ArticleEBioMedicine2026
Implementation and evaluation of a community health workers-led digital integrated diseases screening system to provide healthcare for patients at community level in Rwanda.
Article in EBioMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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2 citing papers in PubMed.
- Digital integrated systems in primary health care: advancing universal health coverage in low- and middle-income countries.EBioMedicine · 2026Article
- High diversity and distribution of ticks and tick-borne diseases in Sudan emphasizes the need for implementing cost-effective community One Health strategy.Frontiers in microbiology · 2026Review
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Abstract
backgroundCommunity health workers (CHWs) play a vital role in identifying patients within the community. To enhance their decision-making and reduce unnecessary referrals, Rwanda introduced a digital integrated disease screening tool (d-IDS), embedded within the national community Electronic Medical Records (cEMR) system. This study aimed to design, integrate, and evaluate the d-IDS to support its broader national scale-up.
methodsThis study employed a pre-post effectiveness-implementation hybrid design to implement the d-IDS and evaluate its effectiveness in improving patient management at the community level in five districts during April-July 2024. The d-IDS was designed into a single decision-support workflow embedded within the cEMR platform, and deployed on CHWs' smartphones. The workflow automatically guides CHWs through case registration, symptom assessment, diagnostic testing, and treatment or referral decisions. The d-IDS tool consolidated the screening processes for tuberculosis, malaria, pneumonia, and diarrhoeal diseases. Referral data extracted from the cEMR following d-IDS implementation and retrospective data from similar period (April-July 2023) collected under the paper-based approach; Standard of Care (SOC), were analysed using Chi-square tests. Qualitative feedback from CHWs were gathered through structured interviews to assess acceptability and feasibility.
findingsThe implementation of d-IDS led to a statistically significant 24.2% reduction in overall referrals to health facilities (p < 0.0001) when compared to the SOC period. Of the 3060 individuals screened using the d-IDS, 45.6% triggered further assessment, and 1687 (55.1%) were successfully managed by CHWs at the community level. Notably, in Rwamagana district, referral rates dropped from 79.8% to 32.5%, a 59.2% reduction (p < 0.0001). CHWs reported that d-IDS improved workflow efficiency, data accuracy, and decision-making compared to the paper-based approach, especially with features like offline functionality and symptom-guided screening protocols.
interpretationThe findings confirm that d-IDS is both feasible and acceptable for CHW use in community settings. It improves community-based patient management and reduces the burden on health facilities. However, close follow-up mechanisms are necessary to ensure early detection of any worsening conditions. These promising results support the future national rollout of d-IDS as a scalable solution to strengthen primary healthcare and CHW-led service delivery.
fundingThe study received financial support from the United Kingdom (FCDO 40105983), Canada (DFATD 7429348) and Germany (BMZ ACT Accelerator support 25.04.2022).
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