Rwanda

As the Capacity Project has worked to strengthen HRH systems to implement quality health programs in developing countries, it has systematically focused on how differences and inequalities affect women’s and men’s opportunities for education, training and occupational choice. In Rwanda, the Project helped the government follow through on its national policy commitments to gender equality by conducting a study of workplace violence and gender discrimination as barriers to workforce participation. [from author]

The Capacity Project offered technical support to Rwanda’s Ministry of Health to develop the capacity of the district hospital clinical workforce in order to expand client access to a full range of quality FP methods. These included long-acting and permanent methods and vasectomy in particular. [from author]

The Health Sector Strategic Plan II is a three year strategic plan that will guide all interventions in the Rwandan health sector for July 2009 - June 2012. The plan details the direction the health sector will take in the next three years, the achievements and outcomes that will be attained and the interventions that will be undertaken to make sure these targets are met.

Rwanda is one of the pioneers of performance-based financing. Building on lessons from three donor-financed pilots, the government has assumed leadership for this approach and is scaling up a standardized model nationwide. [from author]

Recent years have seen growing awareness of the importance of human resources for health in health systems and with it an intensifying of the international and national policies in place to steer a response. This paper looks at how governments and donors in five countries: Cameroon, Indonesia, Malawi, Rwanda and Tanzania, have translated such policies into action. [from abstract]

A study on workplace violence within the health sector in Rwanda was conducted in 2007 in order to determine the type, impact, context, consequences and prevention strategies of workplace violence in Rwanda; to assist the Ministries of Health, Public service and Labor (MIFOTRA) as well as other stakeholders in developing a political, legal and programmatic response to improve providers’ safety, satisfaction and retention. This study also explored the characteristics of gender-based violence, including gender-based discrimination and its relation to workplace violence. [adapted from foreword]

The results of this survey shed light on several aspects of problems faced by reproductive health services regarding provider performance, equipment and supplies in facilities and laboratories, availability of medicine, initial staff qualification and in-service training, and supervision of health care providers. The results will serve as a guide for monitoring and evaluation of maternal and child health programs, reproductive health programs, HIV/AIDS programs, and other infectious diseases programs. [from preface]

The purposes of this study were to quantify stigma among Rwandan healthcare providers toward patients with HIV/AIDS; to assess healthcare provider fears and perceived risks for HIV while providing services to patients with HIV/AIDS; to quantify practices in hospitals and health centers and among health providers that discriminate against HIV-positive patients; and to evaluate the relationship between provider stigma, provider fears, and perceived risks with discrimination against HIV-positive patients in health facilities and among healthcare providers. [from summary]

These reports demonstratre that non-physician clinicians and nurses can take over many of the tasks in providing HIV care and treatment (including ART) in some resource-limited settings. [from author]

This report describes three health system developments introduced by the Rwandan government that are improving these barriers to care

This study evaluated biases in guideline untilization of evidence-based practice concerning contraception perscription. It was found that in India, Peru, and Rwanda, health care providers underutilize evidence-based practice guidelines as they prescribe contraceptives. This article ends with recommendations for providers to most effectively utilize evidence-based practice. [adapted from abstract]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It reviews a study of how Rwanda, faced with constrained fiscal conditions, has implemented innovative reforms to create fiscal space for human resources and to make these resources more responsive to needs through an analysis of budget documents and policy and regulation changes and key informant interviews. [adapted from author]

The Capacity Project is applying an integrated strategy to strengthen family planning (FP) and reproductive health. The project is helping the Ministry of Health develop the capacity of the clinical workforce to provide a full range of FP methods and services at 13 hospitals and 146 health centers. [adapted from author]

This brief describes the Capacity Project’s work with health workforce planning using HRIS in Rwanda.

The purpose of this human resource for health (HRH) plan is to provide guidance for the staffing of the health services and the training of health service personnel to the year 2020. It analyzes main issues and dimensions in HRH and proposes strategies to meet the targets for the wellbeing of the population as defined in the vision 2020 for Rwanda The plan provides staffing targets for each of the major categories of health personnel.

This document introduces a competency-based curriculum for nurses and midwives in Rwanda developed by the Capacity Project.

The overall objective of this study is to evaluate the capacity as well as the performance of the health facilities (HF) and community associations (community health workers associations (CHW), traditional birth attendant associations (TBA) and associations of people living with HIV (PLWHA), operating in the Gisagara (formerly Kibilizi) District. [from summary]

This report examines the workforce issues surrounding HIV/AIDS service delivery. At the request of the Government of Rwanda, data were collected on current health sector staffing and from 20 public and private facilities of various sizes and characteristics on the time required to provide HIV/AIDS services and the quality of those services. The report presents data relative to the numbers of clients needing different types of HIV/AIDS services, providers’ degree of compliance with service delivery standards, and the time it takes to provide services.

Home-based care (HBC) for HIV/AIDS is increasingly looked to as a more accessible and affordable alternative to more costly inpatient care, both for patients who are unable to travel to or pay for inpatient care as well as for governments that must fund inpatient facilities. Partners for Health Reformplus estimated the cost of HBC for HIV in Rwanda, based on a sample of eight programs offering care in early 2004. The sample comprised facility- and community-based programs. Both types of program implement the medical care recommended in the Ministry of Health guidelines for HBC. [from abstract]

This report presents data on in-hospital care for childbirth and obstetrical emergencies in 14 hospitals. This report examines intervals between critical events

This report presents the results from Rwanda for the of the Quality Assurance Project’s three Safe Motherhood Studies: competence of skilled birth attendants, the enabling environment for skilled attendance at birth, and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility. The Rwanda study focused on an urban referral (tertiary care) hospital with an active maternity department, two mid-sized referral (secondary care) hospitals, and four health centers. [publisher’s description]

These reports review Rwanda’s healthcare staffing, documents practices and levels of effort in providing HIV/AIDS services, and calculates staffing needs for scale-up. It also discusses such issues as training, management, supervision, job satisfaction, and staff motivation and incentives. [publisher’s description]

This report presents findings from Phase 1 of an assessment of the human resources implications of HIV/AIDS services scale-up in Rwanda. Services covered include voluntary counseling and testing, prevention of mother-to-child transmission, and care and treatment, including lab services and drug dispensing. It reports the number and types of staff employed at public and private healthcare sites, estimates the number providing HIV/AIDS services, and identifies employment practices that could facilitate or hinder the human resources scale-up.

This report discusses care provided to 245 women during labor, delivery, and immediate postpartum and their newborns during immediate postpartum. The quality of care for different tasks (e.g., monitoring fetal heart rate) is presented by country, by hospital type, and overall. The report details performance on recommended tasks and should inform program managers and providers in finding similar weaknesses in their own care delivery systems. Report includes 21 data tables and the data collection instrument for observations. [publisher’s description]

This report presents findings from Phase 3 of an assessment of the human resources implications of HIV/AIDS services scale-up in Rwanda. It focuses on the staffing implications and associated costs of HIV/AIDS services scale-up. By documenting current staffing levels and the level of effort necessary to provide HIV/AIDS services, Phase 3 of the study analyzes how many full-time equivalent (FTE) staff will be needed, and at what costs, if the Government of Rwanda is to meet its HIV/AIDS service delivery objectives. The human resources projections are based on data gathered during Phases 1 and 2 of the study.

The Health Sector Policy is the basis of national health planning and the first point of reference for all actors working in the health sector. It sets the health policy objectives, identifies the priority health interventions for meeting these objectives, outlines the role of each level in the health system, and provides guidelines for improved planning and evaluation of activities in the health sector. One of the priority interventions elaborated is Human Resources. [adapted from introduction]

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels. [from abstract]

In an effort to understand the flows of funds throughout the health system, the Government of Rwanda (GoR) conducted, for the second time, a National Health Accounts (NHA) estimation. NHA is an internationally recognized tool for measuring health expenditures in a comprehensive manner — one that includes the public, private and donor sectors. By doing so, NHA offers a financial perspective on who is paying for health care, who is managing health care funds and their allocation, and where the funds are going — by type of provider and service. In short, NHA aims to inform policymakers on resource flows for the entire health system so as to assist in making good policy decisions and averting potentially adverse ones.

The core objective of the plan is national, comprehensive treatment and care for HIV/AIDS with equal access to services, long-term commitment, improvement of Rwanda’s general health services infrastructure beyond HIV/AIDS, and financial transparency. The approach for implementation will involve service integration with existing health system infrastructure, community mobilization, linkage between treatment and care and prevention, multi-country procurement economies of scale, and rapid scale-up and iterative learning based on a collaboratives model.