EDPRS: Drive towards universal public healthcare on course

BY GODFREY NTAGUNGIRA Rwanda considers its population as its fundamental resource for its future development. To drive growth policy makers have identified appropriate health initiatives which have to be nurtured to ensure that a healthy working population is able to partake in development activities. Issues to do with equity and access to healthcare while looking at quality and cost implications are some of the critical concerns. More so the envisaged population growth policies should go hand in hand with strategies to overcome problems in the health sector. Progress in implementation of EDPRS programs in health sector The government of Rwanda is committed to tackling various health sector challenges. The health sector support over the next five years is premised on the need of reducing poverty and improving the health status of the population. In terms of health, Rwanda has made significant progress in the improvement of health and the socio-economic situation of its citizens. The fight against HIV/AIDS has been given priority by the leadership. Rwanda like many other African countries has adopted a multi-sectoral approach to the fight against the Aids pandemic. A national AIDS Commission (CNLS) was established in 2000 and is composed of members from all walks of life (government, private sector, civil society and parliament), and each province has a branch of the National Commission for the Fight against HIV/AIDS. Local Medical Insurance Through Mituelle de Sante, a universal public medical insurance scheme introduced in 2001, the government has enabled over 5 million people, including those living with HIV/AIDS, widows and orphans to access health services easily. The scheme is a global success story. The key thrust is to ensure that efforts are instituted at ensuring health care for all. This scheme is thus the biggest in terms of its membership. It is organised on a household basis, whereby membership entails making an annual payment of Rwf 1000 (less than US$2) per family. This may sound unbelievable to the western world, but it has been proved to be more efficient and very realistic. During the design of this novel programme Government has noted that by basing its health financing systems on solidarity and equity, achieving millennium development goals will not only be accelerated but the society will also grow socially and economically. Government has also facilitated access to drugs for HIV and for related opportunistic infections. Currently Anti-Retroviral (ARV’s) drugs are on the list of essential drugs on offer to patients. This implies that such drugs must be available and accessible to the population at all times. The objective of the health sector is to ensure, promote & improve the health status of the Rwandan population by providing accessible quality, preventative, curative, promotional and rehabilitative health services across board. Performance indicators The health sector has shown good performance in a number of key areas regarding maternal and infant health. 1. The percentage of women using modern contraceptives increased from 10% in 2006 to 27% (mini DHS 2007/8).The Health Management Information System (HMIS) estimates coverage at 31.2%, all of which exceed the target of 25%. 2.The percentage of children fully immunized increased from 75% in 2006 to 80.4%.This slightly exceeded the 2008 target of 80% and this has benefited from all health facilities carrying out outreach services for immunization. 3.On the indicator measuring the percentage of children using Long Lasting Insecticide Treated Nets (LLITN) , significant progress was made, however, the target of 65% was not fully realized with the mini-DHS (2007/8) reporting a score of 60% from a baseline of 16% in 2006. 4. The percentage of assisted births in an accredited facility exceeded the target of 35% with a performance of 62.8% (HMIS 2008) coming from a baseline of 28.2% (2006), this has also been included in all performance contracts of districts for 2009. 5.The utilization rate of primary health care services also increased from 70% to 86% in advance of the 75% target that was set, however the target for per capita allocation to Performance-Based Financing (PBF) was not met fully with a realization of US$1.40 compared to a target of US$1.45 in 2008 and a baseline of US$1.2. 6. On the systematic and early provision of HIV testing of children born to HIV mothers, there has been an increase from 86.7% in 2006/07 to 87.3% in 2008. Condom access points have been intensified and a tool to facilitate dialogue for parents and children regarding use of condoms has been developed, this is anticipated to reduce the barriers in communicating on sexual matters hence reducing risks of increasing spread of sexually transmitted diseases (STDs). Programme interventions 1. Integration of grassroots health workers The formal integration of 60,000 health community workers (CHWs) into the formal health system is considered to be landmark achievement in bringing services closer to the population. Malaria and other childhood killers and ailments are being checked in addition to related outputs by this new form of intervention which has entrenched community distribution of contraceptive commodities. 2. Reducing financial barriers Reducing financial barriers to improve access to health care through the community based health insurance schemes is another remarkable intervention.This in turn has triggered increased motivation of health workers to improve quality and utilization of health services through the Performance Based Contracting Scheme. The trickle down of this intervention means that improved geographical access through the construction, equipping and renovation of health facilities have all strengthened access to quality services and the health system nationally. 3. Replication of guidelines Guidelines have also been developed for the treatment of diarrhea and training conducted in 4 districts.This is set to be replicated in all districts of the country. A national policy on provision and initiating the testing of this guideline has been developed and scale up is planned for 2009. 4. Effecting new policies During the course of 2008 policy actions for the health sector that were achieved include the publishing of the population and family planning promotion policy.Inclusion of assisted delivery in ‘Imihigo’ of districts and their action plans is another policy move in place. Others included the development and approval of a community health policy implementation plan and budget, including partners’ programs as well as the approval of a credible health sector medium term economic framework that supports community health and nutrition policy reforms. Ends

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EDPRS: Drive towards universal public healthcare on course