African Health Initiative

Publications

Tracking rural health facility financial data in resource-limited settings: a case study from Rwanda

Lu C, Tsai S, Ruhumuriza J, et al. PLOS Medicine 2014;11(12).

As part of an economic evaluation of the Rwanda Population Health Implementation and Training (PHIT) Partnership, this article describes a project focused on tracking health center financial data in two rural districts of Rwanda: Kirehe and Southern Kayonza. The authors report on a five-step financial data tracking procedure that draws on financial data from 21 health centers in the two districts.

 

Clinical Mentorship to improve pediatric quality of care at the health centers in rural Rwanda: a qualitative study of perceptions and acceptability of health care workers

Manzi A, Magge H, Hedt-Gauthier et al. BMC Health Services Research 2014;14:275

This study explored perceptions of the Mentoring and Enhanced Supervision at Health Centers (MESH) program from the perspective of Integrated Management of Childhood Illness (IMCI) mentors, mentees and district clinical leadership in the Kirehe and Southern Kayonza districts in Rwanda. Health care workers reported high acceptance and positive perceptions of the MESH model as an effective strategy to build their capacity, bridge the gap between knowledge and practice in pediatric care, and address facility and systems issues. This approach also improved relationships between the district supervisory team and health center-based care providers.

 

Mentoring and quality improvement strengthen integrated management of childhood illness implementation in rural Rwanda

Magge H, Anatole M, Cyamatare FR, et al. Arch Dis Child 2014;DOI: 10.1136/archdischild-2013-305863.

In 2010, Partners In Health and the Rwanda Ministry of Health implemented a nurse mentorship intervention Mentoring and Enhanced Supervision at Health Centres (MESH) in two rural districts of Rwanda. In this study measuring change in quality of care (QOC) following the addition of MESH to didactic training in 21 rural health centers, MESH was associated with significant improvements in all domains of integrated management of childhood illness (IMCI) quality.

The full version of this article is not available to the public at this time.

 

Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership

Drobac PB, Basinga P, Condo J, et al. BMC Health Services Research 2013;13(Suppl 2):S5.

Nationally, health in Rwanda has been improving since 2000, with considerable improvement since 2005. Despite improvements, rural areas continue to lag behind urban sectors with regard to key health outcomes. Beginning in 2009, the Rwanda Ministry of Health (MOH) and Partners In Health (PIH) have spearheaded a health systems strengthening (HSS) intervention in these districts as part of the Rwanda Population Health Implementation and Training (PHIT) Partnership. The partnership is guided by the belief that HSS interventions should be comprehensive, integrated, responsive to local conditions and address health care access, cost and quality.

 

Utilizing community health worker data for program management and evaluation: systems for data quality assessments and baseline results from Rwanda

Mitsunaga T, Hedt-Gauthier B, Ngizwenayo E, et al. Soc Sci Med. 2013;82:87-92.

Community health workers (CHWs) have and continue to play a pivotal role in health services delivery in many resource-constrained environments. The data routinely generated through CHW programs are increasingly relied upon for providing information for program management, evaluation and quality assurance. However, there are few published results on the quality of CHW-generated data, and what information exists suggests quality is low. An ongoing challenge is the lack of routine systems for CHW data quality assessments (DQAs). We describe a system developed for CHW DQAs and results of the first formal assessment in southern Kayonza, Rwanda, May-June 2011. While the results identified gaps in the current data quality, the assessment also identified opportunities for strengthening the data to ensure suitable levels of quality for use in management and evaluation.

The full version of this article is not available to the public at this time.

 

Reduced premature mortality in Rwanda: lessons from success

Farmer PE, Nutt CT, Wagner CM, et al. BMJ 2013;346:f65.

In the immediate aftermath of the 1994 genocide, the Rwandan government created the Vision 2020 strategy for equitable social and economic development, which emphasized health as a pillar of the national cross-sector approach to reducing poverty. For the past decade, health authorities in Rwanda have resisted pitting prevention against care, public sector and private, while expanding access to basic health services to the poor and strengthening the health system. If these gains can be sustained, Rwanda will be the only country in sub-Saharan Africa on track to meet most of the health related millennium development goals by 2015. The approach of Rwanda's Ministry of Health and its development partners to strengthening its health system offers insights for other countries faced with persistent poverty and lagging health indicators.

 

Nurse mentorship to improve the quality of healthcare delivery in rural Rwanda

Anatole M, Magge H, Redditt V. Nurs Outlook 2013;61(3):137-144.

Quality of care at rural health centers in Rwanda is often limited by gaps in individual nurses' knowledge and skills, as well as systems-level issues, such as supply and human resource management. Typically, nurse training is largely didactic and supervision infrequent. Partners In Health and the Rwandan Ministry of Health (MOH) collaborated to implement the nurse-focused Mentoring and Enhanced Supervision at Health Centers (MESH) program. Rwandan nurse-mentors trained in quality improvement and mentoring techniques were integrated into the MOH's district supervisory team to provide ongoing, on-site individual mentorship to health center nurses and to drive systems-level quality improvement activities. The program targeted 21 health centers in two rural districts and supported implementation of MOH evidence-based protocols. Initial results demonstrate significant improvement in a number of quality-of-care indicators. Emphasis on individual provider and systems-level issues, integration within MOH systems and continuous monitoring efforts were instrumental to these early successes.

The full version of this article is not available to public at this time.

 

Towards universal health coverage: an evaluation of Rwanda Mutuelles in its first eight years

Lu C, Chin B, Lewandowski JL, et al. PLoS ONE 2012;7(6):e39282.

Mutuelles is a community-based health insurance program, established since 1999 by the Government of Rwanda as a key component of the national health strategy on providing universal health care. The objective of this study was to evaluate the impact of Mutuelles on achieving universal coverage of medical services and financial risk protection in its first eight years of implementation. Rwanda's experience suggests that community-based health insurance schemes can be effective tools for achieving universal health coverage even in the poorest settings.