Right to health in Rwanda:role of health workers andtheir trainingRight to health in Rwanda:role of health workers andtheir training
Dr Alex Hakuzimana
East African Consultation on the Right to Health
Nairobi, Sept 10-12, 2010
Population & MedicalPersonnelPopulation & MedicalPersonnel
Total population: 9,3 millions
Per Capita GNI:US $367.73(NISR 2007)
Doctors: 1/18,000 inhabitants
Nurses: 1/1690 inhabitants
62.8% of Nurses in rural areas(2008)
38.2% of Nurses in urban areas(2008)
Infant and Maternal MortalityInfant and Maternal Mortality
Infant mortality: 62/1000 (Interim DHS2007/2008)
Under 5 Mortality: 103/1000 (InterimDHS 2007/2008)
Maternal mortality: 750/ 100,000 (DHS,2005)
Assisted deliveries:52% (IDHS2007/2008)
HIV/AIDS, Malaria andTuberculosisHIV/AIDS, Malaria andTuberculosis
HIV prevalence: 3% (DHS+2005)
60% of HIV patients are diagnosed with TB
Malaria admission cases in hospitals36.8% (PNLP/MOH 2006)
Children U5 sleeping under LLIN:60%(MIS 2007)
Malaria prevalence in children U5:2.4%(MIS 2007)
Adults on ARVs 31.379 (TRAC/MoH 2006)
TB annual Risk 2% (WHO) 2007
Number of TB cases:8014(HMIS PNILT 2007)
TB patients who are HIV positive: 89%.PNILT2007
Family PlanningFamily Planning
Contraceptive prevalence: 36% (IDHS2007/2008)
Use of Modern Contraception Methods: -DHS 2000 = 4%-DHS 2005 = 10%
-IDHS 2007/2008=27%
Other indicatorsOther indicators
Under 5 years severe malnutrition: 19.4%(IDHS, 2005)
Per capita utilization of Health facilities :70%(HMIS 2007)
Life expectancy at birth 52.73 (UNDP 2007)
Rate of Enrollment in Community –BasedHealth Insurance
-2006=44%
-2007=75%
-2008=85%
Human Development and Social SectorsResource Allocation (RWF, billions)Human Development and Social SectorsResource Allocation (RWF, billions)
Source: Rwanda MINECOFIN
Key HRH concerns in RwandaKey HRH concerns in Rwanda
Making HRH planning comprehensive
Updating staffing standards
Improving urban/rural imbalance indeployment
Clarifying task allocation to cadres
Providing better quality training, appropriateto staff roles and priority health programmes
Rwanda Human Resources for Health Strategic Plan 2009-2012
Goals of HRH ManagementGoals of HRH Management
Meet the organization's strategic plan andobjectives by placing:
◦The right number of people
◦With the right skills
◦In the right place
◦At the right time
◦With the right attitude
◦Doing the right work
◦At the right cost and
◦With the right work output
AvailabilityAvailability
Available in sufficient quantity - healthworkers, medicines, water, healthpromotion and so on – hence alsounderlying determinants.
Availability is concerned with the physicalpresence of something: water, health carecentre, national health plan, healthcomplaints commissioner.
Current number of physicians byhospital type and province (Dec 2009)Current number of physicians byhospital type and province (Dec 2009)
GPs
Specialists
Total
No. ofhospitals
Western Province
43
1
44
12
Southern Province
54
3
57
10
Eastern Province
78
0
78
9
Northern Province &Kigali
114
11
125
10
District HospitalsTotal
289
15
304
41
Tertiary Hospitals
78
98
176
3
Total
367
113
480
44
Current numbers ofspecialists by tertiaryhospital (Dec 2009)Current numbers ofspecialists by tertiaryhospital (Dec 2009)
Referral hospitalspecialists
CHUK
CHUB
KFH
Total
Internal Medicine
8
9
2
19
Pediatrics
3
2
1
6
Surgery
3
5
2
10
Obstetrics-Gynecology
6
2
3
11
Anesthesia
3
4
2
9
Family medicine (new)
0
0
0
0
Total
23
22
10
55
Current number of nurses perqualification type and facility(Dec 2009)Current number of nurses perqualification type and facility(Dec 2009)
Qualification level
HealthCenters
DistrictHospitals
DistrictPharmacy
GrandTotal
Nurse A0
2
18
0
20
Nurse A1
186
271
0
457
Nurse A2
3,935
2,175
42
6,152
GrandTotal
4,123
2,464
42
6,629
Community health workersCommunity health workers
Professional staff are supported by an increasing number ofnon-formal and usually non-salaried health care providers.
At least 45000 community health workers
Provide:
◦Curative services including IMNCI
◦Mostly preventive services such as immunization, hygiene,reproductive health, nutrition, education, adherence to treatmentand counseling on HIV/AIDS, TB and malaria, environmentalhealth, Care for Orphans and other Vulnerable Children (OVC)and Home Based Care for Terminally Ill Patients and behaviorchange communication
The Ministry of Health does not have ‘control’ over them asit does not employ them.
However, MOH provide them with training and supervision.
Rwanda efforts to address HRHissues: Training and educationRwanda efforts to address HRHissues: Training and education
Health Sector Strategic Plan goals forHRH:
-Strengthening the productive capacity of educationalinstitutions for health professionals;
-Improving management capacity;
-Supporting continuous accreditation andprofessional development;
-Improving the technical capacity of communityhealth workers
Rwanda efforts to addressHRH issues: Training andeducationRwanda efforts to addressHRH issues: Training andeducation
Strategies
–Increase the appropriate number and skills mix for all health cadres
–Improve the quality of teaching and retention mechanisms forinstructors at health science institutions
–Rehabilitate infrastructure to accommodate more students
–Assist health professional bodies to run continuing professionaldevelopment programs
THANKS