RWANDA: Taking care of the business of public health
KIGALI, 1 July 2008 (PlusNews) - Ensuring that health systems reach the people who need them goes beyond equipping hospitals: investment in the efficient management of finances, drug distribution and data management is vital to the success of the public health sector.
"Donors have focused on providing drugs and equipment, but a lot of small managerial interventions have the ability to transform health providers into more efficient operators, which increases their ability to serve their communities," said Josh Ruxin, director of the Access Project, a health programme focused on improving health systems management developed by Columbia University in the United States.
The project, which is active in several African countries, started its work in Rwanda in 2003, providing support to the government in implementing programmes financed by the Global Fund to fight AIDS, Tuberculosis and Malaria.
Blaise Karibushi, the project's country director, explained that in 2006 the Rwandan government started a policy of decentralisation, which shifted decision-making from central to local government, but the staff at district health centres lacked management skills and were therefore unable to deliver quality care.
The project responded by training staff in financial, health data and drug management, human resources, planning and reporting, infrastructure, and managing the "Mutuelle" system - Rwanda's national health insurance fund.
"What we do is essentially apply business management principles to public health," Ruxin said. The staff at several health centres have been taught how to use a computer-based accounting system, which has improved their financial record-keeping, and how to avoid drug stocks running out or expiring by more accurately predicting their drug needs.
Theophile Ndabereye, senior nurse and director of the Mayange health centre in the eastern district of Bugesera, said his centre, which serves about 25,000 people in Rwanda's poorest area, had had no real control of drugs before staff gained the skills to predict their needs.
Good service
The centre is a spotless brick building with a packed waiting room. Ndabereye proudly shows off the highly organised wards and drug store, while a woman in labour paces the corridors, helped along by a relative and a nurse.
"The difference at our health centre since the Access Project came is huge," he told IRIN/PlusNews. "Before then we only handled 200 to 300 people per month, but now we comfortably handle about 3,000; people know they can get good service and don't have to go to the hospital unless the condition is very serious."
With assistance from the Access Project, the centre has introduced voluntary counselling and HIV testing, and increased the number of pregnant women tested for HIV from about 80 to 140 a month. The prevention of mother-to-child transmission of HIV (PMTCT) programme has grown, and the number of women who now deliver at the centre has also grown.
"Before, only five or six women a month delivered here; most opted to have their children at home because the service was poor ... today, we get about 60 or 70 women delivering their babies here," Ndabereye said.
Karibushi noted that there were still a number of problems: some health centres in Rwanda still lacked electricity and running water, which affected hygiene and the refrigeration of drugs, while "training is a constant process because many people leave their jobs for better ones when they have finished their training."
The Access Project started in three districts but has recently expanded to three more, bringing the total number of health centres benefiting to over 70.
The hope is that the improved health centres will work as models the government can emulate in upgrading health centres across the newly decentralised country.
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