This study highlights the challenges and areas in need of improvement as perceived by CHWs and beneficiaries, in regards to a nationwide scale-up of CHW interventions in a resource-challenged country. Identifying and understanding these barriers, and addressing them accordingly, particularly within ...the context of performance-based financing, will serve to strengthen the current CHW system and provide key guidance for the continuing evolution of the CHW system in Rwanda.
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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...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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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...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 | Using qualitative data from Rwanda, this study focuses on four institutional factors that affect health worker performance and career choice: incentives, monitoring arrangements, professional norms and health workers’ intrinsic motivation. It also provides... illustrations of three institutional innovations that work, at least in the context of Rwanda: performance pay, the establishment of community health workers and increased attention to the training of health workers.
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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 providing 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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In 2017, the World Bank and partners created the Global Investment Framework for Nutrition as a roadmap towards achieving the World Health Assembly (WHA) nutrition targets by 2025. The framework estimates that the world needs to mobilize an annual additional investment of $7 billion per year to scal...e-up nutrition-specific interventions at the level needed to achieve the global targets. However, the world is off-track to meet the global targets. And it is unclear whether additional resources will be mobilized for life-saving and cost-effective nutrition-specific interventions, or whether donor support will be enough to meet the annual resource need established by the framework.
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Poor quality health services are holding back progress on improving health in countries at all income levels.
Today, inaccurate diagnosis, medication errors, inappropriate or unnecessary treatment, inadequate or unsafe clinical facilities or practices, or providers who lack adequate training an...d expertise prevail in all countries.
The situation is worst in low and middle-income countries where 10 percent of hospitalized patients can expect to acquire an infection during their stay, as compared to seven percent in high income countries. This is despite hospital acquired infections being easily avoided through better hygiene, improved infection control practices and appropriate use of antimicrobials.. At the same time, one in ten patients is harmed during medical treatment in high income countries.
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The objective of the evaluation is to understand whether the CHW 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 fo...r 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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We systematically reviewed Medline as well as the references of published review articles for relevant studies of adherence to multidrug treatment of both drug-susceptible and drug-resistant TB through February 3, 2018. We included randomized controlled trials (RCTs) as well as prospective and retro...spective cohort studies (CSs) with an internal or external control group that evaluated any adherence intervention and conducted a meta-analysis of their impact on TB treatment outcomes. Our search identified 7,729 articles, of which 129 met the inclusion criteria for quantitative analysis. Seven adherence categories were identified, including DOT offered by different providers and at various locations, reminders and tracers, incentives and enablers, patient education, digital technologies (short message services [SMSs] via mobile phones and video-observed therapy [VOT]), staff education, and combinations of these interventions.
https://doi.org/10.1371/journal.pmed.1002595
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Le présent manuel a pour objet d'orienter les États membres sur les aspects pratiques du maintien des normes sanitaires aux frontières internationales dans les ports, les aéroports et les passages à niveau (points d'entrée) énoncés dans le Règlement sanitaire international (2005). Il fourni...t des conseils techniques pour l'élaboration d'un programme complet de surveillance systématique des vecteurs de maladies et de lutte intégrée contre les vecteurs aux points d'entrée.
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The purpose of this report is to provide an overview of the issues in regulating and managing international emergency in a selection of large and small-scale sudden onset disasters (SODs). In doing so, it aims to contribute to several key international commitments as well as its objective in disaste...rs and emergencies to “reduce the consequences the event may have on world health and its social and economic implications”.
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Le présent document énonce la première stratégie mondiale du secteur de la santé contre l’hépatite virale, une stratégie qui contribue à la réalisation du Programme de développement durable à l’horizon 2030.
Elle couvre les six premières années du plan d’action pour la santé... de l’après-2015, c’est-à-dire la période 2016-2021, en s’appuyant sur le document Prévention et lutte contre l’hépatite virale : cadre pour l’action mondiale et sur deux résolutions relatives à l’hépatite virale adoptées par l’Assemblée mondiale de la Santé en 2010 et en 2014.
Cette stratégie porte sur les cinq virus de l’hépatite (les hépatites A, B, C, D et E), en mettant plus spécialement l’accent sur les hépatites B et C en raison de la lourde charge relative qu’elles représentent pour la santé publique.
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Une fois adoptée et mise en œuvre, la stratégie contribuera à réduire sensiblement les nouvelles infections sexuellement transmissibles et les décès connexes (ainsi que les mortinatalités et le cancer du col de l’utérus), tout en améliorant la santé individuelle, la santé sexuelle des ...hommes et des femmes, et le bien-être de tous. Elle va orienter les efforts visant à : accélérer et cibler l’essentiel des actions de prévention en renforçant des approches à la fois comportementales, biomédicales et structurelles ; faciliter l’accès individuel à l’information concernant le statut personnel vis-à-vis des infections sexuellement transmissibles ; améliorer l’accès au traitement et à l’éventail complet des soins de longue durée, le cas échéant ; et combattre la stigmatisation et la discrimination généralisées. Le projet de stratégie encourage une démarche centrée sur la personne et fondée sur les principes des droits fondamentaux, de l’égalité entre les sexes et de l’équité en santé.
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The mandate of the National Tuberculosis Control Programme is to provide leadership and stewardship to accelerate intense and coordinated efforts to reduce the adult TB burden of 290 per 100,000 population recently established in the 2013 National TB Prevalence Survey. Other key challenges are low T...B case notification, unacceptably high TB death rates, low antiretroviral therapy (ART) coverage among TB/HIV patients and low drug-resistant notification and treatment.
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This document addresses the issue of the medical and rehabilitative care of persons with physical disabilities. It is understood that this policy is to be integrated with the policy documents of other advisory working groups. It should also be emphasised that the physical disability work of CBM occu...rs within the context of CBM’s Disability and Development Policy, with a human rights perspective and working toward full inclusion of people with disabilities within
their society.
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Parte del juego de herramientas para la Prevención; “Cómo reconocer las deficiencias de nacimiento”