Sunday, May 26, 2013

Same Old Problems, new approaches in 2013

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


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.

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.


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.