Ministry of
Health
Rwanda Health Statistical Booklet 2010
Published in
July2011
Rwanda Ministry of Health Annual Statistical Booklet
2010
Table of Contents
List of Tables: ......................................................................................................................................... 4
List of Figures ......................................................................................................................................... 5
Acronyms: ............................................................................................................................................... 6
Foreword ................................................................................................................................................. 7
Introduction ............................................................................................................................................. 8
Health Sector Infrastructure .................................................................................................................... 9
Health Facilities .................................................................................................................................. 9
Health Facility Equipment and Utilities............................................................................................ 13
Communication ................................................................................................................................. 14
Human Resources ................................................................................................................................. 16
Morbidity and Mortality ....................................................................................................................... 17
Outpatient care .................................................................................................................................. 17
District Hospital Outpatient Morbidity ......................................................................................... 18
Health Centre Outpatient Morbidity ............................................................................................. 19
Hospitalization and Mortality ........................................................................................................... 21
Admissions and mortality in health centers and district hospitals ................................................ 21
Leading causes of mortality in health facilities............................................................................. 22
Family Planning ................................................................................................................................ 24
Ante-Natal Care ................................................................................................................................ 25
Cesarean sections at Hospitals ...................................................................................................... 28
Weight at birth and deaths of newborns........................................................................................ 28
Child immunizations ......................................................................................................................... 29
Growth Monitoring ........................................................................................................................... 30
Malnutrition ...................................................................................................................................... 30
Hospitalization for Childhood Malnutrition.................................................................................. 30
Outpatient treatment of Malnutrition ............................................................................................ 30
Community Health Worker Program .................................................................................................... 31
Community IMCI: ............................................................................................................................ 31
Sexual Violence .................................................................................................................................... 33
TB and HIV/AIDS ................................................................................................................................ 34
Tuberculosis (TB) ............................................................................................................................. 34
HIV /AIDS ........................................................................................................................................ 34
VCT............................................................................................................................................... 34
PIT ................................................................................................................................................ 36
Preventing Mother to Child Transmission (PMTCT) ................................................................... 36
HIV exposed infants follow up ..................................................................................................... 38
Care and treatment ........................................................................................................................ 38
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Rwanda Ministry of Health Annual Statistical Booklet
2010
HIV among Groups at high risk. ................................................................................................... 38
MALARIA. ........................................................................................................................................... 43
Laboratory ......................................................................................................................................... 45
SURGERY ............................................................................................................................................ 46
RADIOLOGY ....................................................................................................................................... 47
PERFORMANCE-BASED FINANCING:........................................................................................... 47
COMMUNITY-BASED HEALTH INSURANCE /MUTUELLE (CBHI).......................................... 49
Sources of Data ..................................................................................................................................... 51
HMIS ................................................................................................................................................ 51
Rwanda National Population Projections 2007-2022 ................................................................... 51
TracNet ......................................................................................................................................... 51
PBF ............................................................................................................................................... 52
CBHI indicator database ............................................................................................................... 52
Rwanda District Health System Strengthening Tool (DHSST) ........................................................ 52
Rwanda Interim DHS 2007-2008 (RIDHS) ...................................................................................... 52
Annexes: ........................................................................................................................................... 53
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Rwanda Ministry of Health Annual Statistical Booklet
2010
List of Tables:
Table 1: Number of Health Facilities 2009-2010 ................................................................................... 9
Table 2: Number and type of health facility by district ........................................................................ 11
Table 3: Minimum package of services in different facilities ............................................................... 12
Table 4: Availability of power in health facilities ................................................................................ 13
Table 5: Primary source of electricity in health facilities 2009 – 2010 ................................................ 14
Table 6: Availability of water in health facilities.................................................................................. 14
Table 7: Internet/Telephone access for district hospitals and health centers ........................................ 15
Table 8: Availability of computers in district hospitals and health centers .......................................... 15
Table 9: Number of inpatient beds by health facility type .................................................................... 15
Table 10: Vehicle access at district hospitals and health centres .......................................................... 15
Table 11: Facilities with selected fully functional equipment .............................................................. 16
Table 12: Ratio of health workers to population................................................................................... 16
Table 13: Number of outpatient visits in Health Centers and District Hospitals .................................. 17
Table 14: Top ten causes of outpatient visits in district hospitals in 2010............................................ 19
Table 15: Top 10 causes of morbidity in health centers in 2010 .......................................................... 20
Table 16: Number of admissions in health facilities by gender ............................................................ 21
Table 17: Number of deaths reported in health facilities ...................................................................... 21
Table 18: Top ten causes of deaths in district hospitals and Health Centers ........................................ 22
Table 19: Top 10 causes of inpatient hospitalization in district hospitals and health centers among the
under five in 2010 ................................................................................................................................. 23
Table 20: Family Planning Users by method and units distributed ...................................................... 24
Table 21: Pregnant women registered for ante-natal care ..................................................................... 25
Table 21: Location of assisted deliveries .............................................................................................. 27
Table 22: Causes of maternal death, 2010 ............................................................................................ 27
Table 23: Caesarian sections in District Hospitals and Referral Hospital ............................................ 28
Table 24: Birth and perinatal death in health centers and district hospitals .......................................... 28
Table 25: Childhood vaccination and ITN distribution ........................................................................ 29
Table 26: Nutrition status of children monitored in health centers ....................................................... 30
Table 27: Hospitalization for childhood malnutrition and health outcomes ......................................... 30
Table 28: Outpatient treatment of malnutrition and health outcomes................................................... 31
Table 29: Sexual violence by age and gender ....................................................................................... 33
Table 30: CHWs Participation in Community DOTS 2007 to 2010 .................................................... 34
Table 31: Success rate of Sputum Smear + for Tuberculosis enrolled in 2009 .................................... 34
Table 32: HIV testing of Tuberculosis + Patients ................................................................................. 34
Table 33: Anti-Retroviral Therapy in Rwanda from 2007 to 2010 ...................................................... 38
Table 34: Number and percentage of respondents reporting using a condom at the last sexual
intercourse by type of partner, age, province and sites, (N=1,136) ................................................... 41
Table 35: HIV prevalence of FCSW by background characteristics, 2010 Rwanda BSS. ................... 42
Table 36: Distribution of Malaria diagnoses by health facility type ..................................................... 44
Table 37: Type of lab Tests conducted at different health facilities ..................................................... 45
Table 38: Type of surgery performed ................................................................................................... 46
Table 39: Selected surgical interventions ............................................................................................. 46
Table 40: Medical imagery and other diagnostic testing procedures .................................................... 47
Table 41: Performance-Based Financing payments by year and PBF package .................................... 47
Table 42: Summary of CBHI income and expenditure ......................................................................... 50
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Table 43: Classification of staff categories by qualification ................................................................. 53
List of Figures
Figure 1: Map of Health Facilities in Rwanda, 2010 ............................................................................ 10
Figure 2: Distribution of health facilities by type ................................................................................. 12
Figure 3: Distribution of health facility by management authority ....................................................... 13
Figure 4: Map of Outpatient utilization rate, Rwanda, 2010 ................................................................ 18
Figure 6: Causes of Outpatient visits in district hospitals (updated)..................................................... 19
Figure 7: Distribution of outpatient morbidity in health centers ........................................................... 20
Figure 11: Trend of family planning coverage among married women, 1990-2007 ............................ 24
Figure 10: Infant death ratio by level of health care facility as reported in 2009 and 2010 ................. 29
Figure 12: Children treated by CHWs as part of Community IMCI ..................................................... 31
Figure 13: Outcomes of Community IMCI........................................................................................... 32
Figure 14: Nutritional status-MUAC by CHWs, 2010 ......................................................................... 33
Figure 15: Distribution of people tested for HIV/AIDS by sex ............................................................ 35
Figure 16: Age distribution and seroprevalence of clients tested for HIV in health facilities, Rwanda
2010 ...................................................................................................................................................... 36
Figure 17: Voluntary Counseling and Testing during ante-natal clinics .............................................. 37
Figure 18: Percent of Partner tested from 2003 to 2010 ....................................................................... 37
Figure 19: Circumcision Pattern of Youth Males in the 2009 Rwanda Youth BSS (N = 2,522) ......... 38
Figure 20: Comparison of Youth Sexual Behaviors between 2006 and 2009 BSS, Rwanda ............... 39
Figure 21: Youth Comprehensive Knowledge of HIV/AIDS, Rwanda Comparison between 2006 and
2009 ...................................................................................................................................................... 40
Figure 22: HIV knowledge comparison between 2006 and 2010 FCSW BSS, Rwanda ...................... 43
Figure 23: Graph of proportional morbidity for Malaria 2009-2010 in health centers ......................... 44
Figure 24: Map of proportional malaria morbidity by District 2010 .................................................... 45
Figure 25: Evolution of key Maternal and Child services (Average numbers per facility) .................. 48
Figure 26: Evolution of Average Quality scores from Health Center PBF Quality Assessments ........ 49
Figure 27: Map of Mutuelle Adhesion Rates by district 2010 .............................................................. 50
Figure 28: Evolution du taux d'adhésion aux mutuelles de santé 2003-2011 ....................................... 51
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Acronyms:
ANC – Ante-natal care
ARBEF– Association Rwandaise pour le Bien-Etre Familial (Rwanda Association for Family welfare)
ART – Anti-retroviral therapy
ARV – Anti-retroviral
BCG – Bacille Calmette Guerin vaccination
CPY - Couple Year Protection
DH – District hospital
DHS– Demographic and Health Survey
DOT- Directly Observed Treatment Short Course
DTP – Dyptheria, tetanus, pertusis vaccination
ECG- electro-cardiogram
EPI –Expanded Program on Immunizations
FBO – Faith-based organization
FP – Family Planning
GO – gynaecology-obstetrics
HC – Health centre
HiB – Hemophelus Influenza B vaccination
HIV/AIDS– Human Immunodeficiency Virus/ Aquired Immunodeficiency Syndrome
HMIS – Health Management Information System
iHRIS – Integrated Human Resource Information System
ITN - Insecticide Treated Nets
MCH – Maternal and Child Health
NGO– Non-Governmental Organization
NID – National Identity card
NRH- National Referral Hospital
OPD – Out Patient Days
P0 – polio vaccination dose zero
PBF – Performance-Based Financing
RDHSSF – Rwanda District Health System Strengthening Framework
RH – Referral Hospital
RIDHS – Rwanda Interim Demographic and Health Survey
SS+ - Sputum Smear Positive
TB – Tuberculosis
TPM+ - positive microscope pulmonary tuberculosis
VCT –Voluntary Counseling and Testing
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Foreword
As part of the Government of Rwanda’s commitment to produce evidence-based policies and programs, it is
imperative that we generate and publish reliable statistics and indicators that can be used by all stakeholders. This
Annual Rwanda Health Statistical Booklet has therefore been produced to provide a summary of all key statistics from
the Rwandan health sector in 2010.
This Booklet will enable policymakers, planners and other interested parties to gain an insight into the current state of
the Rwandan Health Sector. These important statistics provide a basis for policies, strategies and planned interventions
to ensure they are responsive to the needs of the health sector and, crucially, are focused on addressing current
priorities that aim to improve the health of the Rwandan population.
Dr Agnes BINAGWAHO
Minister of Health
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Introduction
The Rwanda Annual Health Statistical Booklet 2010 has been developed to provide an overview of key
statistics in the health sector for 2010. This is the second year in a row that the bulletin has been produced
and the first time that there is substantial data available from two calendar years enabling an analysis of
trends over time.
The Booklet is divided into four chapters: Infrastructure; Human Resources; Morbidity; and Special
Programs including Family Planning, TB, HIV/AIDS, Malaria and MCH. This year we have also added a
section on several health financing interventions: Performance-Based Financing and Community-Based
Health insurance. Other macro level financial information has not been included in this document as this is
covered substantially by the National Health Accounts and other special studies and reports.
This booklet aims to show key statistics in the health sector from 2010 in a concise, easily accessible manner
to ensure valuable statistics are readily available to all interested users. Comparisons with 2009 will help
users understand the evolving health situation in Rwanda.
Data have been extracted from a variety of sources: the Rwanda District Health System Strengthening Tool
(DHSST); the Health Management Information System (HMIS); TracNet; PBF databases for clinical
services, community health workers; the Community-Based Health Insurance (CBHI) indicator database,
and several surveys, including: the Rwanda Interim DHS 2007-2008 and the WHO Survey of Human
resources 2009. Details of all data sources are given in the annexes.
This document includes data from primary health care facilties and district hospitals managed by the public
sector or faith-based organisations that operate under a convention with the Ministry of Health (known as
‘agrée’). Limited data is also included from national referral hospitals to provide a more comprehensive
picture of infrastructure and disease burden. This year the Booklet also includes some data from the newly
implemented Community Health Worker Information system (SISCom). It does not include data from
private sector clinics or dispensaries.
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Health Sector Infrastructure
Health sector infrastructure covered in this section includes health facilities and selected resources available within
those facilities, such as staff, equipment, utilities and transport. It is important to note that this section draws data
from multiple sources, primarily the Health Facilities Database, the WHO Human Resource Survey and the Rwanda
District Health System Strengthening Tool (DHSST). The coverage of the DHSST represents a sub-set of health
facilities, and therefore may not be entirely representative of the national picture.
Health Facilities
The number of non-private Health Facilities (HFs) in Rwanda at the end of 2010 was 579; this is up from 541 in the
previous year. This increase was primarily due to the opening of 11 new health posts, 2 new Prison Dispensaries, 17
new Dispensaries and 8 Health Centers. These are classified as Referral Hospitals, District Hospitals, Health Centers,
Health Posts and Dispensaries.
Table 1: Number of Health Facilities 2009-2010
Year
National Referral
Hospitals
District Hospitals
Police Hospital
Health Centers
2009
4
2010
4
40
1
428
40
1
436
Dispensaries
18
35
Prison Dispensaries
16
18
34
541
45
579
Health Posts
Grand Total
Source: Health Facilities Database, HMIS unit 2009-2010
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 1: Map of Health Facilities in Rwanda, 2010
Source: Health Facilities Database, HMIS unit 2010
The number and type of health facility per district is shown in table2
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Table 2: Number and type of health facility by district
District
BUGESERA
BURERA
GAKENKE
GASABO
GATSIBO
GICUMBI
GISAGARA
HUYE
KAMONYI
KARONGI
KAYONZA
KICUKIRO
KIREHE
MUHANGA
MUSANZE
NGOMA
NGORORERO
NYABIHU
NYAGATARE
NYAMAGABE
NYAMASHEKE
NYANZA
NYARUGENGE
NYARUGURU
RUBAVU
RUHANGO
RULINDO
RUSIZI
RUTSIRO
RWAMAGANA
Grand Total
Referral
Hospital
2
1
1
4
District
Hospital
1
1
2
1
2
1
2
1
1
3
2
1
1
1
1
1
2
1
1
2
2
1
1
1
1
1
1
2
1
1
40
Military/
Police
Hospital
1
1
Health
Centre
14
15
18
15
20
21
13
15
11
19
15
8
11
13
11
12
12
16
21
17
18
16
8
15
9
13
18
14
16
12
436
Dispensary
Prison
Dispensary
Health
Post
# of Health
Facilities
1
1
3
1
2
16
16
26
19
26
23
16
22
19
25
26
10
14
15
19
18
26
21
27
23
21
19
13
16
12
17
19
18
18
19
35
18
45
579
1
5
1
4
1
3
7
3
5
1
2
4
2
1
5
1
5
1
1
2
2
2
4
7
3
4
2
1
2
1
1
1
3
2
Source: HMIS National Health Facility Database. Excludes private health facilities and FOSACOM
Of the 579 health facilities, 76% are health centers, 7% District Hospitals, 8% Health Posts and 6% Dispensaries
(see Figure 1). There are also 4 Referral Hospitals, 1 Police Hospitals1 and 18 prison Dispensaries. This
analysis, using data from the HMIS National Health Facility Database, encompasses health facilities managed
by the public sector or Agrees (faith-based organizations), but does not include private health facilities which
administrative districts have not systematically registered.
11
Note: since 2006 Kanombe Military Hospital serves as a District Hospital for the general population in Gasabo district,
so it has been re-classified as a District Hospital in this analysis.
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 2: Distribution of health facilities by type
0%
1%
Health Centers
8%
Prison Dispensaries
7%
6%
Dispensaries
3%
District Hospitals
75%
Police Hospital
National Referral
Hospitals
Source: HMIS National Health Facility Database
The minimum package of services provided by the main categories of facilities is summarized below:
Table 3: Minimum package of services in different facilities
Health facilities
National Referral Hospital
District hospitals
Health centres
Dispensaries
Health posts
Minimum package of services provided
Advanced inpatient/outpatient services , surgery,
laboratory, gynaecology, obstetrics; radiology,
specialized services: ophthalmology, dermatology,
ENT, stomatology, physiotherapy….
Inpatient/outpatient services, surgery, laboratory,
gynaecology obstetrics, radiology
Prevention activities, Primary health care,
inpatient, referral, maternity
Primary health care, outpatient, referral
Outreach activities (immunization, family
planning, growth monitoring, antenatal care)
Two of the four referral hospitals also serve as teaching institutions for doctors and pharmacists. Ndera hospital is the
referral hospital for mental health. Two other facilities, Kanombe Military hospital and Kacyiru Police hospital, cover
the surrounding civilian population in addition to the Rwandese Defence Forces and the National Police
Public health facilities represent 64% of the total number of non-private health facilities in Rwanda, with 28% run by
Faith-Based Organizations referred to as “Agrée”, 1% parastatal, 5% private and 2% by Communities.
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 3: Distribution of health facility by management authority
Number of Facilities by Management
Authority
28%
Agree
Community
Parastatal
64%
2%
1%
5%
Private
Public
Source: HMIS National Health Facility Database 2010
Health Facility Equipment and Utilities
According to the Rwanda District Health System Strengthening Tool2, a web-based database maintained by all of the
districts with data on 465 Health Facilities (of which 41 were DH, Kanombe Military Hospital and Kacyiru Police
Hospital, and 424 HCs), 19% of health centers and 2% of district hospitals had no access to power in 2009 – a figure
that has been nearly halved to 15% of health centers and 0% of district hospitals in 2010. The improvements have
come about mostly because of additional sites being added to the power grid and with the purchase and of generators
and solar installations.
Table 4: Availability of power in health facilities
Power Status
No power
2009
79
Health Centers
%
2010
19%
64
%
15%
2009
1
District Hospitals
%
2010 %
2%
0
0%
Some power (inconsistent grid, generator or solar)
176
42%
196
46%
6
15%
8
20%
Connected to grid (with consistent access)
166
39%
164
39%
34
83%
33
80%
Total
421
424
41
41
Source: Rwanda District Health System Strengthening Tool, 2009-2010
The District Health System Strengthening Tool also showed improvements between 2009 and 2010. The number of
health centers with power increased from 81% to 85% of health centers from 2009 to 2010 respectively. There was a
slight increase in the proportion of facilities connected to the electricity grid from 43% in 2009 up to 46% in 2010. In
most of heath facilities using solar energy and generator, power may not be sufficient. Most other electricity sources
remained proportionally the same.
2
The DHSST did not include health posts or dispensaries
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Table 5: Primary source of electricity in health facilities 2009 – 2010
Primary Electricity Source
Electricity grid
2009
Percentage
2010
Percentage
198
43%
213
46%
54
12%
49
11%
147
32%
155
33%
Biogas
2
0%
1
0%
Other
40
9%
7
2%
No power
21
5%
40
9%
Generator
Solar energy
Total
462
465
Source: Rwanda District Health System Strengthening Tool, 2009-2010
Water supply did not change between 2009 and 2010 – roughly one quarter of the facilities is connected to the
national water supply grid. According to the DHSST the proportion of facilities using local surface water in
2009 is 18% same in 2010.
Table 6: Availability of water in health facilities
Primary Water sources
2009
Percentage
2010
Percentage
Local Water System
149
121
95
84
6
4
2
32%
26%
21%
18%
1%
1%
0%
0%
127
138
93
86
3
4
3
27%
30%
20%
18%
1%
1%
1%
-
National Grid
Rainwater Harvesting
Local Surface Water
Well or Borehole, Covered
Well or Borehole, Uncovered
Tanker Truck
Unknown
Source Doesn't Exist
Total
1
462
-
12
466
3%
Source: Rwanda District Health System Strengthening Tool, 2009-2010
Communication
In 2010, all district hospitals were connected to the internet (up from 88% in 2009), 98% had cell phone coverage (up
from 95% in 2009). The improvements were made in internet connectivity at the health center level with 65% having
access to the internet in 2010 as opposed to 41% in 2009. The proportion of health centers with cell phone coverage
increased from 90% to 97%.
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Table 7: Internet/Telephone access for district hospitals and health centers
Facility type
Internet
2009
District Hospitals
Health Centers
36
88%
2010
41
100%
171
41%
275
65%
Cell Phone Coverage
2009
2010
39 95%
40 98%
377
90%
412
97%
Source: Rwanda District Health System Strengthening Tool, 2009-2010
All district hospitals have more than one computer facilities in 2010. At health center level the situation improved
dramatically during 2010 as only 5% of health centers had no computer facilities (down from 17% in 2009) and 86%
had more than one computer (up from 69% in 2009).
Table 8: Availability of computers in district hospitals and health centers
Health Centers
2009
2010
Hospitals
2009
2010
Availability of functioning
computers
no computers
71
17% 22
5%
0
0%
0
0%
1 computer
60
14%
9%
1
2%
0
0%
>1 computer
290
N
421 100% 425 100% 41 100% 41 100%
37
69% 366
86% 40
98% 41 100%
Source: Rwanda District Health System Strengthening Tool, 2009 & 2010
The table bellow shows the number of beds by health facilities’ types. Overall, bed/inhabitants ratio is 1bed for 587,
9259 inhabitants in 2010 compared to 1bed for 585,7581 inhabitants in 2009
Table 9: Number of inpatient beds by health facility type
Facility types
District Hospital
2009
6,602
2010
6,664
Health Center
9,283
9,585
949
959
16,834
17,208
Referral Hospitals
Total
Source: DHSST and reports from Referral Hospitals
The percentage of district hospitals with ambulance services didn’t change in 2009 to 2010. At the health center level
the proportion of facilities with ambulances increase from 15% to 16%. This is likely to be due to the transfer of some
vehicles to district hospitals as part of the rationalization of the SAMU ambulance network. The Rwanda District
Health System Strengthening Framework further indicates that all District Hospitals and 90% of Health Facilities have
access to at least one form of transportation, including 4x4 vehicles, cars, motos or pickup.
Table 10: Vehicle access at district hospitals and health centres
Vehicle type
District hospitals
2009 (N=41)
Health Centers
2009 (N=421)
2010 (N=41)
2010 (N=425)
Ambulance
39
95%
39
95%
64
15%
66
16%
Any type
41
100%
41
100%
379
90%
323
76%
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Source: Rwanda District Health System Strengthening Tool, 2009 and 2010
According to the DHSST, 90% of hospitals and 95% of health centers have a microscope and 83% of hospitals and
88% of health centers have a refrigerator, 90% of hospitals and 97% of health centers have an autoclave and 65% of
health centers have an incinerator.
Table 11: Facilities with selected fully functional equipment
Binocular
Microscope
Refrigerator
District Hospital
2009 (N=41)
2010 (N=41)
35
85%
37
90%
Health Center
2009 (N=421)
2010 (N=425)
361
86%
405
95%
35
85%
34
83%
362
86%
372
88%
X-Ray
34
83%
37
90%
n/a
n/a%
n/a
n/a%
Autoclave
38
93%
37
90%
300
71%
412
97%
Anesthesia machine
38
93%
37
90%
6
1%
0
0%
Incinerator
37
90%
34
83%
323
77%
275
65%
Source: Rwanda District Health System Strengthening Tool, 2009 and 2010
Human Resources
In 2010 there were 604 doctors and 8202 nurses/midwives working in Rwanda. Based on 2010 data from the
iHRIS, this corresponds to a ratio of 1 doctor per 17,240 inhabitants, 1 midwife per 66,749 inhabitants and 1 nurse
per 1,294 inhabitants. This situation has improved since 2009 when the worst off district had nearly 1,405
inhabitants per nurse.
The greatest increases were in the categories of Administrative staff (largely attributable to the inclusion of Mutuelle
staff, data managers and cashier in this category during 2010) and midwives whose numbers more than doubled
between 2009 and 2010. The only category that saw a reduction was that of paramedical and pharmacist a worrisome
trend that could be due to the promise of more lucrative careers in private sector.
Table 12: Ratio of health workers to population
Staff Category
2009
2010
Doctors
Nurses
Midwives
Paramedical
Pharmacist
Laboratory Technician
Administrative and
support Staff
579
7200
49
1355
111
931
604
8046
156
1102
72
1144
17,240
1,294
66,749
9,449
144,623
9,102
4.3%
11.8%
218%
-17%
-35%
22.9%
3565
3738
2785
5%
Population/HW % change
2010:
Source: Rwanda District Health System Strengthening Tool, Ministry of health: Human resources database 2010
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Morbidity and Mortality
Morbidity data for this booklet is from the HMIS with a health facility reporting rate of 93.5%. It does not include
records from National Referral Hospitals or private facilities.
Outpatient care
In 2010 the total number of new cases seen at HCs and DHs was 9,028,140 of which 8,437,850 (93.4%) were
seen in HCs, 590,290 (6.6%) at DHs and 214,512 at referral hospitals. During 2010, the primary curative care
utilization rate was approximately 0.81 visits per inhabitant (8,437,850visits/10,412,820 population excluding
community based integrated management of child hood illnesses (C-IMCI) by CHW’s) almost the same as in
2009.
Table 13: Number of outpatient visits in Health Centers and District Hospitals
Health Service level
2009
2010
7,996,598
8,437,850
5.5%
District Hospitals
544,284
590,290
8%
CHW Home Based care
744123
914,011
22.8%
Referral Hospitals
214,512
197,278
-8%
9,481,389
10,139,429
6.9%
Health Centers
Total
% change
Source: National HMIS database 2010, CHW Health Information System 2010,
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 4: Map of Outpatient utilization rate, Rwanda, 2010
The high OPD utilization rate may be due to the increased availability of ambulances and mutual membership.
It is also important to note the contribution of community health workers in the provision of community based care
since the introduction of community integrated management of childhood infections (IMCI). The number of OPD seen
by CHWs has increased about 23%. The proportion of reportage is 98% while in 2009, only 66% of the CHW
cooperatives reported. The diseases treated are childhood infections including fever/ malaria, acute respiratory
infections and diarrhea.
District Hospital Outpatient Morbidity
The most frequent outpatient services provided by district hospitals were dental and ophtalmogical care. Together they
represent almost one third of outpatient visits (35%) up from 20% in 2009. An acute respiratory Infection (ARI) and
cardiac disease represents respectively 8% and 4% of the total consultation
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Table 14: Top ten causes of outpatient visits in district hospitals in 2010
Disease Group
<5 years
5 years and
above
Total
Cases
% of
Total
Diseases of teeth and gums
5,486
115,931
121,417
21%
Eye diseases
7,513
73,860
81,373
14%
ARI
16,451
28,486
44,937
8%
Cardiological problems
2,008
24,122
26,130
4%
-
24,456
24,456
4%
1,413
15,801
17,214
3%
782
15,586
16,368
3%
Malaria
4,955
10,432
15,387
3%
Skin diseases
2,493
12,310
14,803
3%
78
13,824
13,902
3%
All other diagnoses
25,384
162,863
188,247
34%
Total
66,563
497,671
564,234
100%
Gastro-intestinal disorders
Physical trauma
Urinary tract diseases
Gyneco & obstetric diseases
Source: National HMIS database 2010
Figure 5: Causes of Outpatient visits in district hospitals (updated)
Top ten causes of consultion in districts hospital
in 2010
All other diagnoses
Gyneco & obstetric diseases
Skin diseases
Malaria
Urinary tract diseases
Physical trauma
Gastro-intestinal disorders
Cardiological problems
ARI
Eye diseases
Diseases of teeth and gums
0
40,000
80,000
120,000
160,000
200,000
Source: National HMIS database 2010
Health Centre Outpatient Morbidity
The picture is quite different in the health centers, where infectious diseases are the primary cause of outpatient
morbidity: ARI, intestinal parasites and malaria account for well over half of the outpatient morbidity (56%). There
was very little change in the distribution of morbidity at the Health Centers level since 2009, where malaria cases
represented 16% of outpatient’s consultation versus 8% in 2010
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Table 15: Top 10 causes of morbidity in health centers in 2010
Disease Group
ARI
Under5
Over5years
1,027,131
Total
cases
2,227,647 3,254,778
% of
Total
39%
Intestinal parasites
161,698
608,396
770,094
9%
Malaria
148,022
505,131
653,153
8%
Diseases of bones and joints
1,903
562,770
564,673
7%
Gastro-intestinal disorders
1,595
438,993
440,588
5%
Diseases of teeth and gums
37,483
292,605
330,088
4%
101,001
312,542
413,543
5%
30,584
349,563
380,147
5%
175,992
181,585
357,577
4%
Eye diseases
58,481
149,884
208,365
2%
All other diagnoses
75,519
989,325 1,064,844
Skin diseases
Physical trauma
Diarrhea
Total
1,819,409
6,618,441
8,437,850
13%
100%
Source: National HMIS database 2010
Figure 6: Distribution of outpatient morbidity in health centers
Source: National HMIS database 2010
20
Rwanda Ministry of Health Annual Statistical Booklet
2010
Hospitalization and Mortality
Admissions and mortality in health centers and district hospitals
Data on mortality in this report comes exclusively from health facility reports in the HMIS. They do not include
deaths in the community that were not registered at a health facility. As a result, the mortality figures are likely to
underestimate the true level of mortality in the country.
The total number of admissions in Health Centers and District Hospitals increased by 9% from 419,117in 2009 up to
456,341 in 2010. Sixteen percent (16.5%) of all admission in 2010 were children under 5 years of age and roughly
two-thirds (73%) were female.
Total deaths among patients admitted in DHs, HCs were 5,171 in 2010, down from 5,022 in 2009. The proportion of
death to total death is high for male (54%) than female (46%). Excluding data from referral hospitals for which total
number of admissions are not reported, this results in a health facility death rate of 1.6%, down from 1.7% in 2009.
The number of death decreased in health centers by 8% from 369 in 2009 to 341 in 2010, this can be attributed to
availability of ambulances that have facilitated in referrals of complicated cases to district hospitals. This is, of course,
an underestimate of overall mortality rates because it does not include deaths in the community, in referral hospitals or
in the private sector.
Table 16: Number of admissions in health facilities by gender
>=5 years
2009
%
<5 years
Total
>=5 years
Total
2010
%
Gender
<5 years
Females
250,585
292,583
70%
34,584
297,636
332,220
73%
Males
41,998
47,927
78,607
126,534
30%
40,877
83,244
124,121
27%
Total
89,925
329,192
419,117 100%
75,461
380,880
456,341 100%
Source: National HMIS database 2009-2010
Table 17: Number of deaths reported in health facilities
Deaths
2009
2010
% of
change
416
341
-2%
District Hospitals
4552
5206
14%
Referral Hospitals
2,147
2,055
-4%
Total
7,115
7,602
7%
Health Centers
Source: National HMIS database 2009-2010
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure8: Number of deaths reported in health facilities by gender, 2010
Source: National HMIS database 2009-2010
Leading causes of mortality in health facilities
The leading cause of death in district hospitals was malaria, accounting for 13% of total deaths in 2010 as compared to
22% in 2009. The other major causes of deaths are HIV & opportunist infections (9%), ARI (9%), Cardiac
diseases (5%) and premature birth (5%).
Table 18: Top ten causes of deaths in district hospitals and Health Centers
Row Labels
Malaria
ARI
HIV & IOS
Premature birth
Cardiac diseases
Tuberculosis
Malnutrition
Diarrhea diseases
Malignant tumors
Physical injuries
Others
2010
Total
5547
707
589
506
441
412
223
192
188
139
125
2025
%
13%
11%
9%
8%
7%
4%
3%
3%
3%
2%
37%
100%
Source: National HMIS database 2010
22
Rwanda Ministry of Health Annual Statistical Booklet
2010
Under five morbidity and mortality
During 2010, 1811 under five deaths were reported both from health centres and district hospitals. This
represent one third of total death.
In 2010, 95 % of the under five deaths in health facilities were in district hospitals.
Neonatal and < 1 mortality death contributes for 70 % to the under five mortality, of which 49 % is among
neonates. Prematurity was reported among 49 % of the neonatal deaths. Among the 896 neonatal deaths
reported in 2010 in health facilities, 571 (64 % died with the 6 days). It appears that neonatal deaths are mainly
linked to poor delivery. Causes of neonatal deaths are being investigated through the initiation of child death
autopsy in health facilities. .
The main causes of under five deaths in heath facilities are prematurity (23.4 %), respiratory tract infections
(15.5 %), Malaria (10.5 %) , malnutrition (6.9%) and diarrhea (4.8 %). Disease specific case fatality rates are
the highest in prematurity (19.4 %), congenital abnormalities (13.2 %), AIDS /OI (8 %) and Malnutrition
(5.6%).
Table 19: Top 10 causes of inpatient hospitalization in district hospitals and health centers among the under five in 2010
Diseases
Number of
Cases
% to total
cases
Number
of deaths
% to total
death
Case
fatality
rate
Respiratory tract infections
26,535
35%
292
16%
1.1%
Diarrhea
17,319
23%
90
5%
0.5%
Paludisme
9,745
13%
198
11%
2.0%
Malnutrition
2,327
3%
130
7%
5.6%
Prematurity
2,279
3%
441
24%
19.4%
Physical Trauma
1,576
2%
9
0%
0.6%
Skin diseases
523
1%
13
1%
2.5%
Gastro-duodenal diseases
359
0%
10
1%
2.8%
Congenital abnormalities
333
0%
44
2%
13.2%
Other
14465
21%
584
32%
4.1%
Total cases 2010
75461
101%
1811
100%
2.4%
23
Rwanda Ministry of Health Annual Statistical Booklet
2010
MATERNAL AND CHILD HEALTH
Family Planning
Figure 7: Trend of family planning coverage among married women, 1990-2007
Family Planning coverage among married women
27
13
10
4
1990
2000
2005
2007
Source (Demographic and Health surveys)
Routine family planning data are reported from both health centers and district hospitals. At the end of 2010, a total
number of 708,265 women of reproductive age were reported as continuing users of contraceptive methods in
health centers and districts hospitals (up 31% from 541,483 in 2009). Couple years of protection, family planning
indicator based on the distribution of contraceptive commodities, also increased by 36%, from 773,672 to
1,045,218 during the same period
The calculation assumes, that among the women of reproductive health 49 % are women in union and that 76% of
family planning users are women in union. Therefore Family planning coverage for women in union is 44.7%. The
most used method is Depo provera (66%) and Pills (18.5%). Surgical methods (0.1%) and DIU (1%) are not
commonly used probably because they require qualified personnel and training.
Table 20: Family Planning Users by method and units distributed
Method
Implant
Continuing
users at end
of Dec 2010
New
Users
Units
distributed
CYP
81,622
191,48
135,365
473,778
Injectable: Depo-Provera
467,955
223,299
1,575,309
393,827
Oral contraceptives (pills)
130,912
72,914
1,395,557
93,038
Natural FP – cycle beads
7,347
3,638
17,509
35,018
IUD
2,862
936
7,093
24,826
Natural FP - selfobservation
Barriers
5,179
7,254
0
14,508
11,500
8,525
953,294
7,944
888
285
0
2,280
708,265
335,999
4,084,127
1,045,218
Surgical Contraception
Grand Total
Source: National HMIS database 2010
24
Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 9: Distribution of contraceptive users by method (end 2010)
Source: National HMIS database 2010
Ante-Natal Care
A total of 321,388 pregnant women registered for Ante-Natal Care (ANC) in 2010. This represents a decrease in ANC
coverage rate of 75.3% from 78 % in 2009 (343,164 new registrations). This decrease might be explained by the
overestimation of the number of expected pregnancies. Nevertheless, of the women who registered a higher proportion
had at least one standard visit (increase from 25% to 30%), and the proportion who had 4 standard visits increased
from 14% to 16%. The proportion of high risk pregnancies are almost the same as in 2009 (16%) and 2010 (15%).
Table 21: Pregnant women registered for ante-natal care
Description
New registrations
Total
2009
% of new
registrations
Total
2010
% of new
registrations
321,388
323,442
Standard Visit 1st trimester
81,221
25%
96,032
30%
Standard Visit 2nd trimester
145,027
45%
134,883
42%
Number of women with 4 standard visits
44,555
14%
52,286
16%
High-risk pregnancies screened
52,280
16%
47,419
15%
% High-risk pregnancies referred
14,827
28.3%
13,445
28.3%
Source: National HMIS Database 2009/2010
25
Rwanda Ministry of Health Annual Statistical Booklet
2010
High risk pregnancies referred to the next level of care represent 28% of the total number of high risk pregnancies
screened during ANC sessions (almost the same 28% in 2009). This low percentage of referral rate of high risk
pregnancies is probably a major contributor to the maternal deaths that occurred in health centers. Assisted deliveries
A total of 242,672 assisted deliveries were reported during 2010, of which the vast majority were normal deliveries
(86%) and more than two thirds (68%) were in health centers. The maternal health policy promotes delivery in health
facilities where the delivery is conducted by a trained health professional in order to reduce any complications that
may arise during childbirth.
Figure 10: Map of coverage of assisted deliveries in Health Centers
If we compare the figure for assisted deliveries in the health centers, district hospitals and referral hospitals to the total
number of expected deliveries we can estimate the coverage of assisted deliveries at 56.8% in 2010, a decrease as
compared to 61% in 2009. The decrease in assisted deliveries could be attributed to the fact that the number of
expected deliveries which is used as denominator to calculate the assisted delivery coverage is overestimated due to
the increased use of family planning, resulting in reduction/underestimation of the coverage. Maternal deaths recorded
in health centers and district hospitals are almost the same in 2009 and 2010
26
Rwanda Ministry of Health Annual Statistical Booklet
2010
Table 22: Location of assisted deliveries
2009
Location of
delivery
Normal
deliveries
Dystocic
2010
Total
Maternal
Deaths
Normal
deliveries
Dystocic
Total
1305 165541
Maternal
Deaths
Health
Centers
District
Hospitals
174207
1,534
175741
45
164236
46,491
26,272
72,763
133
43489
28377
73296
162*
+23%
Referral
Hospitals
2,436
2,868
5,304
38
1960
1875
3835
42
+10%
223,134
30,674
253,808
216
209,685
31,557
242,672
221
-1.8%
Total
17
%
change in
maternal
deaths
-64%
Source: National HMIS database 2009/2010 + KFH, CHUK, CHUB.
Maternal deaths occurring in health facilities were 221 out of 242,672 deliveries. This corresponds to a health facility
Maternal Death Ratio of 91 deaths per 100,000 in health centers and district hospitals. This is well below the 20072008 RIDHS figure of 690/100,000, but the two figures are not comparable because of the methods of collection used
and the fact that the RIDHS also includes maternal deaths and unassisted deliveries in the community.
Among all deliveries, the main maternal complications in 2010 are per anal tear (0.43%), Bleeding (0.28%), Infections
(0.27%).
Table 23: Causes of maternal death, 2010
Causes of death
Number maternal death
%
75
18
27
14
7
12
10
13
11
33.9%
8.14%
12.21%
6.33%
3.16%
5.42%
4.52%
5.88%
4.97%
IO/HIV
9
Amniotic embolism
10
Heart failure
7
Pulmonary embolism
3
Anemia in pregnancy
5
Total
221
Sources: Maternal death audit, MCH/MOH, 2010
4.07%
4.52%
3.16%
1.35%
2.26%
100%
Severe bleeding
Malaria
Septicemia
Eclampsia
Other infections
Unknown causes
Obstructive labor
Other causes
Anesthesia complications
27
Rwanda Ministry of Health Annual Statistical Booklet
2010
Cesarean sections at Hospitals
Cesarean section rate slightly increased by 6.7% from 34% in 2009 up to 36.3% in 2010. Overall, the high rate of
caesarian section may be partly due to the increased availability of ambulances and better referral of high risk
pregnancies.
Table 24: Caesarian sections in District Hospitals and Referral Hospital
2009
Health
Facility
Type
#deliveries
#dystocic
deliveries
2010
#cesarean
section
cesarean
% of total
delivery
#deliveries
#dystocic
deliveries
#cesarean
section
cesarean
% of total
delivery
District
Hospital
72,763
26,272
24,189
34%
73296
28377
26330
35.90%
Referral
Hospital
5,304
2,868
1,814
34%
3,835
1,875
1,701
44.30%
TOTAL
78,067
29,140
26,372
34%
77,131
30,252
28031
36.30%
Source: National HMIS database 2009, 2010, Reports from Referral hospitals
Weight at birth and deaths of newborns
In 2010, all public and FBO (agree) health facilities reported 241,277deliveries registered in their records. These
records indicate that 14,621 newborns, or 6.0% of all recorded births for the year, had a weight less than the
acceptable birth rate of 2.5 Kg. Low birth weight is a risk factor for death in infancy. As one would expect with
effective referral of high risk pregnancies, the percentage of low birth weight deliveries is substantially higher at
district hospitals.
Table 25: Birth and perinatal death in health centers and district hospitals
Facility Type
Health
Centers
District
Hospitals
Total
2009
Total
births
Total
deaths
Births <
2.5 kg
% low
BW
2010
Total
births
Total
deaths
Births <
2.5 kg
% low
BW
176331
1410
5642
3.2%
166151
1246
5339
3.2%
73383
3098
11963
16.3%
75126
3345
9233
12.3%
249714
4508
17,605
7.0%
241277
4591
14572
6.0%
Source: National HMIS database 2009-2010, data unavailable from referral hospitals
Health facilities reported that among 241,277 births registered in Health Centers and District Hosptials during 2010,
4591died in-utero or within hours of birth, representing a proportional mortality of 1.9%, almost the same in 2009
1.8%.
28
Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 8: Infant death ratio by level of health care facility as reported in 2009 and 2010
Perninatal mortality rate 2009-2010
5.0%
4.2%
4.5%
4.5%
Mortality rate (%)
4.0%
3.5%
3.0%
2.5%
2009
1.8% 1.9%
2.0%
2010
1.5%
1.0%
0.8% 0.7%
0.5%
0.0%
Health Centers
District Hospitals
Average
Facility types
Source: National HMIS database 2009, 2010. Number of infant deaths (intrauterine+newborns)/total deliveries
Child immunizations
Based upon routinely reported data from health facilities, immunization coverage decreased for all antigens
since 2009, at least a decrease of 10%. This is most probably due to the overestimation of the denominator
(children <1), as explained above real coverage rates will be determined by a population survey (DHS 2010).
This is illustrated by a mini-survey (277.535 number of households) held in November 2010 in the
Northern Province. The proportion of children < 1 was 2.5 % (contrary to the 4.1 % used by HMIS)
and the coverage rate of fully vaccinated children was 92 %.
Table 26: Childhood vaccination and ITN distribution
Indicator
Polio O
2009
Number
% coverage
291,069
72%
2010
Number
% coverage
253,199
61.0%
BCG
324,557
80.3%
289,242
69.7%
Polio 1-DTP-HepB/Hib1
322,231
79.8%
288,612
69.6%
Polio 2-DTP-HepB/Hib2
322,229
79.8%
288,039
69.4%
Polio 3-DTP-HepB/Hib3
321,803
79.6%
290,591
70.1%
Measles
345,459
85.5%
297,819
71.8%
29
Rwanda Ministry of Health Annual Statistical Booklet
247,589
Children who received Insecticide Treated Nets
2010
163,963
61%
39.5%
Source: National HMIS database 2009-2010
Growth Monitoring
Children were monitored for nutrition status passed from 2.7 million times in 2009 to around 2.3 million in
2010. This does not represent the number of children weighed because each child is supposed to be monitored
monthly, however it does suggest that an average of 193,000 children are monitored each month at health
centers. When combined with the CHW growth monitoring reported below, nearly half a million children are
monitored each month. In 2010, for all monitored children 9.1% have malnutrition compared to 10% in 2009
Table 27: Nutrition status of children monitored in health centers
2009
Age
0-11
months
827,268
50,637
10,324
426
% malnourished
6.86%
12-23
months
606,693
65,822
16,605
1,404
24-35
months
530,149
51,154
13,350
36-59
months
455,294
53,265
2,419,404
220,878
Total
Green
Yellow
Red
2010
Oedema
Green
Yellow
Red
Oedema
% malnourished
714410
30628
7157
154
5%
11.96%
513213
54235 12037
816
11.4%
1,817
10.85%
455063
43663
9666
1176
10.5%
14,389
2,477
12.94%
420673
42024 10558
1500
11.1%
54,668
6,124
10.22%
2103359 170550 39418
3646
9.1%
Source: National HMIS database 2009-2010
Malnutrition
Hospitalization for Childhood Malnutrition
2,136 people were hospitalized for malnutrition in 2010, up from 1,920 in 2009. Deaths of people hospitalized
for malnutrition were also down substantially, suggesting more effective case management of malnutrition.
Table 28: Hospitalization for childhood malnutrition and health outcomes
Registrations
Year
Level of care
2009 < 5 years
>= 5 years
Total
2010 < 5 years
>= 5 years
Total
New
Cases
1,212
238
1,450
949
209
1158
Old Recovered
Cases
437
1,057
33
227
470
1,284
887
1058
91
211
978
1269
Status
Referred
to Hospital
93
22
115
55
20
75
Lost to
follow up
53
12
65
45
14
59
Died
16
3
19
5
0
5
Source: National HMIS database 2009, 2010
Outpatient treatment of Malnutrition
64583 people received outpatient treatment for malnutrition in 2010, down slightly from 75278 in 2009. For all
discharged patients 83 % of recovered as compared to 80% in 2009. Deaths of patients treated for malnutrition
as outpatients were also down slightly, especially in the over 5 year age group. These figures reveal a worrying
statistic: nearly 9% of children who registered for care were lost to follow up.
30
Rwanda Ministry of Health Annual Statistical Booklet
2010
Table 29: Outpatient treatment of malnutrition and health outcomes
Registrations
Year
Status
Level of
care
New
Cases
Old Recovered
Cases
2009 < 5 years
35796
28840
26578
563
7272
3370
6787
135
675
19
43068
32210
33365
698
6688
243
30945
24079
26645
362
5009
139
6644
2915
5224
92
644
27
37589
26994
31869
454
5653
166
>=5 years
Total
2010 < 5 years
>=5 years
Total
Referred
to Hospital
Lost to Died
follow
up
6013 224
Source: National HMIS database 2009-2010
Community Health Worker Program;
Community IMCI:
During 2010, Over 743,589children were treated by CHWs comparing to 462, 104 in 2009.The innovative
Community Health Worker program began to produce useful data for the first time in 2009 with the roll-out of the
Community Health Worker Information System (SISCom). A major focus of CHWs has been on community integrated
management of childhood infections (IMCI). Three major ailments: fever, pneumonia and diarrhea. Over two third
children treated presented with fever symptoms (77%), cough/cold symptoms were next with 12%.
Figure 9: Children treated by CHWs as part of Community IMCI
Source: SISCom 2010
31
Rwanda Ministry of Health Annual Statistical Booklet
2010
The SISCom data also suggest that outcomes of CHW IMCI treatment are generally good. 88% were reported cured, while less
than 10% were referred and a very small proportion 0.02% died while under the care of the CHW. The mortality data should
be interpreted with caution.
Figure 10: Outcomes of Community IMCI
Source: SISCom 2010
In addition to providing community IMCI, CHWs are involved in nutrition monitoring using simple middle-upper arm
circumference measuring tapes. During 2009, CHWs monitored the nutritional status of children more than 7517261 times
(an average 626438 children were monitored each month). For the year, less than 1% of the measurements were in the
red zone and another 4% were in the yellow zone. Malnutrition rate is high in the following districts: Rusizi (12.3%), Huye
11.5%, Ngororero 9.9% and Gakenke 9%. The districts with low malnutrition rate are Nyarugenge 1.3%, Gasabo 1.2%,
Gisagara 1.1%, Ruhango 1%, Kicukiro 1% and Ngoma 0.7%.
32
Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 11: Nutritional status-MUAC by CHWs, 2010
Source: SISCom 2010
Sexual Violence
Over four thousand and five hundred cases of sexual violence were reported by district hospitals (4,577) and one-third
(33%) of these cases had objective symptoms of sexual violence. Ninety-five percent of the cases investigated were
among females (95%). The largest group of victims was females between 5 and 18 years of age (57%). Males
represented about 5% of the cases investigated; the percentage is the same as in 2009 (5%).
Table 30: Sexual violence by age and gender
2010
Type of case
< 5 years
5 - 18 years
>18 years
Total
F
M
F
M
F M
297
28
869
35
272
7
1508
Number of cases with symptoms of
sexual violence
Number of cases received at the 831
hospital suspected of sexual violence
92
2602
103
901
48
4577
% change
from 2009
18%
22%
Source: National HMIS database 2009-2010
33
Rwanda Ministry of Health Annual Statistical Booklet
2010
TB and HIV/AIDS
Tuberculosis (TB)
In 2010, 7065 TB patients were registered; 6434 (91%) new cases, 442(6.3%) retreatment cases and 139(2, 7%) other
cases. The notification rate of all TB cases was 70/100,000 inhabitants and it was 41.4/100,000 inhabitants for the new
smear-positive pulmonary cases. Over ninety percent (97.9%) of all TB patients registered in 2010 were tested for
HIV. The seroprevalence of HIV was 31.8% among TB patients, ranging from 23% among new smear-positive and
42% among all other cases. About all cases (97.2%) co infected with TB-HIV received Cotrimoxazole-preventive
treatment (CPT). The community based DOTS covers 30 out of 30 districts.
Table 31: CHWs Participation in Community DOTS 2007 to 2010
Year
# of
districts
Population
covered
Suspected cases
Number of positive
suspects
Detected by Total
Detected by
CHW
CHW
Total
% of
suspected
cases
detected
by CHW
% suspected
positive
detected
by CHW
2009
24
9860652
52,235
5,840
2,275
365
11.2%
13.2%
2010
30
10117029
70325
6850
4049
396
10%
9.7%
Source: TRAC Plus/ TB Unit Report 2008-2010
The participation of CHWs is most significant in relation to the administration of treatment: 48.1% of patients
registered in 2010 in the districts concerned have received DOTS from CHWs. 10% of all suspected cases were
sensitized by CHWs and 9.7% of all confirmed cases were referred to health facilities by CHWs. In 2010 the success
rate of treatment by CHWs (97%) and overall treatment success rate (84.8%).
Table 32: Success rate of Sputum Smear + for Tuberculosis enrolled in 2009
Success rate of Sputum Smear +
Total under
Cured
Completed
treatment
treatment
3,140 (78.7%)
4096
335 (8.2%)
Overall Success rate of patients
Success rate followed by CHW
84.8%
97%
Source: TB program annual report 2010
Table 33: HIV testing of Tuberculosis + Patients
HIV testing
TB patients tested
Total TB patients
Tested
7065
6914 (97.9%)
Number of HIV
positive
2198(31.8%)
Number of HIV positive
under CMX
2,137 (97.2%)
Source: TB program annual report 2010
HIV /AIDS
VCT
During 2010, a total of 1,862,642 people were tested through voluntary counseling and testing services (up from
1,393,018 in 2009) and 1,641,752 (88%) knew their test results. Each year, the average number of people tested
voluntary in all health facilities was increased of 25%. The number of VCT sites increased from 403 to 434. (TRAC
34
Rwanda Ministry of Health Annual Statistical Booklet
2010
Plus/ HAS Unit 2009 & 2010 Annual Reports). The pie chart below describes the distribution of tests by gender, 54 %
of those tested were female.
Figure 12: Distribution of people tested for HIV/AIDS by sex
46%
54%
male
female
Source: TRACPlus/HAS Unit 2010 Annual Report
In 2010, about half of those tested were in the age group over 25 years (44.7%). The seroprevalence of
HIV is high among people aged above 25 years (3.1% down from 3.6% in 2009). In the age group below
18, the seroprevalence was estimated at 0.7% (down from 0.9% in 2009); in the age group between 18
and 25 years, the seroprevalence was estimated at 1.7% (down from 1.9% in 2009). The chart below
shows the percentage of people tested and the percentage of people with HIV Positive by age group.
35
Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 13: Age distribution and seroprevalence of clients tested for HIV in health facilities, Rwanda 2010
50
44.8
45
percentage (%)
40
35
30.7
30
24.5
20
% clients tested HIV
positive
15
% client tested
25
10
5
3.1
0.7
1.7
0
< 18 years
18-25 years
Age
>25 years
Source: RBC/TRACPlus/HAS Unit 2010 Annual Report.
PIT
In Rwanda, Provider initiated testing (PIT) was rolled out in all health facilities in 30 December 2010,
health facilities have already started to provide PIT services and 187258 patients have been counselled
and 5339 (2.8%) tested HIV positive.
Preventing Mother to Child Transmission (PMTCT)
With regard to Prevention of Mother to Child Transmission of HIV/AIDS (PMTCT), the number of women
who were receiving Ante-Natal-Care services in PMTCT settings is 307, 904. Among them 297145 (96.5 %)
accepted to be tested for HIV and 99% of the women tested returned for information about their HIV
serological status.
Among 297145 women tested for HIV in ANC services during the year 2010, 8343 were HIV positive
(2.8% of HIV seroprevalence in pregnant women in PMTCT).
36
Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 14: Voluntary Counseling and Testing during ante-natal clinics
8343
2010
294289
307904
8704
2009
296230
303113
8806
2008
296286
305995
0
Number of women who were
tested HIV Positive
Number of women who
accepted to be tested for HIV
and received their results
Number of women who were
received in ANC
50000 100000 150000 200000 250000 300000 350000
Source: RBC/ TRACPlus/HAS Unit 2008/2009/2010 Annual Reports.
Rwanda has also started to implement the new WHO recommendations of provision of ARV triple
therapy to the HIV-infected pregnant women starting at 14 weeks of pregnancy. The launching was done
on 15th November 2010.
In total, 8072 HIV-infected pregnant women received ARV prophylaxis and triple therapy prophylaxis
constituted. HIV-infected pregnant women were estimated to 10,310, 78% of them received ART
prophylaxis. From January to December 2010, 250142 (84%) of partners of pregnant women have been
tested and 6125 of them tested HIV positive (2.4% of HIV seropositivity). The number increased along
the years.
Figure 15: Percent of Partner tested from 2003 to 2010
90%
84% 85%
80%
78%
70%
66%
60%
53%
50%
40%
33%
30%
20%
% of Partners of
pregnant women
tested
26%
16%
10%
0%
2003 2004 2005 2006 2007 2008 2009 2010
Source: RBC/ TRACPlus/HAS Unit 2008/2009/2010 Annual Reports.
37
Rwanda Ministry of Health Annual Statistical Booklet
2010
HIV exposed infants follow up
Among children expected to receive ARV prophylaxis, 7610 (74%) received it and 7368 started cotrimoxazole
at 6 weeks of age. The DNA PCR test was also performed for 7220 exposed infants in their first 2 months of
life.
Care and treatment
The number of patients on ARVs increased from 76726 patients (end 2009) to 89,660 patients by the end of
December 2010. The number of HIV infected children on ARVs, increased from 6676 children (end 2009) to
7,479children by the end of December 2009. Health facilities offering ARVs also increased dramatically from
269 to 337 throughout the country.
Table 34: Anti-Retroviral Therapy in Rwanda from 2007 to 2010
2007
2008
2009
2010
% change
(2009-2010)
Patients on ART
48,069
63,149
76,726
89,660
16.8%
Children on ART
4,350
5,635
6,676
7,479
12%
171
195
269
337
25%
Health facilities providing
ART
Source: RBC/ TRACPlus/HAS Unit 2008/2010 Annual Reports.
The analysis of gender differences of patients on ART treatment show that women represent almost two-thirds
of the adult patients (62%), while male and female children are equally represented in the patient population.
HIV among Groups at high risk.
Youth
The 2009 Youth Behavior Surveillance Survey (BSS) in Rwanda carried out in September and
October 2009, provided information on male circumcision in youth
Figure 16: Circumcision Pattern of Youth Males in the 2009 Rwanda Youth BSS (N = 2,522)
Source: RBC/ TRACPlus/HAS Unit 2008/2009/2010 Annual Reports.
38
Rwanda Ministry of Health Annual Statistical Booklet
2010
The 2009 BSS collected information on self-reported circumcision prevalence among male respondents
including age at circumcision, type of practitioner who performed the circumcision, reason for not being
circumcised and future desire to be circumcised. Circumcised males were also asked the main reason for their
circumcision. Tables 10a and 10b display the various results.
Overall, only 16% of males aged 15-24 reported having been circumcised. This rate varied by age group, with
the 20-24 year old group reporting lower frequency of circumcision (6%). Overall, 93% of those who were
circumcised reported having had circumcision performed by a health professional.
Overall 61% of circumcised males reported that health and hygiene were the major reasons for undertaking the
procedure, while only 17% cited HIV prevention as the primary reason.
Youth Sexual behavior trends analysis
Figure 17: Comparison of Youth Sexual Behaviors between 2006 and 2009 BSS, Rwanda
Source: RBC/ TRACPlus/HAS Unit 2008/2009/2010 Annual Reports.
In 2009, the percentage of females who ever had sex was 26% compared to 20% in 2006 (p-value = 0.001). For
the males, the increase between 2006 and 2009 was significant but less pronounced (39% vs 34%, p-value =
0.01).
Similarly, 35% of the youth reported having sex in the 12 months prior to the 2009 survey, an increase
compared to the 2006 survey which reported 26% of youth (p-value < 0.010). However, a gender difference is
noticeable. While, in 2009, only 6% more males had sex in the 12 months preceding the 37 survey as compared
to 2006, this difference increases to 10% for the females between the two years (or surveys, or survey years).
Overall, 28% used condom at first sex in 2009 against 21% in 2006 (p-value < 0.01). In 2009, 51% of the youth
used condom at last sex against 39% in 2006 (p-value < 0.0001). This percentage varied among gender as
shown in the figure 22 above. For example in 2006 the percentage of females who reported having used condom
at last sex was 23% against 45% in 2009 (p-value < 0.0001). For the males, the percentage of those who
reported having used condom at last sex was 49% in 2006 vs 59% in 2009 (p-value < 0.001).
39
Rwanda Ministry of Health Annual Statistical Booklet
2010
Youth Comprehensive knowledge of HIV.
Figure 18: Youth Comprehensive Knowledge of HIV/AIDS, Rwanda Comparison between 2006 and 2009
Source: RBC/ TRACPlus/HAS Unit 2008/2009/2010 Annual Reports.
Two types of trends can be seen in figure 23. In one hand, the percentage of youth who, in 2009, said
that “Proper Condom Use” can protect against HIV was 84% against 72% in 2006 (p-value < 0.001).
Similar change was also observed in the percentage of those who said “Abstinence” can protect against
HIV/AIDS.
On the other hand, the percentage of youth who said that “Being faithful to one, uninfected partner can
protect against HIV/AIDS” drop from 61% in 2006 to 29% in 2009. Preliminary informal inquiries
show that this big decline may be explained by the fact that most prevention programs focus mostly on
“Abstinence and Proper Condom Use”.
This leads in 2009 to sizeable drop in the percentage of youth who had a “Comprehensive Knowledge”
of HIV as compared to 2006 from 19% to 11%. “Comprehensive knowledge” is defined as knowing
simultaneously that proper use of a condom, having one faithful partner and abstinence can protect
against HIV/AIDS and recognizing that a person apparently in good health can transmit HIV/AIDS at
the same time rejecting the two most common misconceptions about HIV/AIDS transmission.
40
Rwanda Ministry of Health Annual Statistical Booklet
2010
Female sex workers
Condom use
Table 35: Number and percentage of respondents reporting using a condom at the last sexual intercourse by type of partner, age,
province and sites, (N=1,136)
Did not use
condom
(N=225)
Total
Characteristics
Age group
Use condom
With non
paying
sexual
partner only
(N=42)
With paying
partner only
(N=856)
With both
paying and non
paying partner
Number
n
%
n
%
n
%
n
%
157
469
342
288
25
67
50
62
16
14
15
22
3
12
14
11
2
2
4
4
105
317
221
173
67
68
65
60
24
73
57
42
15
16
17
15
80
21
26
2
3
40
50
17
21
East
Kigali city
North
West
South
266
264
266
274
266
63
24
49
42
47
24
9
18
15
18
5
3
13
13
8
2
1
5
5
3
158
194
160
176
168
59
74
60
64
63
40
43
44
43
43
15
16
17
16
16
Road/public place
1065
114
179
11
17
10
31
5
3
4
688
78
65
68
167
20
16
18
157
35
22
6
4
90
57
26
17
86
317
271
238
271
1336
12
40
49
39
63
225
14
13
18
16
23
17
1
11
6
8
12
42
1
3
2
3
4
3
67
205
179
153
152
856
78
65
66
64
56
64
6
61
37
38
44
213
7
19
14
16
16
16
15-19
20-24
25-29
30-39
40 +
Province
Site
Hotel/Nightclub/other
Cabaret/Bar/Restaurant
Years of experience
<1
1-2
3-4
5-7
8+
Overall
On the whole, the vast majority of FCSW (83%) reported using a condom during their last sexual intercourse.
Among those FCSW reporting having used a condom, 3% reported using a condom with non paying partners,
64%reported using a condom with a paying partner. This proportion varied by age group, province, site and
years of experience. For instance, 91% of the FCSW working in Kigali reported having used condom at last sex
compared to 74% of those working in the East Province (p-value <.0001).
41
Rwanda Ministry of Health Annual Statistical Booklet
2010
HIV Prevalence by Background Characteristics
Table 36: HIV prevalence of FCSW by background characteristics, 2010 Rwanda BSS.
Characteristics
N
n
HIV Prevalence
(%)
15 - 19
110
39
35
20 – 24
382
168
44
25 – 29
297
157
53
30 – 39
253
157
62
40 +
70
44
63
East
123
40
33
Kigali city
233
131
56
North
260
122
47
West
251
137
55
South
245
135
55
Road/public place
932
487
52
Hotel/Night-club/Other
90
36
40
Cabaret/Bar/Restaurant
Level of education
None
90
42
47
Age group
Province
Site
321
164
51
Primary
652
336
52
Vocational
17
9
53
Secondary
122
56
46
Yes
308
145
47
No
804
420
52
9
3
33
30
11
37
266
156
59
807
395
49
<1
58
20
34
2-3
4-5
6-7
8+
250
127
51
227
111
49
207
104
50
235
1112
135
565
57
51
Additional occupation
Current marital status
Married and staying with a husband
Separated but cohabitating with another sexual
partner
Separated but not cohabitating with a sexual
partner
Never married nor not cohabitating with a
sexual partner
Years of experience as CSW*
Overall
Overall, 565 (51%) FCSW tested HIV positive. HIV prevalence varied by age group, province,
marital status, other source of income, and years of experience. For instance, HIV prevalence
increased with age, from 35% among those aged between 15 and 19 years to 63% among those aged
40 years and above.
42
Rwanda Ministry of Health Annual Statistical Booklet
2010
Likewise, HIV prevalence increased with years of experience as FCSW from 34% among FCSW with
less than one year of experience as FCSW to 57% among FCSW with eight or more years of
experience as FCSW. Similarly, there was a regional variation in the HIV prevalence with 33% HIV
positive among FCSW in the East Province compared to 56% HIV positive among FCSW in Kigali
City. HIV prevalence was lower (47%) among FCSW having an additional occupation/source of
income compared to 52% among those who did not have an additional occupation/source of income.
HIV prevalence was significantly lower among FCSW married and living with their husband (33%)
compared to those never married nor not cohabiting with a sexual partner (49%) and those separated
but not cohabitating with a sexual partner (59%).
HIV comprehensive knowledge
Percentage
Figure 19: HIV knowledge comparison between 2006 and 2010 FCSW BSS, Rwanda
100
90
80
70
60
50
40
30
20
10
0
85 89
90 95
86 86
92 95
74 69
36
46
18 22
Abstinence
Being Faithfull Proper use of Reject mosquito Reject sharing A health looking Comprehensive
to one partner
condom
bite
meal with an
person can
knowledge
infected person have HIV/AIDS
HIV Knowledge
2006
2009
Source: RBC/ TRACPlus/HAS Unit 2008/2009/2010 Annual Reports.
Two types of trends can be seen in Figure 3. On one hand, the proportion of FCSW who correctly rejected that
mosquito bites can transmit HIV dropped to 69% compared to 74% in 2006 (p-value <0.0001). On the other
hand all the other positive attitude indicators remained the same or increased resulting in an overall increase in
comprehensive knowledge from 18% in 2006 to 22% in 2010.
MALARIA.
Malaria continues to be the top cause of death among patients at district hospitals (654 deaths reported in 2010), the
number 8th cause of outpatient morbidity. Malaria death represents 13% of total death in 2010. The malaria mortality
rate at district hospitals was 19.2%, during 2010, up from 16.3% in 2009. During the end of 2010 there was a
surprising upsurge of malaria cases: During 2010, 655697 cases of malaria were reported, compared to 703,562 in
2008 (a decrease of over 7%).
43
Rwanda Ministry of Health Annual Statistical Booklet
2010
Table 37: Distribution of Malaria diagnoses by health facility type
Facility type
Health Center
District Hospital
Malaria diagnosis
Simple malaria (confirmed)
Severe malaria
Grand Total
Source: National HMIS database 2009-2010
2009
691,110
2010
645555
12452
10142
703562
655697
Figure 20: Graph of proportional morbidity for Malaria 2009-2010 in health centers
Malaria propotional morbidity rate (%)
25.0%
20.0%
15.0%
10.0%
22.1%
19.9%
19.8%
16.7%
15.7%
15.2%
14.8% 14.4%
14.4%
13.5%
12.7%
11.5%
17.3%
12.4%
11.6%
9.9%
9.2%
8.5%
5.5%
5.2%
3.7%4.2%
2.9%2.8%
5.0%
0.0%
01 02 03 04 05 06 07 08 09 10 11 12 01 02 03 04 05 06 07 08 09 10 11 12
2009
2010
Malaria propotional morbidity rate
Source: National HMIS database 2009-2010
The graph of proportional morbidity displays the classic seasonal trend with peaks in June and December.
The map below shows the geographic distribution of Malaria by district in 2010. This highlights that fact
that the highest number of cases are in the Eastern and Southern regions.
44
Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 21: Map of proportional malaria morbidity by District 2010
Source: HMIS database, 2010
Laboratory
During 2010, approximately 95% of all reported lab tests were conducted at the health centre level. 38.4%) of the tests
completed were thick blood smear, 36.6% blood laboratory exam (there is an increase of 2.21% when compared to the result of
2009, 15.5% were stools, in 2009, 39.87%, thick blood smear were 34.4% of blood and 16% of stools.
Table 38: Type of lab Tests conducted at different health facilities
Type of Lab
Exam
Thick blood
Smear
Stools
2009
Health
District
Centre
Hospitals
4708640
278566
2010
Total
Health
District
Centre
Hospitals
4987206
5274334
264380
Total
5538714
1853356
134604
1987960
2113024
129589
2242613
Urine
746154
21239
767393
845568
22606
868174
Sputum
157492
96007
253499
164270
95459
259729
Blood
4215576
94709
4310285
5176155
112799
5288954
Other
157015
44788
201803
183394
41263
224657
11838233
669913
12508146
13756745
666096
14422841
TOTAL Lab
tests
Source: National HMIS database 2009-2010
45
Rwanda Ministry of Health Annual Statistical Booklet
2010
SURGERY
A total of 77,469 surgical interventions were performed during 2010, an increase of 8.5% percent since
2009. Over half of all surgeries were urgent interventions (60.8%).
The most common type of surgery reported was Major Surgery (60.07%), Composed of Urgent (65.85%)
and planned (34.15%) , While minor surgery were 40% with planned of 58. 8% and urgent of 41.2%
Table 39: Type of surgery performed
Type of
surgery
2009
Planned
Urgent
2010
Total
Planned
Urgent
Total
%
change
Major surgery
15,638
27,751
43,389
15890
30643
46,533
7.2%
Minor surgery
17,510
10,533
28,043
18192
12744
30,936
10.3%
Total surgical
33,148
38,284
71,432
34,082
43,387
77,469
8.5%
Source: National HMIS database 2009-2010
Table 40: Selected surgical interventions
2009
Selected surgical
Planned Urgent
2010
Total
Planned Urgent
Total
General Surgery:
 Appendectomy
 Hernia
 Laparotomy
 Thyroidectomy
 Cataract
 Adenomectomy 
 Trachoma
 Glaucoma
 Others
Gyneco-obstetrical surgery:
 Caesarean section
 Hysterectomy
 Ectopic pregnancy
 Other Laparotomies (G-O)
 Myomectomy
 Curettage
Orthopedic surgery:
 Amputations
 Osteosynthesis
 Others
101
1,903
364
147
2,272
94
1
222
95
153
543
8
4
-
196
2,056
907
155
2,276
94
1
222
5373
1468
6841
1,625
369
22564
84
24189
453
27
368
175
159
143
255
22
1636
149
687
1602
36
96
1679
106
1899
362
145
2088
83
1
243
5479
73
188
508
1
5
3
1
0
1825
179
2087
870
146
2093
86
2
243
7304
170
623
197
1795
1524
346
24
388
196
183
24806
92
116
272
13
1550
26330
438
140
660
209
1733
185
783
3281
151
643
2029
44
48
2011
195
691
4040
Source: National HMIS database 2009, 2010
46
Rwanda Ministry of Health Annual Statistical Booklet
2010
RADIOLOGY
Reports from district hospitals on medical imagery and other diagnostic testing procedures indicate over
113,970 X-rays conducted during 2010 (22% more than in 2009). Overall, 21% more diagnostic testing
procedures were undertaken in 2010. There were sharp increases in the number of abdominal radiology
exams (176%).
Table 41: Medical imagery and other diagnostic testing procedures
Exam type
2009
93,422
Total Radiology Exams
2010 % change
22%
113970

Lungs
43,608
50632
16%

Bones
44,204
57108
29%

Abdomen without
preparation
3,302
3569
8%

Abdomen with dyes
391
1078
176%

Other Radiology
1,917
1583
-17%
Gastroscopy
725
858
18%
Echography
25,375
29790
17%
958
665
-31%
120,480
145,283
21%
ECG
Total Exams
Source: National HMIS database 2009-2010
PERFORMANCE-BASED FINANCING:
Between 2009 and 2010 there was a 9.4% increase in funding for purchase of indicators as part of the performance-based
financing initiatives. The amount was split fairly evenly between HIV (47%) and primary care indicators (53%).
Table 42: Performance-Based Financing payments by year and PBF package
PBF Package
2009
2010
% Change
2009-2010
PMA
2,404,033,343
2,594,998,464
8%
VIH
2,030,597,207
2,256,593,237
11%
Grand Total
4,434,630,550
4,851,591,700
9%
Source: PBF database 2009-2010
47
Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 22: Evolution of key Maternal and Child services (Average numbers per facility)
Source: PBF database 2009-2010
48
Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 23: Evolution of Average Quality scores from Health Center PBF Quality Assessments
Source: PBF database 2009-2010
COMMUNITY-BASED HEALTH INSURANCE /MUTUELLE (CBHI)
Membership has continued to expand in the community-based health insurance program. Average adhesion rate
for the country stood at 91% in 2010. As displayed in the map in Error! Reference source not found.,
dhesion rates are not evenly distributed across the country, but range from a low of 78% in Ruhango district up
to 99% in Karongi, Nyamasheke and Gatsibo districts.
49
Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 24: Map of Mutuelle Adhesion Rates by district 2010
Source: CBHI department records
The individual membership payment represents 46% of total income. The total Expenditure represents 68% of
total income.
Table 43: Summary of CBHI income and expenditure
Income
2010
 Individual membership payments to the mutuelle fund
7,550,768,265
 Membership payment on behalf of individual by other
organizations (Global Fund, Commercial firms, etc….
2,870,891,857
 Other receipts (copayment, donations, interest, etc….)
5,954,045,397
TOTAL INCOME
16,375,705,519
Expenditure
 Cost of hospitalization for mutual members, other care OPD,
drugs, etc…) for mutual members and payments made to other
heath centers for care provided to mutual members
5,877,736,888
 Amount transferred to the district pooling risk
4,119,816,273
 Running cost for mutual section (salaries, stationary,
supervision, Training, etc…
1,162,811,154
TOTAL EXPENSES
11,160,364,315
Profit/Loss
5,215,341,204
% Profit/Loss
31,8%
NB: the cost of Drugs, OPD, hospitalizations are combining in the same line
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Figure 25: Evolution du taux d'adhésion aux mutuelles de santé 2003-2011
Evolution of enrollement rate(%), CBHI,2003-2010
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
2003
2004
2005
2006
2007
2008
2009
2010
Source: Rapport Annuel CTAMS
Sources of Data
HMIS
The main source of data on morbidity and mortality is the Health Management Information System (GESIS). This
system has been recently upgraded to capture data from monthly and annual reporting formats that were revised at the
end of 2007. Data is recorded in health centres and hospitals on registers and patient forms and is then compiled
monthly and transmitted on paper forms to district hospitals. These reports are entered into the HMIS at the district
hospitals and transmitted electronically to the HMISUnit at the central level where data are uploaded into the central
database. At the time this analysis was produced, 93.5% of expected monthly reports were entered into the system for
all district hospitals and health centres in Rwanda. For certain types of analysis, such as coverage rate calculations,
adjustments are sometimes made to compensate for under-reporting. It is important to note that the HMIS does not
currently include private health facilities, nor does it include data from National Reference Hospitals.
Rwanda National Population Projections 2007-2022
Population denominators have been obtained from the National Institute of Statistics Rwanda (NISR), population
projections are based upon the 2002 census.
TracNet
Rwanda’s TRACnet is a dynamic phone and web-based information management solution that collects, stores,
retrieves, and disseminates critical program, patient and drug information related to HIV/AIDS care and
treatment. Funded through CDC/PEPFAR, the system is developed by Voxiva and supports the Government of
Rwanda in the rapid expansion of HIV/AIDS clinical services in hospitals and health centres throughout the
country. Under the leadership of the Ministry of Health and the Treatment and Research AIDS Centre (TRAC),
TRACnet has increased the efficiency of Rwanda’s HIV and AIDS program management and has enhanced the
Government’s capacity to monitor the quality of patient care. Deployment of TRACnet started in late 2004, and
as of December 2010, the system has been scaled up to 337 facilities providing care and treatment services to
89,660 ART patients. TRACnet collects HIV/AIDS aggregated data of all health centres providing HIV AIDS
services with a satisfactory completeness of 90% and timeliness of 62%.
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Rwanda Ministry of Health Annual Statistical Booklet
2010
PBF
Performance-based financing (PBF) uses a web-based database to collect a very selected number of mostly output
indicators that are used to track progress and calculate performance based payments for community health worker
cooperatives, health centres and district hospital. The system also uses data from quarterly quality evaluations to
ensure that data and service quality are maintained, and to reduce the performance payment accordingly. The system
is in the process of being expanded to integrate community-based services (Community PBF). PBF data is cited
occasionally for comparison purposes because the reporting rate is virtually 100% and the data are carefully validated
each quarter.
CBHI indicator database
The community-based health insurance program uses a web-based database to collect a very limited number of
indicators that are used to track progress and determine the financial viability of individual CBHI or mutuelle sections.
The reporting rate for 2010 was approximately 84% of the 428 mutuelle sections reporting.
Rwanda District Health System Strengthening Tool (DHSST)
Over the past few years, the Clinton Foundation has been supporting the Ministry of Health to strengthen its district
health system, leading to the development of the Rwanda District Health System Strengthening Framework. In 2008,
this Framework was applied to all districts of Rwanda. In 2009 a completely new, web-enabled version was developed
and data were collected in December 2010. It is a costing and strategic planning tool for use by District Health Units,
health centres and district hospitals in Rwanda. The data collection phase of this project gathered valuable data on,
amongst other areas, health infrastructure, equipment, finances and staffing to facilitate gap analyses and needs
costing. The tool’s underlying data includes 40 district hospitals and 396 health centres and will soon include the
national reference hospitals. It does not include private health facilities. It is currently being simplified in order for it
to be updated on an annual or semi-annual basis by all districts.
Rwanda Interim DHS 2007-2008 (RIDHS)
The 2007-2008 Rwanda Interim Demographic and Health Survey was carried out from December 2007 to April 2008
as a follow-up to three previous surveys undertaken in 1992, 2000 and 2005. A total of 7,377 households were
interviewed. Three questionnaires were administered: the household questionnaire, the women’s questionnaire, and the
men’s questionnaire. The survey covered demographic characteristics, marital status, birth history, knowledge and use
of family planning methods, fertility preferences, antenatal and delivery care, breastfeeding practices, vaccination and
childhood illnesses, male circumcision as well as blood testing for anemia and malaria.
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Rwanda Ministry of Health Annual Statistical Booklet
2010
Annexes:
Table 44: Classification of staff categories by qualification
Staff Category
Qualification
Administrative Staff and Administrator A1, A Administrator A2, Public Administrator A0,
Accountant A0, Accountant A1, Accountant A2, C Accountant A3,
Support Staff
Law A0, Law A1, Law A2, Economist A0, Economist A1, E
Economist (MA), Financial A1, Financial A0, Management A0,
Management A1, Management (MA), Secretary A1, Secretary A2,
Secretary A3, Law (MA), Communication A0, Demographer A0,
Computer Technician A0, Other Support Staff, drivers, Electrician
A1, Electrician A2, Electrician A3, Electromechanical Engineer A0,
Electromechanical Engineer A1, Electromechanical Engineer A2,
Electrician (A0), Electrician(A1), Electrician(A2), Documentalist
Doctors,
Specialist Doctors
Doctors
Bio-Chemistry A2, Human Biologist A1, LABO.A0, LABO.A1,
Laboratory technician
LABO.A2, LABO.A3
Medical Assistant A1, Medical Assistant A2, INF.(MA),.NurseA0,
Nurses
Nurse.A1, Nurse.A2, Nurse.A3, Health auxilliary,
Midwife A1
Midwives
Anaethesiologist A0, Anaethesiologist A1, Dentist A0, Dentist
Paramedical
A1, Hygienist +Assistant A1, Hygienist +Assistant A2,
Physiotherapist A0, Physiotherapist A1, Physiotherapist A2,
Physiotherapist A3, Physiotherapist (MA), Environmental Health
A0, Nutritionist A0, Nutritionist A1, Nutritionist A2,
Ophtalmologist A1, Orthopedist A1, Psychiatrist A0, Clinical
Psychologist A0, Clinical Psychologist A1, Radiologist A1,
Radiologist A2, Mental Health A1, Public Health A0, Public
Health A1, Ophtalmologist A0, ASS SOC.A1, ASS SOC.A2,
Educators .A3+Mon Ens., Educators A0, Educators A1, Educators
A2, Sociology A0
Pharmacist A0, Pharmacist A1
Pharmacist
Other (no qualification mentionned)
Other
53