ROLES AND RESPONSIBILITIES INSUPERVISION AND REPORTINGSYSTEM IN THE DECENTRALISATIONFRAMEWORK
Existing Health Facilities
•National Referral Hospitals : 4
•Provincial Hospitals: 5
•District Hospitals: 36
•Health Centers: 458
•Health posts: 192
•Community Health Workers: + 45000
•Private sector: (1 Hospital, 40 clinics and 280dispensaries).
Building a Health SystemBuilding a Health System
3
Referral
Hospital
(5)
District Hospital
(34 to 42)
Health Center
(234 to 469)
Community Level
(0 to 14,837)
~80% of burden of disease addressed here
Physician Specialist
(150)
Physician Generalist
(475)
Nurse Generalist
(8,273)
Community Health
Workers
(45,011)
Complexity of care
WHO-recommendedhealth worker density:2.3 per 1,000 pop.
Rwanda’s health workerdensity:
0.84 per 1,000 pop.
New : 3 Referral
4 Provincial
Health post
Some demographic data
•Population: 10.537,222
–Population density: 416/km2
–Increase in population (2002-2012)-29.6%
–Average annual growth 2.6%
–Female: 51.8%
–Male: 48.2%
–Current staffing is based on populationratios and institutional size withoutconsideration of needs.
MOH, RWANDA
Current ratios of HRH & the distribution in countryspecific to health facilities:
Proportion of professionals currently;
Doctors ratio 1: 16,000 population
Nurses ratio 1: 1,346
Midwives ratio: 1: 92,149
•Distribution of health professionals in the Country
28.3% of 661 specialized physicians in and around the capital city
80% of G.Ps are deployed in rural area indicating unbalanced deployment.
Integrated roles and responsibilities in supervision
Central Level
District
Sector
Community
MOH Dpts + Partners at central level
Social Dvpt and territorial
administration Unit
Social Affairs + CS
CHWs + Local Leaders
Roles et Responsibilities in the reporting andsupervision
MINALOC
Mayor & Executive
Secret. of District
Exec. Secret. of
Sector
Central level Dpts +
Partners at central level
HC
H Post
CHW + Local Leaders
Chief of Village
Social Dvpt Unit:
Health Desk
DH
Exec. Secret. of
Cell
MINISTER
MOH
and PS
Admin supervision
Technical supervision
Technical and adminsupervision
Reporting to
A copy of report to
Provincial Hospitals
Financial accessibility to health care
•Health Insurances are cross-cutting at all levels ofthe health system.
•There is no health service free of charge inRwanda
•Currently, four regimes of health insurance:Community health insurance, Public workershealth insurance, military health insurance andprivate health insurance.
•In total more than 95% of Rwandans are covered(Universal Coverage)
•The Government pays for indigents
Policy level
•Haring law has been reviewed
•Existing Health policy
•Health System Strategic Plan II (revision of HSSP I)
•Departmental policies and strategies: NCDs, QualityCare management, Health Insurance, PBF etc.
•A set of ministerial instructions: (on management ofhealth facilities in decentralized framework, Drugs use,Customer care,
•Law on full autonomy of health facilities in Parliament(from semi-autonomy regime).
In the line with EDPRS II and Vision 2020.
