Below
is my contribution to issue 3 of Ubuzima Magazine, published by the Rwanda
Health Communications Center and the Rwanda Biomedical Center.
I
recommend you to read the full magazine! Lots of great information on our health
sector from the MOH and RBC
Same
Old Problems, new approaches in 2013
By Dr. Agnes BINAGWAHO
Despite lingering
challenges, 2012 was another year of incremental performance in health delivery
to the Rwandan population. One visible improvement was the 50 percent reduction
in acute malnutrition. However we need to not only reduce acute malnutrition but
reduce the incidence of malnutrition in general.
That can be achieved by
focusing our efforts on prevention. We have changed the way malnutrition is
monitored because we realized that the source of the problem does not reside
with the health sector alone but cuts across other sectors like Agriculture and
Minaloc ( the Local Government Ministry), which are responsible for kitchen
gardens, tree planting, distribution of small livestock, such as poultry for
producing eggs, goats for milk etc.
However, the population
also needs to be educated on how to eat these nutrients properly when they are
available and that falls under Migeprof (Gender Ministry) and the National
Women’s Council. The National Women’s Council which is decentralized down to
village level will be used to help in monitoring not just kitchen gardens but
the plate of the child as well. This is the first time we are going to monitor
not what is available to the village and the family but the nutrient value in
what children are actually eating.
To fight malnutrition of
under-fives, we have hatched a new plan to complement what we have been doing.
Because many pregnant women are themselves malnourished, they give birth to
malnourished children. So we are also going to monitor the plate of the pregnant
woman and then monitor the plate of the child as well.
Volunteers from the
National Women’s Council will meet with families to see what the children are
eating. Before this, we were monitoring only the kitchen garden but the reality
is that while the garden or cow may indeed be there, their products are not
being given to the child. That is the next frontier in monitoring the fight
against malnutrition.
HRH
Overall my impression of
the Human Resources for Health program is that it is positive thus far. We need
to increase the number of health professionals in order to assure quality care
for Rwandans. By improving basic care, reducing child and maternal mortality,
we have been able to increase life expectancy from around 30 years in 1994 to
55 today. This transition has its own dynamics and we are now staring at the
emergence of new chronic diseases that are not the result of any new epidemic
but because the population is aging. It is evidence of our success against
infectious diseases.
All people who need HIV
treatment are on treatment. We have managed to control malaria and
Tuberculosis. But going forward we now need specialists to deal with the
emerging health problems related to age and consumption. We need to deal with
heart diseases and chronic diseases such as cancer. We also need to improve
child mortality by improving neonatology because the rate of death of neonates
is what pulled down our child mortality indicators.
So we decided to create a
program that brings to Rwanda around 100 Americans from the best universities
every year, to teach, to mentor, bedside and also transfer clinical skills to
Rwandan professionals at the level of post-graduate. Through this we hope to
produce 500 specialists and sub specialists. Through this program we are going
to be able to staff every district hospital with one gynecologist one
pediatrician, one internist, one anesthetist and one surgeon. We shall
also have the capacity to treat our population for cancer and other diseases
that need specialized care. This is not going to be done overnight; it is a
seven year program that brings together all the partners working in education
around the program. We are stopping petty training and focusing on good
sustainable academic training.
This program will reinforce
our universities to provide teaching and at the end of the day we are going to
have a very skilled workforce in the health sector.
Decentralization
We are making great
progress in management of the sector. Management at the central level has been very
good and certified by various audits.
We are now actively
supporting the decentralized sector with the people we have trained and
mentored. We are now going to move to the district level deploying people with
skills in monitoring and evaluation of health programs. They also have skills
in in-service training, supervision etc. Those people are now well trained and
functional and we are going to base them in districts where they will be at the
service of the districts. The Director of a hospital will report to the
Director of health and to the Vice mayor. By decentralizing the audit function
to the district and having these highly skilled people distributed equitably
across the entire country, we are going to see even better management of the
health sector.
This is a big move towards
ownership of the sector by the districts. Because it is not fair to
decentralize tasks without decentralizing the capacity to do that, we are
confident they will transfer this knowledge and capacity since they have been
doing it well at the central level.
2013 targets
Customer care and putting
in practice the knowledge we have acquired through various programs such as HRH
(Human Resources for Health) is our collective target for 2013. Our workforce
is skilled and knowledgeable and what we need is to marry knowledge with
practice. Health workers need to know that they need to care and apply their
knowledge with customer care in mind.
