Rwanda: Our Impact

 {Photo credit: Todd Shapera.}Community health workers and children, Rwanda.Photo credit: Todd Shapera.

It has been 20 years since the genocide that killed over a million citizens and devastated the Rwandan health system and economy. In some respects, it feels more recent. Our memories of both the violence and our collective inadequacies in the international response are still raw. But the progress Rwanda has made toward economic and social stability in just two decades is astonishing and a cause for celebration.   

 {Photo Credit: Candide Tran Ngoc/MSH}Mr. Nkurunziza Justin, human resources manager at Kibungo Provincial Hospital in Rwanda.Photo Credit: Candide Tran Ngoc/MSH

The health workforce is the core of every health system. In Rwanda, where qualified clinical staff are in short supply—the country has an average of one nurse for every 1,500 inhabitants and one doctor per 15,306 citizens —efficiently allocating human resources is crucial to the provision of quality services.

 {Photo credit: Zina Jarrah/MSH, Tanzania.}A community health worker takes blood to check for malaria.Photo credit: Zina Jarrah/MSH, Tanzania.

Diarrhea, malaria, and pneumonia are leading causes of child mortality, accounting for nearly 44 percent of deaths among children under five worldwide.

 {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.