RWANDA HAS continued to invest substantially in the health sector in order to improve access to health service while at the same time improving quality of services provided. This follows the commitment made by African leaders when they met in 2001 in Abuja, Nigeria, where they “pledged to commit 15 per cent of their national budgets to health spending”. By 2010, only four African countries; Rwanda, Botswana, Zambia and Togo were complaint with the Abuja pledge. So, how has Rwanda managed to leverage this investment to improve levels of healthcare service delivery, particularly in rural areas? Many observers and institutions have argued that Rwanda’s commendable progress has been as a direct result of “extensive economic and governance reforms undertaken between 1995 and 2008”, a 2009 World Bank report summarises. Similarly, a report by KPMG, released in 2012, notes that Rwanda was able to “deliver acceptable outcomes, by combining different modes of financing and by successfully lobbying for external funding and by making the quality of government health bureaucracy a priority”. Equally observant, Pose and Samuels (2011), from the Overseas Development Institute in the United Kingdom, emphasise that Rwanda has indeed made remarkable improvements on key health indicators, including “infant and child mortality; immunisations coverage; use of family planning; malaria mortality and morbidity; and HIV prevalence”. Therefore, in part one of two parts of my article, we take a closer look at how the modernisation of health facilities in rural areas has led to significant improvements in the delivery of health care. Next week in part two, we pay attention to two important reforms; Community Based Health Insurance; and accountability through Imihigo. Modern health services in rural areas Traditional methods of health care are very common in Africa. In fact, the majority of the rural population in many African countries continue to embrace traditional methods far more than modern health care methods. For example, expectant women in rural areas have relied on the assistance of traditional birth attendants to deliver new born babies. However, for many decades, such methods have proved inefficient and in many cases have carried a high risk of complications associated with poor hygiene, and lack of midwifery skills. For that reason, maternal mortality continues to be severe in Africa. Under those circumstances, the state of health care, particularly with regards to improving maternal health services in rural Rwanda, had to undergo radical changes. In addition to providing several modern facilities all over the country, government embarked on a public campaign to sensitise the rural population about the benefits of using modern health facilities and services. Would-be mothers have been encouraged to visit health clinics during the entire duration of their pregnancy. Indeed, Chambers and Boot (2012), also from the Overseas Development Institute, indicate that one of the reasons why maternal health care has improved rapidly in Rwanda has been due to “a very effective public education campaign on the importance of these activities for mother and child health”. In the same way, this same report points out that these education campaigns about using modern health services have been running hand in hand with “a system of fines imposed on women who fail to attend antenatal care and deliver in health care centres”. Evidently, the use of modern health services has led to a reduction in maternal mortality, and an improvement in life expectancy at birth. For instance, the same Chambers report indicates that maternal mortality rate dropped sharply “from 1,071 per 100,000 live births in 2,000 to a recorded 383 per 100,000 in 2010”. Rwanda has continued to perform better in the area of reducing child mortality and subsequently improved life expectancy, as some of the rewards from prioritising immunisation coverage. It is safe to argue that current data would support the continued decline in child mortality. By contrast, the use of modern health services in rural areas of most regional countries remains limited. Some analysts have blamed the inadequate public campaigns as the reason behind the poor level of modern facilities’ usage. To be continued… The writer is a UK Parliamentary Intern and holds a Master of Science in Public Service Policy. Twitter: @Jsabex
