Multi-sectoral Response Rwanda Anita Asiimwe, MD,MPH Treatment and Research AIDS Centre [TRAC]...
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Multi-sectoral ResponseMulti-sectoral ResponseRwandaRwanda
Anita Asiimwe, MD,MPH
Treatment and Research AIDS Centre [TRAC]
Rwanda
Rwanda ProfileRwanda ProfileGenocide in 1994 1 million killed
(Former leadership based on exclusion)8.6
5.8
2.61.6
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
Urban Rural
women
men
Current governance structures demonstrated better leadership with principles of equity
220
72%
52%
300
92%
70%
GDP per capita
Primary school enrollment
Access to clean water
20002000 20062006
povertypoverty
High maternal & infant mortality High maternal & infant mortality
IlliteracyIlliteracy
Rwanda Profile Rwanda Profile
Fertility rate: 5.6
Attend ANC at least once: 90%
Deliveries in health facilities: ~ 30%
Knowledge of individual HIV status among the
positives: 42%
DHS+ 2005
Government Strategy:CNLS (PMU), PSC, HIV Cluster.
Development Partners:GOR,USG PEPFAR,GF (3 diseases),WB /MAP,UN-family, ADB, Lux Development
Areas of Coordination:
management, supervision, training, common procurement (drugs, lab equipment, reagents), monitoring and evaluation, performance contracting
Strong GOR Coordination
project objectives Strengthen prevention measures to slow down the
spread of HIV/AIDS
Expand support and care for those infected or affected by HIV/AIDS
Progress was solid with virtually all targets met or surpassed
Background of MAP ProjectBackground of MAP Project2003-20072003-2007
Program managementProgram management
Established unit within CNLS to manage and coordinate activities (ownership)
Harmonized procurement procedures to facilitate joint procurement (economy and alignment)
Simplified logical framework (allows poor communities to manage) and synchronized indicators, ensuring consistency in reporting with national M & E plan and national tools e.g TRACnet
Key ComponentsKey Components
o Health Sector HIV/AIDS Support (US$10.9M): diagnosis, care & treatment
Public Sector Support (US$7.0M): prevention, care & support services
Civil Society Support (US$10.7M.): preventive interventions, OVCs, income-generating activities
o Program Management, M & E (US$3.4M.): capacity building, coordination
One Year extension US$ 10M end 2007
care and treatment
MAP has financed an expansion in treatment for AIDS patients which has provided life saving ARV therapy to individuals in 14 districts within the context of the national treatment plan
S1
381113413625931190581324383554366
41891253
870
139133938460
3120
1610
4 1
100
10000
1000000
PERIODE
NOMBRE DE PATIENTS ET NOMBRE DE SITES PAR PERIODE
MAP-Supported health MAP-Supported health facilities offering ARVfacilities offering ARV
•Nyagatare
MAP ARV ProgramMAP ARV Program
• First to extend ART services outside of Kigali, ensuring a pro-poor focus
• Developing replicable models of care and support, which are being scaled up with financing from other development partners
• Building capacity at sites with no prior experience through facility upgrading, laboratory capacity, HR which in turn has a positive impact on health systems
Schematic of participating Schematic of participating health facilitieshealth facilities
Gihundwe
HDHDHD
Cyangugu
Nyagatare
HDHDHD
Umutara
Butare Univ Hospital
HDHDHD
ButareProvincial and District
Health Teams
Provincial and District
Health Teams
Provincial and District
Health Teams
CHKPMU/CNLS
TRAC
CAMERWA
Central oversight and support structures
CS
HFHF
HFHF
HF
particular resultsparticular results
Majority of patients are poor females who are disproportionately affected by HIV/AIDS
Adherence rate is 96% which is in line with international standards
Patients on 2nd line ARV 1.7% compared to 2.5% national
SITES MAP ET TOUS LES SITES
SITES-MAP18%
SITES_National82%
PATIENTS SOUS ARV: MAP VS NATIONAL
SOUS ARV_National
86%
SOUS ARV-MAP SITES
14%
Patients on ART in MAP supported health facilities
5863
593520358246131
1796
2873
3965
5070
6456
5590
4323
3119
1927
0
1000
2000
3000
4000
5000
6000
7000
Jun-05 Dec-05 Jun-06 Dec-06 Apr-07
Enfants Adultes TOTAL
Juin 2005
Decembre2005 Juin 2006
Decembre2006 Avril 2007
SIT
ES
_MA
P
PA
TIE
NT
S
1927 3119 43235590 6456
1214
14 31
311
10
100
1000
10000
Evolution of health facilities and patients on ART: MAP
SITES_MAP
PATIENTS
Résultats cumulés de l'approche Résultats cumulés de l'approche
contractuelle (fin septembre 06)contractuelle (fin septembre 06) Indicateurs de performance MEMISA Cordaid
(ex Cyangugu)
Prévu Réalisé %
1 Nb de personnes testées (VCT) 27,852
122,789 441%
2 Nb de couples testés (VCT) 18,936 13,636 72%
3 Nb de femmes enceintes bénéficiant le PMTCT
21780 26,050 120%
4 Nb de couples bénéficiant le PMTCT 4,583 7,098 155%
5 Nb de mères VIH+ sous NVP 1,308 834 64%
6 Nb de nouveaux nés des mères VIH+ sous NVP
1,308 516 39%
7 Nb de personnes VIH+ recevant le CMX 23,532 12,996 55%
8 Nb de tuberculeux testés pour le VIH 264 380 144%
Performance Based FinancingPerformance Based Financing Trends in HIV Testing,
before/after introduction of PBF Scheme, ex-Kabutare District
0
200
400
600
800
1000
1200
1400
1600
1800
Before 395 36 335 80
After 1711 202 558 246
VCT Partners Pregnant Women Partners
Trends in Key HIV Indicators, before/after introduction of PBF Scheme,
ex-Kabutare District
0
5
10
15
20
25
Before 5 5 6 7
After 22 10 14 10
Preg. Women Rec NVP
HIV+ Women Inst Deliv
Children Rec NVP
Children tested 9 mos
Hospital UpgradingHospital Upgrading
Lab UpgradingLab Upgrading
0
1
2
3
4
5
6
7
Kabutare Hospital: Additional Personnel Funded by MAP
MAP 2 1 3
Government 5 6 0
PhysiciansLab
TechniciansAdministrative
staff
Population:Physician
Ratio dropped from
45,400 to 34,000:1
Lessons LearnedLessons Learned High level quality care can be offered in the remotest
areas and thanks to HIV and AIDS services that have re-enforced the health system that decentralization supports strongly at the onset
Joint planning and field visit including all partners is a way to accelerate harmonization thus supporting to improve care offered
Standardizing data collection forms is key to the national program
Training & supervising stakeholder in reporting results is key at improving the planning process
o Decentralize monitoring to district levelo Ownership of social programs by local authorities
problems to be addressedproblems to be addressed
o limited knowledge of planning, management & monitoring of activities & funds for small NGOS
o insufficient attention to key areas (OVCS, HBC)
o shortages of personnel, high turnover & lack of incentives
o time consuming in monitoring and implementation of activities
conclusionconclusion
The philosophy of the MAP project was a very useful innovation for the country and has served as the step stone for the replication of the services country wide.
Strong government coordination in the spirit of the 3 ones, and zero tolerance for corruption has fuelled this success
Thank
you!