1. ROLES AND RESPONSIBILITIES IN SUPERVISION AND REPORTING SYSTEM IN THE DECENTRALISATION FRAMEWORK Dr. Bonaventure NZEYIMANA Ministry of Health nzeyimana.bonaventure68@gmail.com Tel: (+250) 788585815

2. 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 280 dispensaries).

3. Building 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-recommended health worker density: 2.3 per 1,000 pop. Rwanda’s health worker density: 0.84 per 1,000 pop. New : 3 Referral 4 Provincial Health post

4. 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 population ratios and institutional size without consideration of needs. MOH, RWANDA

5. Current ratios of HRH & the distribution in country specific 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.

6. 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

7. Roles et Responsibilities in the reporting and supervision 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 admin supervision Reporting to A copy of report to Provincial Hospitals

8. Financial accessibility to health care Health Insurances are cross-cutting at all levels of the health system. There is no health service free of charge in Rwanda Currently, four regimes of health insurance: Community health insurance, Public workers health insurance, military health insurance and private health insurance. In total more than 95% of Rwandans are covered (Universal Coverage) The Government pays for indigents

9. Policy level Haring law has been reviewed Existing Health policy Health System Strategic Plan II (revision of HSSP I) Departmental policies and strategies: NCDs, Quality Care management, Health Insurance, PBF etc. A set of ministerial instructions: (on management of health 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.