Digitally Integrated Disease Management System in Rwanda: Community Healthcare Worker Perspectives

As digital health tools are increasingly deployed to support community-based primary healthcare, understanding frontline user experiences is critical for effective implementation and scale-up. Here, community health workers' (CHWs) perspectives on the digitally integrated disease management system (d-IDS) in Rwanda are discussed. The d-IDS intervention was intended to improve the cost-effectiveness of community-based screening, patient management, and disease surveillance through a mobile digital platform. Before implementation, user acceptance testing and cascade training prepared CHWs, their supervisors, and health facility staff. During implementation, continuous supervision and qualitative assessments of the system were conducted. Qualitative data were collected through focus group discussions and semi-structured key informant interviews. The CHWs widely appreciated the system's ease of use, comprehensiveness, availability in Kinyarwanda (local language), offline functionality, improved data management, and ability to expedite effective patient management cascades compared with paper-based registers. Home-based screening reduced patient time and costs of care and enhanced equity and access to care, bringing Rwanda closer to achieving Universal Healthcare Coverage. However, challenges included increased workload, inadequate or lack of incentives, internet connectivity constraints, system rigidity in updating household records, and initially low digital literacy among some CHWs. Ongoing digitalization initiatives will inform national scale-up and policy choices.