Leadership, Management & Governance: Our Impact

 {Photo credit: MSH Rwanda}Left to right: Lisa Godwin, USAID Rwanda Health Office Director, Dr. Diane Gashumba, Rwanda's Minister of Health, Alain Joyal, RHSS Project Director, Management Sciences for Health.Photo credit: MSH Rwanda

Over the past five years, the United States Agency for International Development (USAID) has invested in measures to strengthen and sustain Rwanda’s health sector through its Rwanda Health Systems Strengthening (RHSS) Project (2014-2019). In a ceremony at the Kigali Serena Hotel, USAID, the Ministry of Health (MoH), as well as the implementing partner, Management Sciences for Health (MSH), marked the culmination and remarkable achievements of the five-year effort to strengthen the country’s health sector.

{Photo credit: Todd Shapera}Photo credit: Todd Shapera

Cesarean section (C-section) delivery, which is usually initiated when complications arise during pregnancy or delivery, is one of the most frequent surgeries performed at health facilities worldwide.

{Photo credit: Todd Shapera}Photo credit: Todd Shapera

When Ruhengeri Hospital in northern Rwanda upgraded from a district to a referral hospital in 2014, it began receiving cases from 15 health centers in its own district and five hospitals in surrounding districts. In 2015 alone, the hospital had nearly 6,000 monthly outpatient visits—about 25% above previous levels and among the highest in the country. While these numbers indicate how important the status upgrade was in relation to local health needs, the facility struggled to consistently meet those needs.

{Photo Credit: Irene Nambi, MSH}Photo Credit: Irene Nambi, MSH

Linda* arrived at Kibagabaga Hospital exhausted and desperate. Referred by a smaller health center, she had already been in labor for more than 24 hours. A midwife admitted Linda and put her on an IV. There, she waited for several hours until an obstetrician examined her. Realizing that the baby had an accelerated heartbeat, which is a sign of distress, the doctor ordered a Cesarean section (C-section). When the baby emerged, he was not responsive. Hospital staff worked to help him breathe and eventually, he let out a wail.

 {Photo credit: Irene Nambi, MSH}Beatrice Uzamukunda visits with a nurse in Rwamagana Hospital.Photo credit: Irene Nambi, MSH

By Irene Nambi On an early morning at Rwamagana Hospital in Rwanda’s Eastern Province, patients began to fill the busy outpatient department. As health workers started receiving patients, Beatrice Uzamukunda rushed in with her daughter, Esther. “My baby was very ill with a very high temperature. I was so worried that I had almost lost hope as we approached the facility,” says Beatrice.

 {Photo credit: Rebecca Weaver/MSH}With the support of IHPplus, midwives are able to apply the helping babies breathe (HBB) approach to resuscitate newborns.Photo credit: Rebecca Weaver/MSH

“I became a nurse because my grandmother was a nurse, my sisters are nurses, and one of my aunts is a nurse,” says Neema Kitima, Head Midwife at Bahira Hospital in Bukavu, Democratic Republic of the Congo (DRC). While 80% of births in DRC occur at health facilities with a trained assistant, maternal and neonatal mortality rates remain among the highest in the world. The most recent Demographic and Health Survey (2013–2014) showed that maternal deaths account for 35% of all deaths of women 15–49 years old.

A student from the center for educational activities of Sévaré reads of poem about female genital mutilation.

I do not agree with cutting I didn’t choose to be born a woman So why should I suffer By this removal that I have to endure?   On International Youth Day, communities around the globe will call for – and create – safe spaces for youth to express themselves, influence decision making, seek confidential care and information, and call out violations of their human rights. This year, youth highlighted the urgency of ending gender-based violence, female genital mutilation (FGM), and child marriage in a very public space in central Mali.

24-year-old Hawa Swaleyi facilitates a discussion about relationships with her youth group at Kapiri Health Center, Malawi.

The grounds around Kapiri Health Center in Malawi’s Nkhotakota District are a beehive of activity, with boys and girls of all ages playing hotchpotch, kicking a makeshift ball, and chattering loudly. Suddenly, they run for the indaba—a repurposed outpatient waiting shelter. Hawa Swaleyi is approaching, carrying her frame with an aura of grace and positivity. With a familiar smile she greets her youth group, who cheerily respond in sing-song voices.

This story was originally published on systemone.id. SystemOne LLC, (Springfield, MA), Management Sciences for Health (MSH) (Medford, MA) and the Tableau Foundation (Seattle, WA) recently concluded the first Data Fellowship Program for TB staff from the National TB programs and Ministries of Health. Eight participants from five participating countries attended the week-long training session in Johannesburg, using their own country’s GxAlert diagnostic data to uncover ways to improve healthcare delivery and patient impact.

By Priyam Sharda, Design Research Lead for M4ID, and Shafia Rashid, Principal Technical Advisor for Management Sciences for Health. Photos by M4ID. “For the first three months, the baby is just blood. There’s nothing there to take care of,” said one Kenyan father-to-be in Kakamega County, Western Kenya, where we were meeting with communities and health care providers to learn about their attitudes toward women’s health, pregnancy, and care at health facilities.

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