Rwanda

Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels. [from abstract]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It reviews a study of how Rwanda, faced with constrained fiscal conditions, has implemented innovative reforms to create fiscal space for human resources and to make these resources more responsive to needs through an analysis of budget documents and policy and regulation changes and key informant interviews. [adapted from author]

The overall objective of this study is to evaluate the capacity as well as the performance of the health facilities (HF) and community associations (community health workers associations (CHW), traditional birth attendant associations (TBA) and associations of people living with HIV (PLWHA), operating in the Gisagara (formerly Kibilizi) District. [from summary]

This document introduces a competency-based curriculum for nurses and midwives in Rwanda developed by the Capacity Project.

Home-based care (HBC) for HIV/AIDS is increasingly looked to as a more accessible and affordable alternative to more costly inpatient care, both for patients who are unable to travel to or pay for inpatient care as well as for governments that must fund inpatient facilities. Partners for Health Reformplus estimated the cost of HBC for HIV in Rwanda, based on a sample of eight programs offering care in early 2004. The sample comprised facility- and community-based programs. Both types of program implement the medical care recommended in the Ministry of Health guidelines for HBC. [from abstract]

The Health Sector Policy elaborates the Government of Rwanda’s overall vision of development in the health sector, as set out in Vision 2020 and the Poverty Reduction Strategy Paper, building on lessons learned from the implementation of the health sector policy adopted in 1996. Furthermore, the Health Sector Policy takes account of changes in the institutional environment resulting from the implementation of the national decentralisation policy.
The Health Sector Policy is the basis of national health planning and the first point of reference for all actors working in the health sector. It sets the health policy objectives, identifies the priority health interventions for meeting these objectives, outlines the role of each level in the health system, and provides guidelines for improved planning and evaluation of activities in the health sector.

The development of the Health Sector Strategic Plan is one of the steps following on from the Government of Rwanda’s decision to pursue a sector strategy process in the implementation of its Poverty Reduction Strategy Paper. It provides an overarching framework for health sector support over the next five years with the principal aim of reducing poverty and improving the health status of the population. It comes at a time when the Government of Rwanda has shifted its focus towards sustainable development through the implementation of its PRSP and is embarking on the policy of decentralisation.

The core objective of the plan is national, comprehensive treatment and care for HIV/AIDS with equal access to services, long-term commitment, improvement of Rwanda’s general health services infrastructure beyond HIV/AIDS, and financial transparency. The approach for implementation will involve service integration with existing health system infrastructure, community mobilization, linkage between treatment and care and prevention, multi-country procurement economies of scale, and rapid scale-up and iterative learning based on “Collaboratives” model. The plan vision is increased longevity and improved quality of life for people living with HIV/AIDS in Rwanda.

The purpose of this human resource for health (HRH) plan is to provide guidance for the staffing of the health services and the training of health service personnel to the year 2020. It analyzes main issues and dimensions in HRH and proposes strategies to meet the targets for the wellbeing of the population as defined in the vision 2020 for Rwanda The plan provides staffing targets for each of the major categories of health personnel.

This report describes three health system developments introduced by the Rwandan government that are improving these barriers to care

The Capacity Project is applying an integrated strategy to strengthen family planning (FP) and reproductive health. The project is helping the Ministry of Health develop the capacity of the clinical workforce to provide a full range of FP methods and services at 13 hospitals and 146 health centers. [adapted from author]

The transformation of the university taught knowledge into a practical professional activity and decision responsibility of a medical doctor needs a period of learning by doing under guidance and supervision. The government’s proposal of a medical internship gives place for such a transformation. A medical internship is therefore incorporated in the curricula of medical doctors’ training in Rwanda. [author’s description]

This document outlines the national medical internship program in Rwanda, including how the deployment of these interns can help alleviate the deficiency of health

In an effort to understand the flows of funds throughout the health system, the Government of Rwanda (GoR) conducted, for the second time, a National Health Accounts (NHA) estimation. NHA is an internationally recognized tool for measuring health expenditures in a comprehensive manner — one that includes the public, private and donor sectors. By doing so, NHA offers a financial perspective on who is paying for health care, who is managing health care funds and their allocation, and where the funds are going — by type of provider and service. In short, NHA aims to inform policymakers on resource flows for the entire health system so as to assist in making good policy decisions and averting potentially adverse ones.

This study evaluated biases in guideline untilization of evidence-based practice concerning contraception perscription. It was found that in India, Peru, and Rwanda, health care providers underutilize evidence-based practice guidelines as they prescribe contraceptives. This article ends with recommendations for providers to most effectively utilize evidence-based practice. [adapted from abstract]

This presentation was part of the ECSA Workforce Observatory Meeting in Arusha. It describes an evaluative study to determine issues and causes of health worker problems and shortages done in Rwanda to aid in informing policy reform.


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This report discusses care provided to 245 women during labor, delivery, and immediate postpartum and their newborns during immediate postpartum. The quality of care for different tasks (e.g., monitoring fetal heart rate) is presented by country, by hospital type, and overall. The report details performance on recommended tasks and should inform program managers and providers in finding similar weaknesses in their own care delivery systems. Report includes 21 data tables and the data collection instrument for observations. [publisher’s description]

This report presents findings from Phase 3 of an assessment of the human resources implications of HIV/AIDS services scale-up in Rwanda. It focuses on the staffing implications and associated costs of HIV/AIDS services scale-up. By documenting current staffing levels and the level of effort necessary to provide HIV/AIDS services, Phase 3 of the study analyzes how many full-time equivalent (FTE) staff will be needed, and at what costs, if the Government of Rwanda is to meet its HIV/AIDS service delivery objectives. The human resources projections are based on data gathered during Phases 1 and 2 of the study.

This report presents findings from Phase 1 of an assessment of the human resources implications of HIV/AIDS services scale-up in Rwanda. Services covered include voluntary counseling and testing, prevention of mother-to-child transmission, and care and treatment, including lab services and drug dispensing. It reports the number and types of staff employed at public and private healthcare sites, estimates the number providing HIV/AIDS services, and identifies employment practices that could facilitate or hinder the human resources scale-up. In addition to providing statistics relative to the healthcare workforce, the report discusses such issues as user fees and salary disparities.

Based on the findings in the Phase 1 report, this report reviews Rwanda’s healthcare staffing, documents practices and levels of effort in providing HIV/AIDS services, and calculates staffing needs for scale-up. It also discusses such issues as training, management, supervision, job satisfaction, and staff motivation and incentives. [publisher’s description]

This report examines the workforce issues surrounding HIV/AIDS service delivery. At the request of the Government of Rwanda, data were collected on current health sector staffing and from 20 public and private facilities of various sizes and characteristics on the time required to provide HIV/AIDS services and the quality of those services. The report presents data relative to the numbers of clients needing different types of HIV/AIDS services, providers’ degree of compliance with service delivery standards, and the time it takes to provide services. Staffing scenarios are projected to estimate how many staff would be required to meet targets, and from them, costs are projected.

This report presents the results from Rwanda for the of the Quality Assurance Project’s three Safe Motherhood Studies: competence of skilled birth attendants, the enabling environment for skilled attendance at birth, and the causes of the delay in receiving medical attention after a woman arrives at a healthcare facility. The Rwanda study focused on an urban referral (tertiary care) hospital with an active maternity department, two mid-sized referral (secondary care) hospitals, and four health centers. [publisher’s description]

This report presents data on in-hospital care for childbirth and obstetrical emergencies in 14 hospitals. This report examines intervals between critical events—arrival at hospital, initial evaluation by a professional, diagnosis, order of treatment, and administration of treatment—and presents experts’ judgements on whether delays occurred and, if so, when and why. Data are disaggregated by country, hospital type, diagnosis, type of delay, etc. Report includes record review algorithm and 24 data tables. [publisher’s description]

A study on workplace violence within the health sector in Rwanda was conducted in 2007 in order to determine the type, impact, context, consequences and prevention strategies of workplace violence in Rwanda; to assist the Ministries of Health, Public service and Labor (MIFOTRA) as well as other stakeholders in developing a political, legal and programmatic response to improve providers’ safety, satisfaction and retention. This study also explored the characteristics of gender-based violence, including gender-based discrimination and its relation to workplace violence. [adapted from foreword]

Non-physician clinicians and nurses can take over many of the tasks in providing HIV care and treatment (including ART) in some resource-limited settings

This brief describes the Capacity Project’s work with health workforce planning using HRIS in Rwanda.