Twubakane Decentralization and Health Program

Twubakane Program overview brochure: English or French

Twubakane, the Kinyarwanda word meaning “Let’s build together,” united many partners—the Government of Rwanda, USAID, nongovernmental organizations, health workers, and communities. Launched in 2005, the Twubakane Decentralization and Health Program supported the Government of Rwanda to improve integrated service delivery in hospitals, health centers, and communities by strengthening the capacity of local governments, health facilities, and communities to provide, plan for, and manage high-quality 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 focused on six integrated goals:

  • Increased quality and accessibility of family planning and reproductive health services in facilities and communities
  • Improved child survival, malaria prevention and treatment, and nutrition
  • Strengthened capacity for policy-making at the Ministry of Health and by local governments
  • Enhanced decentralized planning, budgeting, and management in the 12 districts
  • Strengthened local health management, including support to facilities and community-based insurance schemes
  • Expanded community engagement and oversight.

Selected Achievements

Twubakane built capacity to offer services at local levels, and provided support for improving policies, protocols, and strategies at the central level. Highlights of results included the following:

  • Assisted the government to update national family planning standards and protocols; introduced family planning services at 45 facilities in 23 districts; and successfully helped establish secondary family planning posts near Catholic-affiliated health facilities—contributing to the dramatic rise in use of modern contraception in Rwanda, from 4% in 2005 to 27% in 2007-2008
  • Saw a 75% increase in Twubakane-supported districts in the number of women delivering with skilled birth attendants in health facilities and improved maternal and neonatal care
  • Supported training of more than 8,000 community health workers in home-based management of malaria; these health workers treated more than 66,000 children, reducing malaria cases in children under 5 by 46% from the previous year
  • Administered 286 sub-grants totaling $17 million to districts, health facilities, and NGOs in support of decentralized health care, including an innovative District Incentive Fund grant program that built district capacity and increased district resource mobilization
  • Worked with the Ministry of Health’s Community Health Desk to develop national integrated community health policy and improve quality of family health services through 134 community-provider partnership Partenariat pour l’Amelioration de la Qualité (PAQ) teams that helped local communities define their health needs—and identify and implement cost-efficient solutions
  • Conducted extensive analyses of gender equality; supported training of health workers, police officers, and others in preventing and responding to gender-based violence.

This five-year, $28-million program was funded by 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.

Annual Reports