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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
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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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Pathways to progress: a multi-level approach to strengthening health systems
Samuels, F., Amaya, A.B., Rodríguez Pose, R. and Balabanova, D.
Overseas Development Institute
(2014)
C1
Findings on maternal and child health in Nepal, Mozambique and
Rwanda, and neglected tropical diseases in Cambodia and Sierra Leone | This report synthesises findings from five country case studies from the health dimension of this project, which focus on maternal and child health (MCH) (Mozambique
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,Nepal, Rwanda) and neglected tropical diseases (NTDs)(Cambodia, Sierra Leone). MCH was selected given its centrality in two of the Millennium Development Goals (MDGs) and its ability to act as a proxy for strengthened health systems. NTDs, while until recently relatively neglected in global policy debates, are now attracting more interest, not least because they are viewed as diseases of the poor whose treatment could positively impact on most of the other MDGs.
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The Kabeho Mwana project (2006–2011) supported the Rwanda Ministry 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 p
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roject 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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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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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
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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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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
This article reexamines a set of study findings that directly relate to the influence of gender on workplace violence, synthesizes these findings with other research from Rwanda, and examines the subsequent impact of the study on Rwanda’s policy environment.
Through public-private partnerships, the government of Rwanda can make more efficient use of public resources by targeting and meeting the needs of specific populations and thus help ensure family planning services and products will be available to all Rwandans in the long term. This report aims to
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inform stakeholders working to strengthen family planning through multisectoral partnerships about Rwanda’s family market.
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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
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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.
The Capacity Project worked to strengthen HRIS in several low-resource countries to assist decision-makers and human resources managers in identifying and responding to critical gaps in HRH. The findings and recommendations in this report cover the Capacity Project’s implementation of HRIS in Swaz
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iland, Rwanda and Uganda.
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This report identifies and analyses policies and laws which currently include of Persons with disabilities in social protection specifically the Vision 2020 Umurenge Programme and considers some of the gaps in the VUP norms which prevent the successful inclusion of Persons with Disabilities.
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 survey was conducted in early 2015. Respondents were 347 people living with HIV in seven (7) towns/districts of five (5) departments of the Republic of the Congo.
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 - This table includes some commonly used M&E tools that are likely to be relevant for the kind of work undertaken by CBM and its partners.
