There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the nationa...l or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda.
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The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry ...ighlight medbox">of Health (MOH) in scaling up integrated community case management (iCCM) of childhood illness in 6 of Rwanda’s 30 districts. The project trained and equipped community health workers (CHWs) according to national guidelines. In project districts, Kabeho Mwana staff also trained CHWs to conduct household-level health promotion and established supervision and reporting mechanisms through CHW peer support groups (PSGs) and quality improvement systems. The iCCM model implemented by Kabeho Mwana resulted in greater improvements in care-seeking than those seen in the rest of the country. Intensive monitoring, collaborative supervision, community mobilization, and CHW PSGs contributed to this success. The PSGs were a unique contribution of the project, playing a critical role in improving care-seeking in project districts. Effective implementation of iCCM should therefore include CHW management and social support mechanisms. Finally, re-analysis of national survey data improved evaluation findings by providing impact estimates.
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DHS Further Analysis Reports No. 108 - This report examines levels, trends, and inequalities in maternal health in Rwanda from 2010 to 2014-15 amon...g women age 15-49 with a recent birth. The analysis uses Demographic and Health Survey (DHS) data for 15 key indicators of maternal health: 6 for antenatal care, 3 for delivery, 1 for postnatal care, and 5 for barriers to accessing medical care. Levels and trends in these indicators were analyzed overall and by three background characteristics: women’s education, household wealth quintile, and region.
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This study examines the ability of political, legal, health, and communities to respond to gender-based violence in Kigali, ...to-highlight medbox">Rwanda.
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Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by pro...viding incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery 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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This article reexamines a set of study findings that directly relate to the influence of gender on workplace violence, synthesizes these findings w...ith other research from Rwanda, and examines the subsequent impact of the study on Rwanda’s policy environment.
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2nd edition. Known as “Community Case Management of Sick Children” (CCM), this approach sends community-based health workers out to find, diagnose, and successfully treat sick children, in partn...ership with their families. Inspired by the classic “Immunization Essentials”, this guide methodically documents what is known about CCM and how to make it work. First, health program managers are introduced to the basics. Then, CCM Essentials walks its readers through the process of designing and managing a high-quality CCM program. The ultimate result: lives of newborns, infants and children saved around the world
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From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public heal...th 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 literature, 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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The objective of the evaluation is to understand whether the CHW ...ight medbox">program has achieved its intended objectives, thus contributing to the overarching objectives defined in the HSSP III of improving the health status of the population by “Ensuring universal accessibility of quality health services for all Rwandans”.
This evaluation has focused on CHWs, who are selected, trained and deployed by the MoH to deliver a defined set of tasks at community level. CHWs are the central element of the Community Health Policy and of the community health strategy plan (CHSP) of the MoH.
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DHS Further Analysis Reports No. 109 - This report documents trends in key child nutrition indicators in Rwanda. Data from the Demographic and ...n class="attribute-to-highlight medbox">Health Surveys (DHS) in 2005, 2010, and 2014-15 were analyzed, disaggregated by selected equity-related variables, and tested for trends. Over the survey period, Rwanda had high rates of exclusive breastfeeding, with regional variation. Rates of continued breastfeeding were also high but generally decreased as mother’s education and household wealth increased in all survey years. Complementary feeding practices varied by region, mother’s education, household wealth, urban-rural residence, and sex of the child.
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DHS Further Analysis Reports No. 89 - The 2010 Rwanda Demographic and Health Survey shows that 3... percent of Rwandan adults age 15-49 have been infected with HIV. The prevalence was much higher in urban areas, among women, and among adults who had multiple lifetime sexual partners and used a condom at last sexual intercourse. The
level of and differences in HIV prevalence in Rwanda in 2010 are very similar to those observed in 2005. Using data from the two recent Rwanda Demographic and Health Surveys, implemented in 2005 and
2010, this study examined changes in key HIV-related knowledge, attitudes, and sexual behavior indicators. Significant changes in selected indicators during 2005 and 2010 were determined by Student ttest with p-values less than 0.05.
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DHS Further Analysis Reports No. 107 - This report, based largely on the 2014-15 national survey in Rwanda, focuses on changes and trends in reprod...uctive behavior since 2010. In the 4-5 years after the 2010 survey, fertility continued its decline to 4.2 births per woman as contraceptive prevalence increased slightly. However, the earlier downward trend in number of children desired appears stalled. This is clearly evident from an increase in the proportions of married women and men who say they want more children. Child mortality has significantly declined and remains strongly related to fertility; while age at marriage has continued to increase. The demographic goals specified in the 1998-99 plan for development, Rwanda Vision 2020, appear on track, but the annual rate of population growth remains high, currently 2.5%, because fertility is high. Furthermore, large numbers of young people are now entering their child-bearing years. Although most trends seem encouraging, especially compared with other countries in sub-Saharan Africa, significant population growth is expected in Rwanda, from 12 to 16 million people by 2030, and to 22 million people by mid-century, even with assumed reductions of fertility.
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This report investigates the impact of potential misclassification of samples on HIV prevalence estimates for 23 surveys conducted from 2010-2014. ...In addition to visual inspection of laboratory results, we examined how accounting for potential misclassification of HIV status through Bayesian latent class models affected the prevalence estimates. Two types of Bayesian models were specified: a model that only uses the individual dichotomous test results and a continuous model that uses the quantitative information of the EIA (i.e., the signal-to-cutoff values). Overall, we found that adjusted prevalence estimates matched the surveys’ original results, with overlapping uncertainty intervals. This suggested that misclassification of HIV status should not affect the prevalence estimates in most surveys. However, our analyses suggested that two surveys may be problematic. The prevalence could have been overestimated in the Uganda AIDS Indicator Survey 2011 and the Zambia Demographic and Health Survey 2013-14, although the magnitude of overestimation remains difficult to ascertain. Interpreting results from the Uganda survey is difficult because of the lack of internal quality control and potential violation of the multivariate normality assumption of the continuous Bayesian latent class model. In conclusion, despite the limitations of our latent class models, our analyses suggest that prevalence estimates from most of the surveys reviewed are not affected by sample misclassification.
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This report outlines the Ministry of Health’s National ...box">Health Research Agenda in which it identifies research priorities in health. It will be implemented in the same time frame as the Health Sector Strategic Plain 2012-2018. The Ministry of Health being the implementing agency of this document, is calling upon all partners, relevant ministries, higher learning institutions, students, development partners, etc to embrace this research agenda and ensure that researches conducted in Rwanda address priority areas identifies.
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The 2013 RMIS is a nationally representative, household-based survey that provides data on malaria indicators, which are used to assess the progress of...pan> a malaria control program. The primary objective of the 2013 Rwanda Malaria Indicator Survey (2013 RMIS) was to provide up-to date information on the prevention of malaria to policymakers, planners, and researchers.
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BMC Public Health (2019) 19:1608
https://doi.org/10.1186/s12889-019-7853-3
This study of Adolescent Boys and Young Men highlights the importance of engaging adolescent boys and young men in sexual and reproductive ...ass="attribute-to-highlight medbox">health and rights (srhr) and gender equality. This paper establishes a conceptual framework for engaging adolescent boys and young men. It reviews current research on boys’ and young men’s specific risks and realities in relation to their general health status, violence, sexuality and sexual and reproductive health, media violence, sexual exploitation, and other vulnerabilities.
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