Epidémiolgie - Santé Publique (Epidemiology - Public Health) - Utilisation des outils numériques par les agents de santé communautaire dans la stratégie d'endiguement et d'atténuation de l'épidémie de Covid-19 au Rwanda - une recherche-action Use of digital tools by community health workers in the strategy to contain and mitigate the Covid-19 epidemic in Rwanda - action research

The coronavirus (Covid-19) pandemic has put the health systems of countries in Europe and the Americas, which are considered to be highly efficient, to the test. Less impacted than the rest of the world, the African continent is also facing the spread of Covid-19. The African continent appears to be the future focus of this epidemic if significant steps are not taken to slow down and contain the epidemic. Rwanda, an East African country, is also affected, with more than a hundred cases diagnosed to date, of which more than 75% are imported cases. Rwanda has a large network of community health workers (CHWs) spread throughout the country whose role is essential in the field of primary health care. The experience of the Ebola epidemic has shown that CHWs played a key role in controlling the epidemic but also highlighted the need to involve CHWs early in the epidemic response to ensure optimal effectiveness. CSAs can be indispensable actors in this fight. The use of digital tools, which are being increasingly used, particularly in Rwanda, as a communication tool within the health system with its CHWs can provide important added value to these actors to implement an effective strategy against the Covid-19 epidemic. The objective of this action-research project is to develop, implement and evaluate the feasibility and contribution of connected tools for the detection and monitoring of Covid-19 cases and contacts by CHWs in a strategy to contain and mitigate the Covid-19 epidemic in Rwanda. The intervention will be based on an application providing access to a website that will offer hetero-questionnaire assessment for any person suspected of Covid-19. The questionnaire will focus on symptoms suggestive of Covid-19 (including fever, myalgia, anosmia and agueusia), signs of severity (shortness of breath, inability to eat or drink mainly) and co-morbidities. Depending on the situation, the patient will be referred to simple surveillance by the CSA with containment modalities defined by the Rwandan health authorities, or will be referred to a health centre for paramedical evaluation, or to the district hospital in case of signs of severity. Contacts will be identified by the CHWs with assistance in identification through the website following the questionnaire in case of symptoms in favour of a Covid-19. CHWs will monitor contacts by administering the same hetero-questionnaire to monitor the occurrence of symptoms. The project will train CHWs (n=400) in 2 districts (urban and rural) already equipped with smartphones. Judgement criteria will include the proportion of CHWs adhering to the project, the perception of the CHWs on the role and satisfaction of the populations, the number of questionnaires completed and possible cases detected, the number of people referred to a health centre or district hospital and the number of contacts identified, followed by the CHWs and the number of cases identified among these contacts. This pilot project will be subject to a rapid evaluation (at 1 and 3 months) in order to propose its extension to the whole country in case of favourable feasibility results (process indicators).