RWANDA PRIMARY HEALTH CARE AND DECENTRALISATION OF HEALTH SYSTEM

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RWANDA PRIMARY HEALTH CAREAND DECENTRALISATION
OF HEALTH SYSTEM
Claude SEKABARAGA, MD, MPHDirector
of planning, policy and capacity building
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PRIMARY HEALTH CARE SERVICES
MOH HRF, OAI
30 DISTRICTS DH, DP, CDLS,
MUTUELLE
416 SECTORS Health center
2080 CELLS Health community post
14980 AGGLOMERATIONS 2 Community health
workers
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PRIORITY INTERVENTIONS OF PRIMARY HEALTH CARE
SERVICES

• Increase the use of family planning methods,
  especially the long term methods
• Investment in strong prevention interventions of
  major diseases
• Universal access to curative care for all people
  living in Rwanda through universal coverage of
  health insurance
• Improvement of quality of care through quality of
  training, e-health, investment in infrastructure,
  drugs management, equipment and performance based
  financing of providers
• Decentralization of health services at Umudugudu
  (Health post) and households level (Community
  Health workers)
• Mobilization of financial resources.

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INNOVATIVE INTERVENTIONS

• Public subsidies (Health facilities budget
  support) through performance based financing
• Community health insurances
• High subsidy of drugs and products of higher
  prevalence diseases (Immunization, malaria,
  Hiv/aids and TB)
• Autonomy of management of health facilities
  (hospitals and health centres), include now
  personnel
• Decentralisation, integration and task shifting
  in delivery of health care services.

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DECENTRALIZATION OF
HEALTH SERVICES
System /process Achievements
1. Setting up of Board and Management Structures in all facilities 100 of health centers and 75 of hospitals have set up governance bodies
2. Planning for the Health Sector at the Decentralized level Each District has a Health Strategic Plan, All Hospitals have a 2008 Action Plan linked to the HSSP, 40 of Health Centers have comprehensive 2008 plans
3. Physical Infrastructure There are 402 Health Centers, 36 District Hospitals, 30 District pharmacies and 4 National Hospitals
4. Decentralization of Budget 85 of funds have been decentralised
5. Improvement of Community Health Services 2 Community health workers for each umudugudu have been elected and are being trained
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HEALTH SECTOR BUDGET DECENTRALISATION
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GOR HEALTH BUDGET TRANSFERS TO DISTRICTS 17,1
billions of RWF (32 millions USD)
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HEALTH OFF BUDGET (NGOS) TRANSFERS TO
DISTRICTS 10,4 billions (18 millions USD)
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FAMILY PLANNING
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ANTE NATAL CARE
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BIRTHS DELIVERIES
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IMMUNIZATION
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HIV TESTING SERVICES
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PREVENTION OF TRANSMISSION OF HIV FROM
MOTHERS TO CHILDREN SERVICES
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PREGNANT WOMEN TESTED HIV
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ART SERVICES AND PATIENTS
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TB DETECTION
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COMMUNITY HEALTH INSURANCE IN RWANDA
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UTILISATION OF CURATIVE CARE
SERVICES IN RWANDA
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• IMPACT ON HEALH
• OF POPULATION

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MALARIA MORBIDITY
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HIV PREVALENCE
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TUBERCULOSIS MORBIDITY
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Challenges of primary health care Solutions
Quality of Care BCC for health providers, Performance Based Payments, citizen voice systems
Brain Drain of Human Resources for health Management of HRH labour market based
High level of poverty as vicious circle with health status Universal coverage of community health insurance with mobilisation of resources to temporarily subsidy poorest categories
Lack of resources for infrastructure and equipment Mobilise and decentralise infrastructure maintenance, construction and equipment
Poor transport and communication system for emergency Development of a national medical emergency transport system (SAMU)
Off budget with many implementers and difficulties of alignment and harmonization Sector Wide Approach (SWAP) with Joint Work plan and sector budget support

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LESSONS LEARNT

• Decentralisation and community participation
  Accessibility, early treatment, ownership,
  implication of local leaders, community health
  workers, youth and women organisations, autonomy
  in management.
• Community health insurance Financial barrier,
  utilisation of primary health services.
• Performance based financing Quality, Rural to
  urban brain drain, local investment Equipment,
  maintenance
• Strong prevention Universal distribution of
  mosquito-nets, hygiene and environment.
• Partnership Public, private, civil society and
  international cooperation implication.

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CONCLUSION

• Decentralisation and community participation
  contributed to rapid and efficient results
• Primary health care have been improved very much
  in terms of prevention of major diseases like
  malaria, HIV/AIDS, although many challenges due
  to level of poverty and quantity and quality
  human resources
• Great efforts must be put in elimination of
  major diseases like malaria, diseases due to lack
  of hygiene and/or which vaccines exist, universal
  access to mosquito-nets and health insurance.