information from
the data manager or the CHWs
accurate? Are either groups of
information accurate at all?
There is no way of telling. Still,
helpful information can and has
been drawn from both parties.
Services: Maternity
I recommend the construction
of a new maternity building. I
originally comprised my own
recommendations for the new
building and its specifics, but
later discovered GHC had a
detailed plan of what they
would want their building to
include. This plan includes a
blueprint, budget, and
description of all materials
needed for the project.
The physical aspects of the
building plan include: one
bathroom for patients with two
toilets/showers/and sinks, one
bathroom with one
toilet/shower/and sink for staff,
two stock rooms, three
consultation rooms, one
sterilization room, one work
room, three delivery rooms, one
waiting room, a veranda, and
a
Projected cost of the project,
including projected tax costs, is
126,931,901 RWF.
Potential challenges to these

suggestions mainly revolve
around funding. Generating the
funding for such a project will
be difficult.
Services: Nutrition/Milk
Distribution
Research should be completed
on strategies to cut down wait
time for mothers and children.
A permanent schedule for when
MUAC, height, and weight
measurements should be
developed. The developed
schedule should be followed
stringently and without
exception.
Potential challenges to these
recommendations are the
willingness of the staff to
change the way the service is
run currently.
Services: Vaccination
Distribution
A way to ensure all mothers
arrive with their children on
time to the vaccination
distribution should be
developed. I suggest that the
health center supplies a
minimum of two staff members
to distribute vaccinations- one
can document while the other
distributes. Or, both nurses can
arrange the booklets by
vaccination needed, give the
injections, allow the mothers to
leave, and then complete all
documentation. A more efficient
way for mothers to be arranged
in order to receive the
medications for their children
13

should be developed. One
possibility could be supplying a
larger room for the process to
occur.
Some challenges to these
recommendations could be
determining a way to ensure all
mothers arrive on time, GHCs
staff availability, and the staff
members willingness to change
the current process.
Services: Prescription
Distribution
I have no recommendations for
this area of service. Distribution
of prescriptions runs smoothly
and effectively.
Childhood Illnesses
The causes of the high number
of cough/cold cases, as well
as malaria, diarrhea, and eye
infections should be
determined. A challenge to this
determination may be locating
the documentation of each
specific case and the time it will
take to review the provided
data.
Antenatal Care
I recommend that every new
registration be screened for HIV
without exception. I also
recommend finding a way to
encourage mothers attend all
four ANC visits. Challenges in
this could be the cooperation of
the staff at GHC as well as
finding a way to accomplish the
goal of all mothers attending all
ANC visits.
Malaria in Pregnancy
I recommend that CHWs
ensure mothers are utilizing
their bed nets properly. This
may be a challenge considering
the CHWs busy daily schedule.
Postnatal Care
Recommendations for PNC
include finding a way to ensure
mothers attend all PNC visits
without exception. This could
be challenging because of the
difficulty of instilling the
importance of these visits to
mothers.
Vaccinations
See Services: Vaccination
Distribution for
recommendations and
challenges in this category.
Nutrition
Because of the presence of
malnutrition in any form, which
needs to be eradicated, I would
recommend providing health
and nutrition lessons to various
age and gender groups in the
community. Potential
challenges to this
recommendation may be
mobilizing the people of the
community to attend the
classes, instilling the
importance of a balanced diet to
the participants, and ensuring
the participants pass on the
information they learn to their
friends, family, and
acquaintances.
Bed Net Distribution
Considering the data and the

number of confirmed cases of
malaria, I recommend
distributing a higher quantity of
bed nets (as GHC has many in
stock) and to attempt to bring
mass campaigns here to
encourage bed net distribution
and use. I also recommend
interacting with the group
STOMP to learn strategies of
malaria prevention and reaching
the full potential the use of bed
nets offers. Potential challenges
could be organizing time to
work with STOMP, unknown
rules and regulations of bed net
distribution, cooperation of the
general public, and identifying a
mass campaign to come to
GHC.
These women were diverse in
themselves, despite their close
living proximity (they live next
door to each other). One, the
woman with a child under two
years of age, is the wife of a
Community Health Worker and
seemed to possess more general
health knowledge (I assume,
because of her husbands role in
the community). The other, the
pregnant woman, had little
general health knowledge. The
women were interviewed
together in the community
health workers home. The
women would take turns
answering the questions first as
to not have the woman with the
community health worker
husband take the lead
constantly. The woman with a
14

child answered in depth what a
balanced diet should be, while
the pregnant woman did not
mention an adequate example of
a balanced diet. The woman
with a child said her family eats
fruits and vegetables five times
a week, while the pregnant
woman said she and her
husband eat them once a week
due to the frequency of the
village market. The pregnant
woman washes her hands on
fewer occasions than the
woman with a child. Both
families use Mutuelle health
insurance.
These interviews lead me to two
conclusions: poverty and the
time of year play a large role in
the diets of the families, and
that people without constant
access to a CHW are not well
educated in the area of general
health. These women would
benefit from general health
lectures.
Potential Project Proposals
Maternity based proposals:
Construct a new
maternity building at
GHC
Create incentive for
mothers to attend all
ANC visits
Other health based proposals:
Begin support group for
mothers of malnourished
children
Install running water at

GHC
Host all requested
trainings to CHWs
Begin health/nutrition
based educational
sessions at GHC and
Gituku Inclusive Model
School
General/secondary proposals:
Provide funding for
books and sports
equipment for Gituku
Inclusive Model School
Begin English club at
Gituku Inclusive Model
School
Begin English lessons at
GHC for staff
Build accommodations
for GHC staff
Begin computer skills
lessons at GHC
ACKNOWLEDGEMENTS
I would like to thank four
specific individuals. First, my
supervisor, Sister Sophie
Bagaaya, for her help and
support. Second, my
counterpart, Hirwamahoro
Robert, for his involvement in
translations and setting
appointments with local leaders.
Third, GHCs data manager,
Marie Rose, for her contribution
to the data collection of this
study. Finally, I would like to
thank my Kinyarwanda tutor,
Placidie, for helping me
translate many surveys.
In addition to the
aforementioned individuals, I
would like to thank all of the
members of the GHC staff as
well as all of the CHWs who
participated in this study.
Without their participation the
study could not have been
completed.
Finally, I would like to
acknowledge my fellow PCVs.
The time and effort they put
into completing their CNAs
inspired me to realize the
potential of this study. Thank
you.
REFERENCES
Information from the

CAN packet helped me
to construct this study
Information from GHCs
monthly reports helped
me profile the
community as well as
collect data on the
community
APPENDICES
1. The maternity building
proposal comprised by GHC is
attached to this study.
2. A short rough draft of a
support group for mothers of
malnourished children is also
attached.
15

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Community Needs Assessment Final

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Community Needs Assessment

Village And Surrounding

Caroline M. Burns, BSN RN

observation, document analysis,

area. The study also indicates

The results gathered by this

Acronyms and Abbreviations

In conclusion, there are many