Rwanda: Our Impact

 {Photo credit: MSH/Candide Tran Ngoc}Diogène shows his CBHI card.Photo credit: MSH/Candide Tran Ngoc

Thirty-seven year-old Diogène lives in the Eastern province of Rwanda. In March 2012, he began to feel ill. He was short of breath, couldn’t walk uphill, and had chest pains. Diogène held community-based health insurance (CBHI), which enabled him to see a doctor at the Ngarama district hospital, where he was diagnosed with heart disease.

Using RapidSMS, a community health worker requested an ambulance to transport Dorcelle to the Musanze Health Center, where she delivered a healthy baby. {Photo credit: Candide Tran Ngoc/MSH.}Photo credit: Candide Tran Ngoc/MSH.

In 2011, Drocelle gave birth to her fourth child, and, for the first time, delivered at a health center. Throughout her pregnancy, Drocelle had been monitored by a community health worker, Elizabeth, who regularly visited her at home and encouraged her to go to the Musanze Health Center for antenatal care. When Drocelle went into labor, she contacted Elizabeth, who sent a RapidSMS text message to the Musanze Health Center requesting an ambulance. Without the ambulance, it would have taken Drocelle three hours to walk to Musanze Health Center.

 {Photo credit: Candide Tran Ngoc/MSH}A Rwandan nurse immunizes a child.Photo credit: Candide Tran Ngoc/MSH

Until recently, nurses and midwives in Rwanda had varying degrees of knowledge, training, and capacity. Some had received inadequate instruction abroad and others had even bought counterfeit diplomas. Because there was no system in place to ensure nurses were adequately prepared, many Rwandans were subjected to inconsistent care and unreliable service quality.

Photo credit: C. T. Ngoc/MSH.

Eugénie is a widow and farmer living in the southern province of Rwanda, who struggles to provide for her three children. For many years, Eugénie suffered from a renal tumor. Although she had community-based health insurance (CBHI) that covered 90 percent of her medical fees, Eugénie was unable to pay the remaining 10 percent. Her health deteriorated.

The USAID-funded Integrated Health Systems Strengthening Project (IHSSP) welcomed Mr. Peter Malnak, the new USAID Mission Director, to Rwanda on August 28, 2012.Launched in November 2009, IHSSP is a five-year project, led by Management Sciences for Health (MSH), which seeks to improve access to quality health services for all Rwandans. IHSSP also works with the nation’s administrative districts and supports their efforts to collaborate with community and civil society organizations to manage health services throughout Rwanda.Mr.

Dativa is a mother of two living in eastern Rwanda. Her first baby was born at home; she felt that the health center was too far away. During her second pregnancy, a community health worker encouraged Dativa to deliver at the health center. When Dativa went into labor, she took the advice. The community health worker helped her to take a motorcycle taxi to the nearest health center at Nzige, which would normally be a 90-minute walk.Dativa was examined by an experienced nurse who quickly detected a fetal malposition, which required urgent transfer to the district hospital.

{Photo credit: C. Tran Ngoc/MSH.}Photo credit: C. Tran Ngoc/MSH.

Before RapidSMS, a cell phone-based technology designed to support maternal and child health at the community level, was in place people in remote areas of Rwanda couldn’t access health care easily. Extremely ill patients were brought to facilities using hand-carried stretchers.

Jean Kagubare, MSH's Performance-Based Financing Principal Technical Advisor. {Photo credit: MSH.}Photo credit: MSH.

After the Rwandan genocide in 1994, the Government of Rwanda has worked to rebuild its shattered health system. Management Sciences for Health (MSH) works in partnership with the US Agency for International Development (USAID) and the Rwanda Ministry of Health to develop innovative health financing initiatives to provide more effective, quality HIV and primary health services. MSH spoke with Jean Kagubare, MSH's Performance-Based Financing Principal Technical Advisor, about implementing a national PBF model in Rwanda. What was the state of the health system after the genocide in Rwanda?

With an increasing demand for services, pressure to achieve the health Millennium Development Goals, and severe resource limitations, governments and donors have come to recognize that a good understanding of the cost of services is essential to effective and efficient use of available resources.In Rwanda, the USAID-fundedIntegrated Health Systems Strengthening Project (IHSSP)led by Management Sciences for Health (MSH) is assisting the Ministry of Health (MoH) in a major study of the cost of health services which is expected to result in groundbreaking changes in the way the health services ar

Nyamata hospital in Rwanda successfully cut down its quarterly medicine procurement budget by 2.7 million Rwandese Francs (12% of the budget) in a period of six months with support from USAID-funded Management Sciences for Health's Strengthening Pharmaceutical Systems (SPS) Program.


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