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Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000–2010: a systematic review
Maurice Bucagu, Jean M. Kagubare, Paulin Basinga, Fidèle Ngabo, Barbara K Timmons & Angela C Lee
Reproductive Health Matters
(2012)
CC
From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public health system, with the aim of reducing maternal and newborn deaths in line with Millennium Development Goal 5, among many other improvements in national health. Based on a systematic review of the lit
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erature, national policy documents and three Demographic & Health Surveys (2000, 2005 and 2010), this paper describes the reforms and the policies they were based on, and provides data on the extent of Rwanda’s progress in expanding the coverage of four key women’s health services. Progress took place in 2000–2005 and became more rapid after 2006, mostly in rural areas, when the national facility-based childbirth policy, performance-based financing, and community-based health insurance were scaled up. Between 2006 and 2010, the following increases in coverage took place as compared to 2000–2005, particularly in rural areas, where most poor women live: births with skilled attendance (77% increase vs. 26%), institutional delivery (146% increase vs. 8%), and contraceptive prevalence (351% increase vs. 150%). The primary factors in these improvements were increases in the health workforce and their skills, performance-based financing, community-based health insurance, and better leadership and governance. Further research is needed to determine the impact of these changes on health outcomes in women and children.
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There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the S
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tandard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda.
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Policy Research Working Paper 6100 | Impact Evaluation Series No. 60 | This study examines the effect of performance incentives for health care providers to provide more and higher quality care in Rwanda on child health outcomes. The authors find that the incentives had a large and significant effec
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t on the weight-for-age of children 0–11 months and on the height-for-age of children 24–49 months. They attribute this improvement to increases in the use and quality of prenatal and postnatal care. Consistent with theory, They find larger effects of incentives on services where monetary rewards and the marginal return to effort are higher. The also find that incentives reduced the gap between provider knowledge and practice of appropriate clinical procedures by 20 percent, implying a large gain in efficiency. Finally, they find evidence of a strong complementarity between performance incentives and provider skill .
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Health Systems for Outcomes Publication | This report summarizes the findings of a qualitative study on health workers’ performance and career in Rwanda to identify bottlenecks, strengths and shortcomings for human resources in the health sector, as perceived by both health workers and users of he
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alth services.
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Draft May 2011
The first ever nursing and midwifery services policy document in the history of MoPH was developed with the following aims:
1. Create a positive environment for Nursing and Midwifery Policy and Practice
2. Promote education, training and career development for nurses an ... d midwives.
3. Contribute to the strengthening of health systems and services
4. Monitor the development of nursing and midwifery professions and ensure their quality
5. Streamline Nursing and Midwifery Workforce Management
6. Develop Partnerships for Nursing and Midwifery Services more
The first ever nursing and midwifery services policy document in the history of MoPH was developed with the following aims:
1. Create a positive environment for Nursing and Midwifery Policy and Practice
2. Promote education, training and career development for nurses an ... d midwives.
3. Contribute to the strengthening of health systems and services
4. Monitor the development of nursing and midwifery professions and ensure their quality
5. Streamline Nursing and Midwifery Workforce Management
6. Develop Partnerships for Nursing and Midwifery Services more
Health Systems for Outcomes Publication | The government of Rwanda has identified human resources for health as one of its policy priorities. This study aims to contribute to building a better understanding of health worker choice and behaviour, and to improve evidence based polcies.
Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery
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of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities’ input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes.
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Who wants to work in a rural health post? The role of intrinsic motivation, rural background and faith-based institutions in Ethiopia and Rwanda
Serneels, P., Montalvo, J.G., Pettersson, G., et al.
Bulletin of the World Health Organization
(2010)
C_WHO
This paper examines the extent to which health workers differ in their willingness to work in rural areas and the reasons for these differences, based on the data collected in Rwanda analysed individually and in combination with data from Ethiopia.
Semi-Annual report of the National Union of Disabilities of Rwanda.
Consultancy to conduct desk review on impact of national policies and programs on disability rights and develop an action plan to make existing policies and programs and legislation disability friendly
This paper aimed to demonstrate how participatory action research (PAR) within a Community-based Rehabilitation (CBR) project facilitated community participation to advocate for the rights of people with visual impairment. An advocacy campaign, led by the local people with and without disabilities,
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was launched for the construction of an accessible foot over- bridge (FOB) at Vangani railway station in Maharashtra, India.
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The Republic of the Union of Myanmar’s National Strategic Plan on HIV/AIDS 2016–2020 is the strategic guide for the country’s response to HIV at national, state/regional and local levels. The framework describes the current dynamics of the HIV epidemic and articulates a strategy to optimize in
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vestments through a fast track approach with the vision of ending HIV as a public health threat by 2030. Myanmar’s third National Strategic Plan (HIV NSP III) issues a call to all partners to front-load investments to close the testing gap and reach the 90–90–90 prevention and treatment targets to protect health for all.
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The report reflects on the trends, achievements and challenges in global health over the past decade during which Dr Margaret Chan has been Director-General of WHO. It discusses the role of WHO in dealing with such issues as the rise of noncommunicable diseases, leaps in life expectancy, and emergin
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g threats like climate change and antimicrobial resistance.
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This publication offers practical advice on implementing HIV and STI programmes for transgender people, with a focus on transgender women, aligned with the 2011 Recommendations and the 2014 Key Populations Consolidated Guidelines. It contains examples of good practice from around the world that may
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support efforts in planning programmes and services, and describes issues that should be considered and how to overcome challenges.
This tool describes how services can be designed and implemented to be acceptable and accessible to transgender women. To accomplish this, respectful and ongoing engagement with them is essential.
This tool gives particular attention to programmes run by transgender people themselves, in contexts where this is possible. more
This tool describes how services can be designed and implemented to be acceptable and accessible to transgender women. To accomplish this, respectful and ongoing engagement with them is essential.
This tool gives particular attention to programmes run by transgender people themselves, in contexts where this is possible. more
Inclusive Project Cycle Management - This Inclusive Project Cycle Management (IPCM) training package has been developed for CBM staff and Partner Organisations worldwide. The Trainers’ Manual will guide CBM trainers. It contains the curriculum for the course and training resources for trainers to
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help them deliver the course. The training will be successful if the trainers make sufficient planning time to prepare in advance and to respond to partners training needs. Different contexts and different partners may require different emphasis on areas that may be a challenge. This training material is not suggested as a prescriptive manual but as a suggested framework that can be added to and deepened as required. This means adapting the course to the local context and training needs and competencies of partners. In particular, it would be good to supplement or replace case studies included in the course with local case studies (refer Handout 8) and to have participants draw on their own examples.
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Inclusive Project Cycle Management
CBM’s approach is based on the principles of the UN Convention on the Rights of Persons with Disabilities (CRPD) and on CBM’s responsibility to promote accessibility and the principles of universal design in all spheres of its work, including CBM’s digital content and communications. With this
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toolkit, we want to provide a guide and practice resource to people working with and for CBM so that together we produce accessible digital content and communications, and place accessibility at the centre of our Information and Communication Technologies (ICT) procurement processes. The toolkit contains a selection of tools for producing accessible content in electronic documents, videos, figures and tools to ensure web accessibility. It also provides tools and information for accessible ICT procurement including tips and resources on how to communicate CBM’s accessibility requirements for products and services being purchased; and how to evaluate what providers promise and deliver.
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