Rwanda: Integrated Health Systems Strengthening Project (IHSSP)

2009-2014

Following the successful Rwanda HIV/Performance-Based Financing project, the Integrated Health Systems Strengthening Project (IHSSP) is assisting the Rwanda Ministry of Health in widening its scope to the strengthening of information systems and human resources management in a decentralized structure. Institutionalizing the practice of systematic quality improvement, the Project will work to support the government's efforts to extend quality public health services to the entire country.

In November, 2010, the project facilitated a panel on the impact of the Rwandan Performance Based Financing (PBF) program at the First Global Symposium on Health Systems Research held in Montreux, Switzerland. The panel, moderated by Dr. Yogesh Rajkotia, a senior health economist with USAID, Rwanda, included presentations made by representatives of the Rwandan Ministry of Health (MOH) and Management Sciences for Health (MSH). They were made on behalf of the MOH under the guidance of Dr. Agnes Binagwaho, Permanent Secretary. Dr. Ludwig de Naeyer of IHSSP was a substantial contributor to much of the research. 

The presentations are below:

Choice of Indicator and Amount in the Performance Based Financing [PowerPoint 1MB]
Presenter: Cedric Ndizeye, USAID/IHSSP Rwanda
Authors: Cedric Ndizeye, USAID/IHSSP Rwanda; Dr. Louis Rusa, Ministry of Health, Rwanda; Ludwig De Naeyer, USAID/IHSSP Rwanda; Kathy Kantengwa, MD, MPA, MSH

For Health The Impact of Performance-Based Financing on the Cost of Health Services in Rwanda [PowerPoint 652 KB]
Presenter: David Collins, MSH
Authors: Dr. Agnes Binagwaho, Permanent Secretary, Ministry of Health (MOH), Rwanda; Dr.  Bonaventure Nzeyimana, MOH, Rwanda; Dr. Richard Gakuba, MOH, Rwanda; Dr. György Fritsche, World Bank; Thomas McMennamin, University of California, Berkeley; Christine Mukantwali, USAID/IHSSP, Rwanda; David Collins, USAID/IHSSP, Rwanda

Performance Based Financing for Health In Rwanda [PowerPoint 1020KB]
Author: Dr. Louis U. Rusa, Ministy of Health, Rwanda

Influence of PBF Indicators on Health Coverage [PowerPoint 1MB]
Presenter: Kathy Kantengwa MD, MPA, MSH
Authors: Cedric Ndizeye, USAID/IHSSP, Rwanda; Ludwig De Naeyer, USAID/IHSSP, Rwanda; Kathy Kantengwa, USAID/IHSSP, Rwanda; David Collins, USAID/IHSSP, Rwanda; Steven Karengera, MOH, Rwanda

Strengthening Pharmaceutical Systems (SPS) Program

2007–2012

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Strengthening Pharmaceutical Systems is a follow-on to the Rational Pharmaceutical Management (RPM) Plus Program. MSH is pleased to announce that the US Agency for International Development has awarded us the Strengthening Pharmaceutical Systems (SPS) Leader with Associates Cooperative Agreement. SPS will focus on four key results:

• Improve governance in the pharmaceutical sector
• Strengthen pharmaceutical management systems to support public health services
• Contain the emergence and spread of antimicrobial resistance
• Expand access to and improved use of essential medicines

The five-year, $147.5 million cooperative agreement is led by Dr. Douglas Keene as Program Director, Dr. Sameh Saleeb and Dr. Francis Aboagye-Nyame as Deputy Directors. To help meet goals relating to the key result areas, the SPS Program is building on the successes of RPM Plus while expanding the range of technical areas to include financing, pharmacovigilance, pharmaceutical care, integration of new health technologies, and increased use of the private sector, among others. MSH will accomplish this enhanced program of activities by collaborating with a number of new partner organizations. The SPS core partner team includes:

• BroadReach Healthcare
• Ecumenical Pharmaceutical Network
• The Lewin Group
• LMI Government Consulting
• University of Washington Department of Global Health
• WHO Collaborating Center in Pharmaceutical Policy: Harvard University/Boston University

In addition to the core team, MSH is joined by a select group of organizations that will serve as specialized resources for SPS. These organizations include:

• African Medical and Research Foundation
• American Society of Health-System Pharmacists
• Euro Health Group
• Infectious Disease Institute at Makerere University
• Joint Commission International
• London School of Hygiene and Tropical Medicine

As we work toward the overall goal of SPS, the SPS team is striving to advance the science and "art" of strengthening pharmaceutical management systems. The SPS Program provides a great opportunity for MSH and USAID to continue supporting developing countries in their quest to increase access to essential medicines and facilitate the scale up of vital treatment programs.

 In 2003, the Strengthening Pharmaceutical Systems (SPS) Program's predecessor Rational Pharmaceutical Management (RPM) Plus was invited to Rwanda to evaluate the capacity and readiness of the pharmaceutical and laboratory systems for scaling up antiretroviral therapy. As a result, RPM Plus and currently SPS have been working in Rwanda since 2004 under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and now the President's Malaria Initiative (PMI). The mandate of SPS in Rwanda has changed over time. During the first years of implementation, focus was on interventions related to quantification, procurement, distribution, and management information systems at the national level (Ministry of Health [MOH] and CAMERWA) under the RPM Plus Program. The SPS mandate has been expanded to include capacity building and supervision related to several different areas of pharmaceutical management at the district and facility levels. The SPS Program has centered its technical assistance on medicine safety at national and peripheral levels, specifically in the areas of pharmacovigilance and rational medicine use, which are the program's areas of expertise.

Capacity Project

2004–2009

As a partner with IH on the Capacity Project, MSH undertook three main activities to strengthen the Human Resources for Health capacity of Southern Sudan by:

• Supporting the Human Resources Director of the Ministry of Health to develop a Human Resources for Health Strategy through a baseline assessment of the human resource management needs and a strategy development workshop
• Developing leadership skills through implementation of the Leadership Development Program throughout the county
• Finalizing a set of personnel policies and producing a Personnel Policy Manual for the MOH

Basic Support for Institutionalizing Child Survival (BASICS)

1999–2011

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As a technical assistance partner for newborn and child health to the USAID Bureau for Global Health, the Basic Support for Institutionalizing Child Survival (BASICS) Project develops and implements strategies to reduce preventable infant and childhood deaths in the developing world. MSH works as a partner in BASICS, which began its third phase in October 2004. Under this indefinite quantity contract (IQC), BASICS assists USAID/Washington Bureaus, USAID field missions, host-country governments, donor agencies, NGOs, PVOs, research institutions, and the private sector to scale up and increase the use of newborn and child health and nutrition interventions by families, communities, and health systems. Since 1993, BASICS has worked to achieve substantial improvements in coverage and to expand effective newborn and child health interventions. BASICS focus areas include newborn health, essential nutrition actions like vitamin A supplementation, immunization, integrated management of childhood illness, treatment of diarrhea and pneumonia, and malaria control. In addition to strengthening the delivery of basic newborn and child health services, BASICS has expanded its technical scope to include pediatric HIV & AIDS, birth spacing, and child survival and nutrition in complex humanitarian crises. BASICS areas of expertise include assistance to countries on comprehensive strategies or selected interventions for newborn and child health, building partnerships, delivery of quality newborn and child health services, community-based treatment and private sector approaches to expand access to services, and capacity building and training.

BASICS helped the Rwandan Ministry of Health improve newborn and child health, and decrease preventable deaths through a number of activities: developing a maternal and child health unit within the Ministry of Health to provide technical leadership in newborn and child health services; planning and harmonizing activities across districts and implementing partners to achieve the maximum impact in reducing mortality impact; and improving access to and the quality of preventative and treatment services.

MEASURE Evaluation

2008–2013

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The MEASURE Evaluation project, which began in 1998, is USAID’s flagship Monitoring and Evaluation project and was established based on the premise that generating demand for and improving the use of data in policy formulation, program planning, monitoring and evaluation improves health systems which in turn affects health outcomes. The project is now in Phase III and is led by the University of North Carolina. In addition to MSH, the partners include Futures Group, JSI, Macro International , and Tulane University. MSH provides capacity building in the area of organization and leadership development to enhance sustainability using MSH’s virtual and other tools and also offers direct support to country M&E teams.

Rwanda HIV/PBF Project

2005–2009

Rwanda's HIV/PBF (Performance-Based Financing) Project is designed to increase the delivery of specific HIV & AIDS and primary health care services through an innovative financing project that provides monetary and other incentives through a national output incentive payment program. The approach is designed to promote and reward effective innovation and efficient management in the delivery of quality services. The HIV & AIDS component is to be implemented in a manner that assures that primary care health services are not depleted or weakened by diversion of basic health resources into HIV & AIDS service delivery.

Rational Pharmaceutical Management Plus Program

2000–2008

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MSH provided technical guidance and assists in strategy development and program implementation both in improving the availability of safe, effective health commodities of assured quality and cost—pharmaceuticals, laboratory diagnostics, vaccines, supplies, and basic medical equipment—and in promoting the appropriate use of these commodities in the public and private sectors at the community level, with special focus on managing pharmaceuticals essential for maternal, newborn, and child health.

RPM Plus staff and consultants work within developing countries as well as with regional and global initiatives to provide technical leadership and to develop and apply tools for improving drug management at all levels. The program also disseminates best practices and approaches in commodity management. In response to an urgent request from Centrale d'Achat de Médicaments Essentiels du Rwanda (CAMERWA) to USAID/Rwanda for technical assistance in the quantification of antiretroviral drugs, the RPM Plus Program conducted a general assessment of Rwanda's pharmaceutical and laboratory systems. Following this assessment, in collaboration with USAID/Rwanda and supported by the President's Emergency Plan for AIDS Relief, RPM Plus provided technical assistance to the Ministry of Health and CAMERWA to strengthen Rwanda's pharmaceutical and laboratory sectors.

Advance Africa

2002–2004

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Advance Africa was a family planning/reproductive health service delivery project designed to increase access to and improve the quality of clinical and nonclinical programs in sub-Saharan Africa. The project worked to increase capacity for informed decision-making by clients and communities, and for the public sector to sustain quality family planning/reproductive health service delivery programs. Advance Africa also worked with USAID missions to scale up existing efforts by closing gaps in service delivery, and building partnerships among public and private health and nonhealth organizations. The project implemented innovative approaches to revitalize family planning programs within the broad context of Africa’s HIV/AIDS pandemic. MSH was the prime of a consortium of six international organizations that managed implementation of the Advance Africa project.

International Network for Rational Use of Drugs Initiative on Adherence to Antiretrovirals (INRUD-IAA)

2006–2011

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The International Network for Rational Use of Drugs (INRUD) was established in 1989 to design, test, and disseminate effective strategies to improve the way drugs are prescribed, dispensed, and used, with a particular emphasis on resource poor countries.

Launched in September 2006, the INRUD-IAA initiative is funded by the Swedish International Development Cooperation Agency. The objectives of the five-year initiative are to—

• Develop and validate a set of indicators that can be used to monitor adherence to ART
• Investigate adherence rates and determinants for these rates for ART programs and individuals in two target countries
• Pilot interventions to improve adherence in individual patients and in programs in two countries
• Establish the process needed for national AIDS control programs to scale-up successful interventions as part of national policy in the two countries
• Work with the other three countries in the region to develop national adherence policies and implement interventions to improve adherence

IMPACT

1998–2002

The IMPACT program focused on two areas of development: capacity building from 1998 through 2000 and financial management from 2001 to 2002. MSH developed, tested, and revised a capacity building assessment tool for the IMPACT/Rwanda country office and provided ongoing, long-distance technical assistance, training, and coaching on how to implement the capacity-building plan. In the second phase of the IMPACT project, MSH provided support for pharmaceutical management policy and logistics, as well as technical assistance and materials to Family Health International (FHI) in development of FHI projects.

Norplant Cost Study

1993

The Norplant Cost Study — coordinated by the FPMD Project — provided information to assist decision makers in implementing cost-effective strategies to improve access to Norplant (a hormonal contraceptive) in developing countries. It examined unit cost of contraceptive methods in the Centre Universitaire de la Santé Publique (CUSP) in Butare, a large outpatient health center. The study results helped managers evaluate the cost implications of different program decisions and to plan and budget effectively for the future.