New District Governments Provide Health Care to Rwandans
MISSION OF THE MONTH |
RWANDA
 | FrontLines: August 2008
By David Kampf
Challenge
Rwanda is still largely
associated with the genocide and ethnic conflict that overwhelmed
its population in 1994. But much has changed since the end of the war. The country now enjoys greater stability, safety, and solid economic growth.
Despite these advances, Rwanda ranks near the
bottom of the U.N. Human Development Index which measures well-being around the world, ranking 161 out of 177 countries. The country is burdened with a small economy,
few natural resources, and a high poverty rate.
Eighty percent of Rwandans rely on subsistence agriculture. The country’s women have an average of six children, and
the use of modern methods of family planning remains low. And many health indicators—maternal, infant, and under-5 childhood mortality—have only recently returned to pre-genocide levels.
Adrienne Mukansanga, a nurse at the USAID-supported Nyamagabe Health Centre in Rwanda’s Southern Province,
administers a vaccination..
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Innovative Response
In 2005, the Rwandan government
initiated a process of redistricting and administrative
reform, forming new local governments empowered to deliver basic services, including
health care. Districts are now held accountable for achieving results.
In that same year, USAID launched the Twubakane
Decentralization and Health Program to supply funds to the new districts so they could better
provide services.
Twubakane (meaning “let’s build together” in Kinyarwanda, the local language) operates in
12 districts across Rwanda and serves over 3 million people.
Twubakane districts are eligible to receive financial support if they can demonstrate the ability to plan, budget, and manage activities.
“Twubakane is a unique program,”
said Dennis Weller, USAID’s mission director in Rwanda. “Without a responsive and capable government, adequate
health care is not sustainable.
Twubakane balances the need to develop the abilities of government officials and systems,
and ensure access to lifesaving
health services and medicines—
governance and health go hand-in-hand.”
Good governance enables districts, health facilities, and communities to provide quality services for maternal and child health including family planning,
management of childhood illnesses, and prevention and treatment of malaria.
Results
District incentive funds are being used to purchase equipment for health facilities, build public latrines, increase enrollment in Rwanda’s community health insurance programs, conduct fiscal
censuses, and other activities.
“The project came at the right time,” said Paul Jabo, the vice mayor in charge of economic
affairs in Gasabo District. “Now, the link between the administration and health is obligatory, and the mayors are responsible for the lives of their citizens…and Twubakane is there to support the process.”
Many Rwandans now have access to high-quality health care according to USAID’s Weller. “The overall health of Rwandans is improving as men, women, and children receive family planning, malaria, and nutrition services without needing to come to the capital city,” he said.
Nearly 140 health facilities assisted by Twubakane have trained personnel who can provide a wide range of family planning methods, including long-term options. Initial data indicates significant increases in the use of modern family planning methods.
“I was always struggling with either a child or pregnancy,”
explained Muriel Mukandinda, a 39-year-old mother of five, as she was waiting to receive family planning
services at a Twubakane-supported health center in the Eastern Province. “Now I have the time and energy to do more, and I think it will result in my farm being more productive.”
Malaria rates are falling as well. At the end of March, Twubakane had trained over 3,200 community health care workers to treat children under 5 within 24 hours of the onset of fever.
Sister Scholastique, a nurse in Kicukiro, a malaria endemic district on the outskirts of Kigali, explained that “since we introduced home-based management for malaria, we are no longer overwhelmed by many patients at the health center. Most of the fever cases are treated at the community level by community health workers, and we receive only severe cases and have time for preventive activities.”
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