Rwanda: Our Impact

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.

After successfully supporting the national scale-up of performance-based financing (PBF) for health centers in Rwanda, Management Sciences for Health (MSH) is now providing technical assistance to the Rwandan Ministry of Health (MoH) to sustain and improve this model and to introduce PBF at the community level. PBF is an innovative health financing solution that structures the flow of resources to pay for results rather than simply paying for processes or reimbursing activity costs.

In order to achieve the Government of Rwanda's long-term health vision to "provide sustainable financial resources for the delivery of primary health care for all" by 2020, specific long-term objectives related to health have been set and defined. The objectives are to establish a fair and efficient universal health financing system based on national solidarity, capacity-to-pay, prepayment, and financial protection for all.

Management Sciences for Health (MSH) is participating in the First Global Symposium for Health Systems Research being held from November 16-19, 2010 in Montreux, Switzerland.

Coptic Waiting in Tent. Photo Credit: MSH StaffOn November 4–6, 2009, in Gisenyi, Rwanda, the Initiative on Adherence to Antiretrovirals of the International Network for the Rational Use of Drugs (INRUD-IAA) hosted its third annual meeting on antiretroviral therapy (ART) adherence. Results of an INRUD-IAA research study showed that the adherence indicators chosen for study are clinically meaningful—that is, they correlate to increases in patients’ CD4 counts and weight gain.

A laboratory worker at Kabusunzu Health Center in Kigali, Rwanda. Photo Credit: Tempe Goodhue.Rewarding health service providers in Rwanda for positive results has increased the number of clients served and improved the quality of the services they receive. MSH has documented noteworthy gains in indicators of maternal-child health from 2005 through mid-2009.

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