Changing Policy- Rwanda's change in guidelines

African Regional meeting on interventions for Impact in essential obstetrics and new born care

Addis Ababa 21-25 Feb 2011

Stephen Rulisa, MD, MMed (Ob/Gyn)University Teaching Hospital of Kigali (CHUK)National University of Rwanda

Rwanda

• Population approx. 10m, 1m in Kigali

• 90% subsistence farmers• Life expectancy gone up

50.1 yrs

• Adult HIV prevalence 3%

Addis Ababa 21-25 Feb 2011

2

KUTH KUTH

Rwanda

Addis 21-25 Feb.2011 3

Milles collines

Mountain gorillas Lac Kivu

MAIN CAUSES OF DEATH (MoH 2010)

Policy Changes

• Maternal and child survival are on top of the list of Rwanda’s health priorities, having been identified as absolutely crucial for the long-term health of the country on its road to development.

“Healthier mothers mean healthier children, and healthier children mean a healthier, more productive society in the future”.

Main support documents

• EDPRS: targets for maternal deaths in 2012 is 600/100.000 LB

• Vision 2020• Health systems strategic plan (HSSP II)• National Reproductive Health Policy• National Strategic plan 2009-2012

Priorities in Maternal Health

• Priority n° 1 : To offer to all population quality, accessible and affordable package of Maternal and Neonatal health services

• Priority n° 2 : To improve Essential Obstetrical and Neonatal Care (EONC) as well as EMOC and FP services (RH Supplies security , infrastructures and equipment)

• Priority n° 3 : To empower women and families for decision making regarding their Sexual and reproductive Health concerns

• Priority n°4 : To ensure diagnosis and quality treatment for women with Obstetrical fistula and their re-insertion and re-integration in the community,

Priorities in Maternal Health(2)

• Priority n°5 : To integrate Gender in all MNH strategies and activities

• Priority n° 6 : To reinforce the implication and participation of the population in their RH expectations and needs : male involvement in RH as well as empowering the CHW (ASM)

• Priority n°7 : To strengthen the MOH Information System (HIS) which can enable quality surveillance , M&E of EONC/EMONC, FP and Human Resources for Health (HRH) management activities

Key strategic interventions

• Capacity building in RH• Maternal Deaths review: clinical and community level• FP made a priority: available in health posts and HC• Coordination of activities through Safe motherhood

technical working group• Distribution of equipment and ambulances • FANC: new protocol• Community care: CHW, package, incentives, associations

Supportive approaches

• Rwandan parliamentarians Network to address development and population issues: active involvement

• Health insurance Coverage: from 3% in 2002 to 96% in 2010.Delivary at health facilities increased from 52% in 2007 to 62% (2010)

• Performance based financing (PBF)in all health facilities: aiming to motivate health providers (incomes), increase the quality and quantity of delivered services.

• Motivating women to utilize health services through incentives such as free delivery services if 3 ANC visits done, ITN,

Supportive approaches(2)

• Involvement of Local government in monitoring of MCH indicators (IMIHIGO) and sensitizing the population (Umuganda)

• Community interventions: CHW elected, re-orientation of former TBA

• Involvement of Faith based organizations: sermon guide;

Innovative changes in health policies

• Increased budget allocation for health over the years Fiscal decentralization increased community

participation and allocated funds to district governments

Performance contracts were established between the president and district mayors

A PBF system to allocate money to health facilities based on performance/Results

Community health insurance , over 96% health insurance

Policy changes..

• Involvement of professional bodies and other stake holders

• Decentralized Emoc at health centres• Introductions Oxytocin, mgso4, misoprostol, on

essential drug list & decentralized to health centers • Strengthened CHWs at community level, community

PBF through cooperatives • TBAs training to CHWs• Formation of clusters from different ministries to

address health issues

Policy Changes

• Use of Innovative technologies Rapid sms, phone for health,..Phones to CHWInternet Access- health facilities a priority

Outcome of Policy Changes

From far…. & still going!!

• Thank you

AMESEGINALEHU