Twubakane Decentralization and Health Program

Women examining cardTwubakane, the Kinyarwanda word meaning “Let’s build together,” united many partners—the Government of Rwanda, USAID, nongovernmental organizations, health care providers and communities. Launched in 2005, the Twubakane Decentralization and Health Program supported the Government of Rwanda in addressing the many challenges it faces in meeting the growing population’s priority health care needs. Twubakane focused on:
  • Increasing the use of quality family health services in health facilities and communities
  • Strengthening the capacity of local governments and communities to support improved health service delivery at decentralized levels.

High rates of maternal and child illness and death hinder social and economic development and burden a health care system also suffering from resource gaps, inconsistent quality of care and a need for improved community health services.

Working in 12 of Rwanda’s 30 districts—Rwamagana, Kayonza, Ngoma and Kirehe in Eastern Province; Gasabo, Kicukiro and Nyarugenge in Kigali City; and Kamonyi, Muhanga, Ruhango, Nyamagabe and Nyaruguru in Southern Province—Twubakane’s approach to building a solid foundation for effective, decentralized health care included six integrated components:

  • Increasing accessibility, quality, and use of family planning and reproductive health services in health facilities and communities
  • Increasing accessibility, quality, and use of integrated child health services in health facilities and communities, with a focus on malaria and nutrition
  • Improving the capacity of the ministries of health and local administration to put policies and procedures in place for decentralization, with a focus on the health sector
  • Strengthening districts’ capacity to plan, budget, mobilize resources, and manage services, with an emphasis on health services
  • Strengthening health facilities’ capacity to manage resources and promote and improve the functioning of the community-based health insurance (mutuelles de santé)
  • Increasing community access to, participation in, and ownership of health services.

This five-year, $28-million program was funded by the US government through USAID and collaborated with Rwanda’s Ministry of Health, Ministry of Local Administration, Ministry of Finance and Economic Planning, and Ministry of Gender and Family Promotion. Led by IntraHealth International, Twubakane’s partners were RTI International, Tulane University, EngenderHealth and VNG (Netherlands International Cooperation Agency). Local partners included RALGA (Rwanda Association of Local Government Authorities) and Pro-Femmes.

Twubakane Program Overview Brochure (English) or (French)

Annual Reports