Project description

Title: Primary Health Care and Combating HIV/AIDS
Commissioned by: German Federal Ministry for Economic Cooperation and Development (BMZ)
Country: Rwanda
Lead executing agency: Ministère de la Santé (MINISANTE)
Overall term: 2004 to 2010

Context

Rwanda, and in particular the country’s poor, suffers greatly from the health problems characteristic of sub-Saharan Africa: high infant and maternal mortality, deficient family planning, the burden of HIV/AIDS and other infectious diseases and a lack of well-trained staff. Although there has been significant progress in recent years, the above-mentioned indicators are still at the same level as shortly before the genocide in 1994. This situation has its root cause mainly in the poor quality of health institutions and access to health services. In spite of the nation-wide introduction of a health insurance system, the difficult geographical conditions and above all the costs of health services are a great burden, particularly for the poor.

Objective

The state of health among the impoverished population in the Nyaruguru, Huye, Gisagara, Musanze and Gicumbi districts is improved.

Approach

The programme supports the qualitative improvement of the health system and promotes access to services and their acceptance. The programme consists of three components: health system development, sexual and reproductive health and human resources development in the health sector. The following approaches are being taken:

• The partner is supported in all questions of reproductive health, e.g. regarding the health of mother and child, HIV controlling and family planning.
• Access to health services is promoted by supporting a community-administered insurance system (“Mutuelles”). The motivation of staff and the quality of services is to be improved through the performance-based financing of health facilities.
• Further and advanced training of health staff is offered on an ongoing basis in cooperation with the German Development Service (DED) and Capacity Building International (Inwent) as well as in close collaboration with local institutions such as the National University of Butare.
• In addition to the procurement of medical equipment, the development of a national, integrated maintenance system for this equipment is also supported.

Experience from the partner districts is integrated into national policy-making.

German development cooperation makes an important contribution to coordinating the activities of the various donors in the health sector within the context of developing a sector-wide approach (SWAp). In 2007, German development cooperation also began providing sectoral budget assistance in the form of a direct grant to the budget of the health ministry in the partner country.

The programme promotes the cross-cutting issues of gender and HIV/AIDS mainstreaming, i.e. making HIV/AIDS a consideration in all development cooperation activities.

Apart from DED and Inwent, GTZ also cooperates with KfW Entwicklungsbank and the Centre for International Migration and Development (CIM).

In cooperation with the international non-governmental organisation Population Services International (PSI), public-private partnerships (PPP) have been concluded with four Rwandan companies to protect staff against HIV/AIDS.

Results achieved so far

The health services in the programme’s partner districts have been improved in quality and demand for these services has increased. The fast development of the health insurance system and continuing training of staff, who are now significantly more motivated, are all indications of a consolidation of the health system. Substantial progress is also to be noted in family planning, the appropriate handling of births and HIV counselling and testing.

The Demographic and Health Survey (DHS) data of 2005 show

• stabilisation in the spread of HIV at 3 percent of the total population
• a reduction in infant mortality to 86 of 1,000 live births

The results of a scaled-down version of the same survey (MINI DHS, 2008) indicate further success compared with 2005:

• an increase in the number of births with professional assistance from 39 percent to 52 percent
• a more than twofold increase in the use of modern contraceptives from 10 percent to 27 percent

In cooperation with its development partners, Rwanda has laid down the first foundations for achieving the Millennium Development Goals in the health sector: Reduce child mortality (Goal 4), Improve maternal health (Goal 5) and Combat HIV/AIDS, malaria and other diseases (Goal 6).