Healthcare in Rwanda

Rwanda, and especially its health sector, has come a long way since the genocide of 1994, during which much of the infrastructure and systems of the country were destroyed. Today, progress in Rwanda is defined by the strong leadership that has led the country to be called a "Model for Economic Development." Under these conditions, it is exciting to be an NGO working in Rwanda, supporting development and witnessing the important milestones and changes.

Overview

Rwanda’s Health Sector Strategic Plan (HSSP-II) clearly defines its nine strategic objectives at the health center level.

1. To improve the accessibility to, quality of and demand for Family Planning/Mother & Child Health/Nutrition services

2. To consolidate, expand and improve health center services for the prevention of disease and promotion of health

3. To consolidate, expand and improve health center services for the treatment and control of disease

4. To strengthen the health center’s institutional capacity

5. To increase the availability and quality of human resources for health

6. To ensure financial accessibility to health services for all and sustainable and equitable financing for the health center

7. To ensure geographical accessibility to health services for all

8. To ensure the availability and rational use of quality drugs, vaccines and consumables at the health center

9. To ensure the highest attainable quality of health services at the health center

To ensure that these goals are met by 2012, the Ministry of Health oversees the entire health sector in Rwanda, which consists of 5 referral hospitals, 40 District hospitals, approximately 400 health centers, and about 60,000 Community Health Workers (four per village). Community Health Workers promote health center usage and provide basic care in their villages. Health centers provide basic primary care, including vaccinations, HIV testing/treatment, family planning, wound care, and maternity/delivery services. Health centers refer patients to District Hospitals, which, when necessary, refer patients to one of five referral hospitals in the country.

Additionally, Rwanda has a Faculty of Medicine at the National University of Rwanda, four nursing schools, and a community health insurance program, “Mutuelle de santé communautaire.” This system provides the structure through which community members can be educated about disease prevention through community health workers, access primary healthcare through health centers, seek advanced care (through District and referral hospitals), and seek affordable healthcare through Mutuelle health insurance.

With such an organized system in place, it is no wonder that Rwanda is on track to achieve most of the Millennium Development Goals that relate to health. Notably, Rwanda’s maternal mortality rate in 2009 was 383 per 100,000 live births, down from 750 in 2005. This rate also compares positively to surrounding countries such as Uganda (440 per 100,000 live births) and Kenya (560).

CCHIPs Role

As health centers are the gateway to the formal health system in Rwanda, this is where CCHIPs chose to focus its interventions. Health centers in Rwanda act as mini-hospitals, with 15-25 inpatient beds, a delivery room, a laboratory, and a pharmacy. Despite their importance to the healthcare system, they are often in need of additional capacity and resources to be effective. For example, when we started working at Shingiro Health Center, we discovered that quality of care could be improved by providing nurses with additional medical trainings, patient wards could be made safer through investments in mold and asbestos removal, and access to care could be improved through the provision of essential medicines.

Through interventions like these, WWHPS is helping Rwanda improve its health centers. WWHPS is developing a model for improving primary health care delivery that will both increase the capacity of health center staff, allowing them to feel more confident in treating patients and making diagnoses, and ensure that health centers have the necessary resources to provide quality primary healthcare. We have already piloted this model -- Comprehensive Community Health Initiatives & Programs (CCHIPs) -- at Shingiro Health Center, and believe that by working closely with the Ministry of Health we will be able to help other health centers benefit from these improvements. 

WWHPS believes that our work will ultimately help the Ministry of Health achieve its goal of improving the health of the people of Rwanda.