Right to health in Rwanda: role of health workers and their training Dr Alex Hakuzimana East African Consultation on the Right to Health Nairobi, Sept 10-12, 2010

Population & Medical Personnel 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 Mortality Infant mortality: 62/1000 (Interim DHS 2007/2008) Under 5 Mortality: 103/1000 (Interim DHS 2007/2008) Maternal mortality: 750/ 100,000 (DHS, 2005) Assisted deliveries:52% (IDHS2007/2008)

HIV/AIDS, Malaria and Tuberculosis HIV prevalence: 3% (DHS+2005) 60% of HIV patients are diagnosed with TB Malaria admission cases in hospitals 36.8% (PNLP/MOH 2006) Children U5 sleeping under LLIN:60%(MIS 2007) Malaria prevalence in children U5:2.4%(MIS 2007) Adults on ARVs (TRAC/MoH 2006) TB annual Risk 2% (WHO) 2007 Number of TB cases:8014(HMIS PNILT 2007) TB patients who are HIV positive: 89%.PNILT 2007

Family Planning Contraceptive prevalence: 36% (IDHS 2007/2008) Use of Modern Contraception Methods: -DHS 2000 = 4% -DHS 2005 = 10% -IDHS 2007/2008=27%

Other indicators Under 5 years severe malnutrition: 19.4% (IDHS, 2005) Per capita utilization of Health facilities : 70%(HMIS 2007) Life expectancy at birth (UNDP 2007) Rate of Enrollment in Community –Based Health Insurance -2006=44% -2007=75% -2008=85%

Human Development and Social Sectors Resource Allocation (RWF, billions) Source: Rwanda MINECOFIN

Key HRH concerns in Rwanda Making HRH planning comprehensive Updating staffing standards Improving urban/rural imbalance in deployment Clarifying task allocation to cadres Providing better quality training, appropriate to staff roles and priority health programmes Rwanda Human Resources for Health Strategic Plan

Goals of HRH Management Meet the organization's strategic plan and objectives 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

Availability Available in sufficient quantity - health workers, medicines, water, health promotion and so on – hence also underlying determinants. Availability is concerned with the physical presence of something: water, health care centre, national health plan, health complaints commissioner.

Current number of physicians by hospital type and province (Dec 2009) GPs Speciali sts Total No. of hospitals Western Province Southern Province Eastern Province780 9 Northern Province & Kigali District Hospitals Total Tertiary Hospitals Total

Current numbers of specialists by tertiary hospital (Dec 2009) Referral hospital specialists CHUKCHUBKFHTotal Internal Medicine89219 Pediatrics3216 Surgery35210 Obstetrics-Gynecology62311 Anesthesia3429 Family medicine (new)0000 Total

Current number of nurses per qualification type and facility (Dec 2009) Qualificatio n level Health Centers District Hospitals District Pharmacy Grand Total Nurse A Nurse A Nurse A23,9352,175426,152 Grand Total4,1232,464426,629

Community health workers Professional staff are supported by an increasing number of non-formal and usually non-salaried health care providers. At least community health workers Provide: ◦ Curative services including IMNCI ◦ Mostly preventive services such as immunization, hygiene, reproductive health, nutrition, education, adherence to treatment and counseling on HIV/AIDS, TB and malaria, environmental health, Care for Orphans and other Vulnerable Children (OVC) and Home Based Care for Terminally Ill Patients and behavior change communication The Ministry of Health does not have ‘control’ over them as it does not employ them. However, MOH provide them with training and supervision.

Rwanda efforts to address HRH issues: Training and education Health Sector Strategic Plan goals for HRH: - Strengthening the productive capacity of educational institutions for health professionals; - Improving management capacity; - Supporting continuous accreditation and professional development; - Improving the technical capacity of community health workers

Rwanda efforts to address HRH issues: Training and education Strategies –Increase the appropriate number and skills mix for all health cadres –Improve the quality of teaching and retention mechanisms for instructors at health science institutions –Rehabilitate infrastructure to accommodate more students –Assist health professional bodies to run continuing professional development programs

THANKS