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RWANDA PRIMARY HEALTH CARE AND DECENTRALISATION OF HEALTH SYSTEM

RWANDA PRIMARY HEALTH CARE AND DECENTRALISATION OF HEALTH SYSTEM. Claude SEKABARAGA, MD, MPH Director of planning, policy and capacity building. PRIMARY HEALTH CARE SERVICES. MOH: HRF, OAI. 30 DISTRICTS: DH, DP, CDLS, MUTUELLE. 416 SECTORS : Health center.

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RWANDA PRIMARY HEALTH CARE AND DECENTRALISATION OF HEALTH SYSTEM

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  1. RWANDA PRIMARY HEALTH CAREAND DECENTRALISATION OF HEALTH SYSTEM Claude SEKABARAGA, MD, MPHDirector of planning, policy and capacity building

  2. PRIMARY HEALTH CARE SERVICES MOH: HRF, OAI 30 DISTRICTS: DH, DP, CDLS, MUTUELLE 416 SECTORS : Health center 2080 CELLS: Health community post 14980 AGGLOMERATIONS: 2 Community health workers

  3. PRIORITY INTERVENTIONS OF PRIMARY HEALTH CARE SERVICES • Increase the use of family planning methods, especially the long term methods; • Investment in strong prevention interventions of major diseases; • Universal access to curative care for all people living in Rwanda through universal coverage of health insurance; • Improvement of quality of care through quality of training, e-health, investment in infrastructure, drugs management, equipment and performance based financing of providers; • Decentralization of health services at Umudugudu (Health post) and households level (Community Health workers); • Mobilization of financial resources.

  4. INNOVATIVE INTERVENTIONS • Public subsidies (Health facilities budget support) through performance based financing; • Community health insurances; • High subsidy of drugs and products of higher prevalence diseases (Immunization, malaria, Hiv/aids and TB); • Autonomy of management of health facilities (hospitals and health centres), include now personnel; • Decentralisation, integration and task shifting in delivery of health care services.

  5. DECENTRALIZATION OF HEALTH SERVICES

  6. HEALTH SECTOR BUDGET DECENTRALISATION

  7. GOR HEALTH BUDGET TRANSFERS TO DISTRICTS: 17,1 billions of RWF (32 millions USD)

  8. HEALTH OFF BUDGET (NGO’S) TRANSFERS TO DISTRICTS: 10,4 billions (18 millions USD)

  9. FAMILY PLANNING

  10. FAMILY PLANNING IN PBF PRIMARY HEALTH FACILITIES PILOT SITES 194% increase 60 50 55 50 45 2 40 R = 0.8635 35 30 25 Percentage 17 20 15 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 2006 2007

  11. ANTE NATAL CARE

  12. BIRTHS DELIVERIES

  13. IMMUNIZATION

  14. HIV TESTING SERVICES

  15. PREVENTION OF TRANSMISSION OF HIV FROM MOTHERS TO CHILDREN SERVICES

  16. PREGNANT WOMEN TESTED HIV

  17. ART SERVICES AND PATIENTS

  18. TB DETECTION

  19. COMMUNITY HEALTH INSURANCE IN RWANDA

  20. UTILISATION OF CURATIVE CARE SERVICES IN RWANDA

  21. IMPACT ON HEALH OF POPULATION

  22. MALARIA MORBIDITY

  23. HIV PREVALENCE

  24. TUBERCULOSIS MORBIDITY

  25. LESSONS LEARNT • Decentralisation and community participation: Accessibility, early treatment, ownership, implication of local leaders, community health workers, youth and women organisations, autonomy in management. • Community health insurance: Financial barrier, utilisation of primary health services. • Performance based financing: Quality, Rural to urban brain drain, local investment: Equipment, maintenance • Strong prevention: Universal distribution of mosquito-nets, hygiene and environment. • Partnership: Public, private, civil society and international cooperation implication.

  26. CONCLUSION • Decentralisation and community participation contributed to rapid and efficient results; • Primary health care have been improved very much in terms of prevention of major diseases like malaria, HIV/AIDS, although many challenges due to level of poverty and quantity and quality human resources; • Great efforts must be put in elimination of major diseases like malaria, diseases due to lack of hygiene and/or which vaccines exist, universal accessto mosquito-nets and health insurance.

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