Rwanda Health Systems Strengthening Project

Project Overview

The Rwanda Health Systems Strengthening (RHSS) Project, led by MSH, advanced the US Government’s commitment to inclusive growth, accountability, resilience, and partnership throughout Rwanda’s journey to self-reliance. RHSS collaborated with the Ministry of Health, local partners, and health system leaders to strengthen their capacity for effective leadership and governance; sustainable health financing and private-sector engagement; improved quality of care; evidence-based decision making; and an effectively mobilized, skilled workforce.  


  • Supported an enrollment drive for the national community-based health insurance scheme, which was integrated with a health insurance membership management system that supported mobile premium payments. Enrollment increased from 74% in 2014 to 83% in 2018—a 38% reduction in the informal workforce facing financial barriers to health. 


  • Supported the launch of the District Operational Research Challenge Fund, a multidonor small grants initiative to build and grow the capacity of the Ministry’s district hospital staff and young health researchers to design and implement sustainable public health programs.


  • Introduced an evidence-based workforce planning tool (WISN) that allows all public district hospitals in Rwanda to calculate adequate staffing levels to ensure quality care and better meet the health needs of populations in their catchment areas. 


  • Utilized the district health information system (DHIS2) software, an open-source health data platform, to customize an electronic infectious disease surveillance and response module. The system was fully integrated into Rwanda's routine health reporting system, and disease surveillance and response are now standard practices across all public health facilities.  


  • Supported the adaptation of community surveillance, preparedness, and response toolkits for Rwanda and created a mobile application that enables community lookouts to alert authorities about unusual health events in human and animal populations.


  • Helped health authorities develop national standards for service quality, measure the performance of all 43 public hospitals against those standards, and offer accreditation to those facilities meeting them, which increased average quality and safety scores from 36% in 2014 to 82% in 2019.


  • Implemented new standards for infection control (antibiotic prophylaxis, hand hygiene, and sterilization) and staff training and patient education, which reduced post-surgery infections among women delivering by Cesarean from 8% to 1.8% in three years in western Rwanda, where Cesareans account for approximately 48% of births. 


  • Laid the groundwork for the automation of medical records and medical claims processing, the creation of a national medical procedure coding system, and the implementation of a medical claims form for both public and private insurance providers. 


  • Trained local facilitators and introduced the Leadership Development Program Plus as an effective approach for hospitals to monitor and resolve priority quality of care issues identified through hospital accreditation.

Project Team