Rwanda
Rwanda is a mountainous east-central African country, often referred to as “the land of a thousand hills.” The country’s burgeoning population is putting pressure on the land’s fertility, the developing economy and health care services.
Rwanda’s health challenges include a critical shortage of qualified physicians and nurses, high maternal and child illness and death rates, and a health care system heavily burdened by malaria and HIV/AIDS.
IntraHealth has been working with Rwandans for nearly 20 years to address the country's need for high-quality health care services. Carried out in the context of Rwanda's recovery from civil war and genocide, this work included assistance in developing the country's first national reproductive health policy, approved in July 2003.
In working with the Ministry of Health (MOH) and local partners, IntraHealth focuses on strengthening human resources for health, building a foundation for community-based health care, developing HIV/AIDS clinical services, increasing access to family planning services, addressing priority gender issues, and integrating child health services, including malaria and nutrition.
Strengthening human resources for health (HRH): IntraHealth is supporting the development of a national HRH strategy and policy and has established an Internet-based human resources information system to facilitate long-term, data-driven workforce planning. To strengthen pre-service education at the MOH’s five nursing schools, IntraHealth worked with multiple donors and partners to strengthen pre-service education for registered nurses and midwives and Bachelors of Nursing.
Building a foundation for community-based health care: For more than seven years, IntraHealth has worked to establish and increase membership in community-run health insurance programs (mutuelles) and community teams that partner with health providers to solve problems and encourage local ownership of health services. As part of the government’s decentralization of health care, IntraHealth is administering District Incentive Funds that provide local authorities the financial and technical resources to implement innovative health and resource mobilization activities. These initiatives range from bringing electricity to health facilities to gifting citizens with goats whose products can help pay mutuelle membership dues.
Developing HIV and AIDS clinical services: IntraHealth supports prevention of mother-to-child transmission (PMTCT) of HIV and couples HIV counseling and testing services at 24 facilities in Rwanda. More than 14,000 pregnant women received comprehensive PMTCT services during the period of October 2006 through June 2007. The program has substantially increased the involvement of male partners in PMTCT, with 78% now agreeing to HIV testing. Through the community-health provider teams, IntraHealth also supports community prevention services, reaching more than 200,000 individuals from October 2006 through June 2007.
Increasing access to family planning services: In support of the government’s initiative to reposition family planning in Rwanda, IntraHealth is assisting the MOH with in-service training for health providers throughout the country, including reintroducing long-term methods and integrating family planning counseling into PMTCT services. Health facilities where in-service training has occurred have demonstrated that where family planning counseling and clinical services are offered, HIV-positive women will become successful clients. For instance, from 2005-2007, 71% of HIV-positive women at Kinihira Health Center accepted a modern family planning method. IntraHealth has published a report detailing the development of Family Planning in Rwanda.
IntraHealth will document the process and outcomes of integrating family planning into its Rwandan HIV/AIDS programs, thanks to a grant from the Tides Foundation. The grant—part of a multi-country Tides Africa Fund initiative jointly funded by Tides and the William and Flora Hewlett Foundation—will help IntraHealth ensure that clients entering Rwanda’s health care system for HIV services also receive the family planning and reproductive health services they need.
Addressing priority gender issus: IntraHealth has helped develop gender studies and tools, including the Study on the Readiness of the Political, Legal, Health and Community Systems to Respond to Gender-Based Violence in Three Districts of the City of Kigali, the Twubakane Gender-Based Violence/Prevention of Mother-to-Child Transmission of HIV Toolkit, and a Workplace Violence/Sexual Harassment (WV/SH) Study. IntraHealth also sponsored a national meeting for disseminating the WV/SH study results. The meeting brought together 72 participants (MOH, Ministry of Public Service and Labor, Ministry of Gender and Family Promotion, and Syndicate of Health Workers), as well as USAID and other partners. The focal institutions identified actions that will contribute to the elimination of gender-based violence in the workplace and met to plan next steps for implementing the WV/SH study recommendations. IntraHealth is also working to improve male participation in family planning, antenatal care, and prevention of mother-to-child transmission of HIV.
Integrating child health services: IntraHealth is working to ensure that child health services address malaria, which accounts for 40% of hospital visits in Rwanda, and malnutrition, which affects nearly half of Rwandan children under five.
In addition, IntraHealth provides assistance in human resources strengthening and quality assurance to the Rwanda HIV/Performance Based Financing Project. The project is working nationally to increase the delivery of HIV/AIDS and primary health care services by rewarding effective management and innovation with monetary and other incentives.
More information about IntraHealth's work in Rwanda can be downloaded here, or in the booklet, Progressive Vision, Positive Change: Building Capacity for a Healthier Rwanda (English and French, 1.2 MB).
Donors/Projects: USAID (Twubakane Decentralization and Health Program, Capacity Project, HIV/AIDS Clinical Services Project, HIV/Performance Based Financing Program) Tides Foundation and the William and Flora Hewlett Foundation
Partners, Twubakane Program: RTI International, Tulane University, EngenderHealth and VNG (Netherlands International Cooperation Agency)
Partners, Capacity Project: JHPIEGO
Partners, HIV/AIDS Clinical Services Program: University of North Carolina Institute for Global Health and Infectious Diseases, Mildmay
Partners, Rwanda HIV/Performance Based Financing Project: Management Sciences for Health (lead partner)
Selected health statistics for Rwanda (WHO, accessed July 2008):
Life expectancy, in years (m/f): 51, 53
Probability of dying under 5 years of age (per 1000 live births): 160
Adult prevalence of HIV/AIDS: 3%*
Maternal mortality (per 100,000 live births): 1300
*This figure is from the Population Reference Bureau 2008 World Population Data Sheet; CIA World Factbook