Integrated Health Systems Strengthening Project: Our Impact

{Photo credit: Philbert Rugumire}Photo credit: Philbert Rugumire

In just two years, staff at Ruhengeri referral hospital in the Northern Province of Rwanda reduced the rate of newborn deaths within their facility to 1.4 percent, one-third of their 2013 baseline. Neonatal mortality in this facility is now half the sub-Saharan African average of 2.8 percent in 2015 (WHO Global Health Observatory Data Repository).

After five years of partnership with the Rwandan Ministry of Health, the Integrated Health Systems Strengthening Project (IHSSP) is drawing to a close. The project, leaders from the MSH home office, USAID Rwanda, and local and international partners gathered in Kigali on November 13 to celebrate the project’s many successes and share the wealth of knowledge it generated. Dr. Agnes Binagwaho, Rwanda’s Minister of Health, thanked MSH for the support it provided, which she said, “…enabled us to accelerate health progress and helped us to achieve our vision.”

 {Photo credit: Todd Shapera.}Community health workers and children, Rwanda.Photo credit: Todd Shapera.

It has been 20 years since the genocide that killed over a million citizens and devastated the Rwandan health system and economy. In some respects, it feels more recent. Our memories of both the violence and our collective inadequacies in the international response are still raw. But the progress Rwanda has made toward economic and social stability in just two decades is astonishing and a cause for celebration.   

 {Photo Credit: Candide Tran Ngoc/MSH}Mr. Nkurunziza Justin, human resources manager at Kibungo Provincial Hospital in Rwanda.Photo Credit: Candide Tran Ngoc/MSH

The health workforce is the core of every health system. In Rwanda, where qualified clinical staff are in short supply—the country has an average of one nurse for every 1,500 inhabitants and one doctor per 15,306 citizens —efficiently allocating human resources is crucial to the provision of quality services.

 {Photo credit: Philbert Rugumire/MSH}Data managers in training at Rubavu District Western Province.Photo credit: Philbert Rugumire/MSH

Rwanda, like many developing countries, has faced major challenges regarding access to accurate health information, such as attendance rates at clinics or statistics on treatments provided. Previously multiple procedures were in place, at times collecting duplicative data, which overwhelmed health workers in charge of collecting the information. The national health management information systems required installing software in each of the computers using the system. There was no way to access data from other computers.

 {Photo credit: MSH/Candide Tran Ngoc}Diogène shows his CBHI card.Photo credit: MSH/Candide Tran Ngoc

Thirty-seven year-old Diogène lives in the Eastern province of Rwanda. In March 2012, he began to feel ill. He was short of breath, couldn’t walk uphill, and had chest pains. Diogène held community-based health insurance (CBHI), which enabled him to see a doctor at the Ngarama district hospital, where he was diagnosed with heart disease.

Dr. Cedric Ndizeye, IHSSP senior PBF advisor (left) works with the Ministry of Health’s Health Financing Unit (Dr. Joseph Ntibiringirwa (center) and Mr. Augustin Dushime (right). {Photo credit: C. Tran Ngoc/MSH.}Photo credit: C. Tran Ngoc/MSH.

Performance based financing (PBF) and community based health insurance (CBHI) are powerful health financing systems in Rwanda.

Using RapidSMS, a community health worker requested an ambulance to transport Dorcelle to the Musanze Health Center, where she delivered a healthy baby. {Photo credit: Candide Tran Ngoc/MSH.}Photo credit: Candide Tran Ngoc/MSH.

In 2011, Drocelle gave birth to her fourth child, and, for the first time, delivered at a health center. Throughout her pregnancy, Drocelle had been monitored by a community health worker, Elizabeth, who regularly visited her at home and encouraged her to go to the Musanze Health Center for antenatal care. When Drocelle went into labor, she contacted Elizabeth, who sent a RapidSMS text message to the Musanze Health Center requesting an ambulance. Without the ambulance, it would have taken Drocelle three hours to walk to Musanze Health Center.

 {Photo credit: Candide Tran Ngoc/MSH}A Rwandan nurse immunizes a child.Photo credit: Candide Tran Ngoc/MSH

Until recently, nurses and midwives in Rwanda had varying degrees of knowledge, training, and capacity. Some had received inadequate instruction abroad and others had even bought counterfeit diplomas. Because there was no system in place to ensure nurses were adequately prepared, many Rwandans were subjected to inconsistent care and unreliable service quality.

Photo credit: C. T. Ngoc/MSH.

Eugénie is a widow and farmer living in the southern province of Rwanda, who struggles to provide for her three children. For many years, Eugénie suffered from a renal tumor. Although she had community-based health insurance (CBHI) that covered 90 percent of her medical fees, Eugénie was unable to pay the remaining 10 percent. Her health deteriorated.