STRENGTHENING HEALTH SYSTEMS TO IMPROVE AND SUSTAIN HIGH IMMUNIZATION COVERAGE IN RWANDA 2007 2009.

1. RWANDA MOH - EPI - ICC - GAVI STRENGTHENING HEALTH SYSTEMS TO IMPROVE AND SUSTAIN HIGH IMMUNIZATION COVERAGE IN RWANDA (2007 – 2009). RWANDA MOH/EPI – GAVI

2. RWANDA MOH - EPI - ICC - GAVI OUTLINE I. INTRODUCTION II. HEALTH SYSTEMS PERFORMANCE REVIEW III. GOAL - OBJECTIVES IV. ACTIVITIES V. BUDGET VI. MANAGEMENT VII. INDICATORS VIII. CONCLUSION

3. RWANDA MOH - EPI - ICC - GAVI I. INTRODUCTION Overall goal of Rwanda EPI: to contribute to improved well-being of the population through reduction of child morbidity and mortality due to vaccine-preventable diseases. Vaccination services integrated into routine activities in PHC facilities. Routine immunization intended to reach infants 0-11 months of age and pregnant women during ANC visits.

4. RWANDA MOH - EPI - ICC - GAVI INTRODUCTION (cont’d) Since 2002, new vaccines included in Rwanda EPI: DTP-HepB/Hib with GAVI support. Context: GAVI HSS to enable countries to address weaknesses and improve the capacity of their health system in order to increase and sustain high immunization coverage. Process: ICC; Rwanda EPI multi-year plan (2006-2010).

5. RWANDA MOH - EPI - ICC - GAVI NEEDS ESTIMATES PROJECTIONS RWANDA POPULATION PROJECTIONS: 2006: 9,0 mios 2007: 9,3 mios 2008: 9,5 mios 2009: 9,8 mios 2010: 10,0 mios 2011: 10,3 mios Expected births: 2006: 360,299 2007: 371,636 2008: 381,299 2009: 391,213 2010: 401,384 2011: 411,820

6. RWANDA MOH - EPI - ICC - GAVI II. HEALTH SYSTEMS PERFORMANCE REVIEW: Strengths & weaknesses STRENTGHS Strong political commitment; HS strategic plan (2005-2009); Administrative & health services decentralization process; PHC coverage; Mutual health insurance scheme; PBF scheme; Community participation (community health workers network). WEAKNESSES Inadequate human resources; Limited financial resources; Inadequate HMIS; Inadequate coordinating mechanisms.

7. RWANDA MOH - EPI - ICC - GAVI II. HEALTH SYSTEMS PERFORMANCE REVIEW: Recommendations Implement health sector human resource development strategy. Resource mobilization for HSS. Improve & integrate existing HMIS. Strengthen health sector coordination at national and district levels.

8. RWANDA MOH - EPI - ICC - GAVI II. HEALTH SYSTEMS PERFORMANCE: Progress review HR development strategy implementation: Special statute & remarquable salary increase for health personnel; PBF scheme implementation at health center, hospital & community levels; Specific pre & in – service training programs for health professionals.

9. RWANDA MOH - EPI - ICC - GAVI II. HEALTH SYSTEMS PERFORMANCE: Progress review (cont’d) 2. Resource mobilization: Increased percentage of Government budget allocated to health sector (6.1%, 2004 – 10%, 2007). GFATM supported projects: round 5 (HSS): 33,945,080 $ US / 2006 – 2010; round 6 (HIV): 58,887,110 $ US / 2007 - 2011). Mutual health insurance coverage (27%, 2004 – 62%, 2006). PEPFAR / USAID.

10. RWANDA MOH - EPI - ICC - GAVI II. HEALTH SYSTEMS PERFORMANCE: Progress review (cont’d) 3. HMIS assessment with relevant recommendations (2006). 4. HS coordination mechanisms: MTEF HSCG ICC

11. RWANDA MOH - EPI - ICC - GAVI III. GOAL - OBJECTIVES Goal: Strengthening health systems for improved and effective PHC in Rwanda. Objectives: (3) To strengthen mobilization, distribution and motivation of health workforce engaged in PHC services. To strengthen supply, distribution and maintenance systems for drugs, equipment and infrastructure for primary health care. To improve organization and management of PHC services at district level.

12. RWANDA MOH - EPI - ICC - GAVI IV. ACTIVITIES Objective 1: Training: Topics: Reach each district (RED) strategy, quality assurance, M&E, epidemiological surveillance… Participants: 30 DMO; 370 vaccinators; 30 district supervisors; 30 district EPI focal points. PBF: 40 DMO

13. RWANDA MOH - EPI - ICC - GAVI IV. ACTIVITIES (cont’d) Strengthening community participation: Training: 12,000 community health workers (CHWs). PBF: 12,000 CHWs Office supplies for 12,000 CHWs Coordination meetings for CHWs (quarterly) Support specific training programs for EPI staff (Epidemiology; lab technology). Participation to scientific conferences.

14. RWANDA MOH - EPI - ICC - GAVI IV. ACTIVITIES (cont’d) Objective 2: Cold chain equipment for 20 HCs Fuel for cold chain Lab equipment Required lab reagents Incinerators Support distribution of vaccines & supplies for districts Solar panels (34 HCs) Maintenance for cold chain, lab equipment, computers & solar panels.

15. RWANDA MOH - EPI - ICC - GAVI IV. ACTIVITIES (cont’d) Objective 3: BCC materials (new vaccines); Epidemiological surveillance; Integrated surveillance monthly report; Monthly coordination meeting for health district stakeholders; Annual planning seminar at district level; Quarterly HIS & EPI bulletin; HIS & EPI annual report; Reward highest performing HCs (MCH…); Implement DQS; Impact evaluation of the project.

16. RWANDA MOH - EPI - ICC - GAVI V. BUDGET (2007 – 2009)

17. RWANDA MOH - EPI - ICC - GAVI VI. MANAGEMENT HSCG: Plan & budget approval PMU : MiNISANTE Specific bank account for HSS/GAVI (national & district levels) Procurement (NTB) Financial reporting mechanism Internal & external audit

18. RWANDA MOH - EPI - ICC - GAVI VII. PROJECT INDICATORS % completeness of CHWs reports % of supervisions conducted % of districts with annual DQS conducted % of completeness of integrated surveillance reports % of districts with functioning incinerator % of coordination meetings held # of vaccinators/100,000 population % of districts with functioning cold chain equipment DPT3 Routine measles coverage Under – 5 mortality rate

19. RWANDA MOH - EPI - ICC - GAVI VIII. CONCLUSION HSS: appropriate strategy & great needs GAVI: additional inputs to GoR efforts & other development partners support. Expected high impact on population & child health.