Changing Policy- Rwanda's change
in guidelines
African Regional meeting on interventions for Impact in essential
obstetrics and new born care
Addis Ababa 21-25 Feb 2011
Stephen Rulisa, MD, MMed (Ob/Gyn)
University Teaching Hospital of Kigali (CHUK)
National University of Rwanda
KUTH
Rwanda
• Population approx. 10m,
1m in Kigali
• 90% subsistence farmers
• Life expectancy gone up
50.1 yrs
• Adult HIV prevalence 3%
Addis Ababa 21-25
2
Rwanda
Milles collines
Mountain gorillas
Addis 21-25
3
Lac Kivu
MAIN CAUSES OF DEATH (MoH 2010)
3.16% 1.35%
4.52%
4.07%
2.26%
Severe bleeding
Malaria
Septicemia
Eclampsia
4.97%
33.93%
Other infections
Unknown causes
5.88%
Obstructive labor
Other causes
4.52%
Anesthesia complications
IO/HIV
8.14%
5.42%
3.16%
6.33%
12.21%
Amniotic embolism
Heart failure
Pulmonary embolism
Anemia in pregnancy
Policy Changes
• Maternal and child survival are on top of the list
of Rwanda’s health priorities, having been
identified as absolutely crucial for the long-term
health of the country on its road to development.
“Healthier mothers mean healthier children, and
healthier children mean a healthier, more
productive society in the future”.
Main support documents
• EDPRS: targets for maternal deaths in 2012 is
600/100.000 LB
• Vision 2020
• Health systems strategic plan (HSSP II)
• National Reproductive Health Policy
• National Strategic plan 2009-2012
Priorities in Maternal Health
• Priority n° 1 : To offer to all population quality, accessible and affordable
package of Maternal and Neonatal health services
• Priority n° 2 : To improve Essential Obstetrical and Neonatal Care (EONC)
as well as EMOC and FP services (RH Supplies security , infrastructures
and equipment)
• Priority n° 3 : To empower women and families for decision making
regarding their Sexual and reproductive Health concerns
• Priority n°4 : To ensure diagnosis and quality treatment for women with
Obstetrical fistula and their re-insertion and re-integration in the
community,
Priorities in Maternal Health(2)
• Priority n°5 : To integrate Gender in all MNH strategies and
activities
• Priority n° 6 : To reinforce the implication and participation of the
population in their RH expectations and needs : male involvement
in RH as well as empowering the CHW (ASM)
• Priority n°7 : To strengthen the MOH Information System (HIS)
which can enable quality surveillance , M&E of EONC/EMONC, FP
and Human Resources for Health (HRH) management activities
Key strategic interventions
•
•
•
•
Capacity building in RH
Maternal Deaths review: clinical and community level
FP made a priority: available in health posts and HC
Coordination of activities through Safe motherhood
technical working group
• Distribution of equipment and ambulances
• FANC: new protocol
• Community care: CHW, package, incentives, associations
Supportive approaches
• Rwandan parliamentarians Network to address development
and population issues: active involvement
• Health insurance Coverage: from 3% in 2002 to 96% in
2010.Delivary at health facilities increased from 52% in 2007
to 62% (2010)
• Performance based financing (PBF)in all health facilities:
aiming to motivate health providers (incomes), increase the
quality and quantity of delivered services.
• Motivating women to utilize health services through
incentives such as free delivery services if 3 ANC visits done,
ITN,
Supportive approaches(2)
• Involvement of Local government in
monitoring of MCH indicators (IMIHIGO) and
sensitizing the population (Umuganda)
• Community interventions: CHW elected, reorientation of former TBA
• Involvement of Faith based organizations:
sermon guide;
Innovative changes in health policies
• Increased budget allocation for health over the years
 Fiscal decentralization increased community
participation and allocated funds to district
governments
 Performance contracts were established between the
president and district mayors
 A PBF system to allocate money to
health facilities based on performance/Results
 Community health insurance , over 96% health
insurance
Policy changes..
• Involvement of professional bodies and other stake
holders
• Decentralized Emoc at health centres
• Introductions Oxytocin, mgso4, misoprostol, on
essential drug list & decentralized to health centers
• Strengthened CHWs at community level, community
PBF through cooperatives
• TBAs training to CHWs
• Formation of clusters from different ministries to
address health issues
Policy Changes
• Use of Innovative technologies
 Rapid sms, phone for health,..
Phones to CHW
Internet Access- health facilities a priority
Outcome of Policy Changes
From far…. & still going!!
• Thank you
AMESEGINALEHU