Political Commitment for Family Planning in Rwanda Presented by Dr. Fidele Ngabo MCH Coordinator, Ministry of Health, Rwanda 23 March 2010 Country commitment at all levels in Rwanda has been and continues to be crucial to the effectiveness of FP promotion

“High population growth is a major challenge facing Rwanda “High population growth is a major challenge facing Rwanda. Slowing down population growth requires innovative measures, including the strengthening of reproductive health services and family planning and ensuring free access to information, education and contraceptive services.” RWANDA ECONOMIC DEVELOPMENT & POVERTY REDUCTION STRATEGY, 2008 - 2012

RAPID Model in Rwanda RAPID projections of the social and economic consequences of high fertility and rapid population growth for such sectors as labor, education, health, urbanization and agriculture shared with President, Cabinet, Parliamentarians Made clear goals of poverty reduction could not be reached with high rates of population growth Highlighted advantages (access to education, health services) possible with reduced family size Presented to full government in 2007 at Akagera retreat

RAPID Model: Key Results for Rwanda 2005 (actual) 2035 Projection Current Fertility 2035 Projection: Reduced Fertility Population 8.8 million 21.5 million 16.4 million Primary School Teachers needed (1 to 44 students) 29,000 76,100 46,400 Doctors (1 to 10,000 persons) 500 2,148 1,068 Food Crop Requirements 7.4 million metric tons 19.1 million metric tons 13.9 million metric tons Per Capita GDP (8% growth rate) 266 USD 857 USD 1,182 USD The RAPID model used projections based on population size to determine needs in education, health, agricultural and economic sectors to support the population. Reduced fertility projection is based on reductions in fertility to 2.3 TFR by 2035 Potential savings projected in the education sector by this reduction would be 146.3 billion Rwanda francs Potential savings projected in the health sector would be 384 milllion USD There would be substantial reduction in the required production of the agricultural sector, with each hectare supporting 15 people instead of more than 20 in 2035 (in 2005 it was 8 people per hectare) Even with reduced economic growth rates, the per capita GDP would be increased by 38% with the reduced fertility projection (projections were run for 4% and 6% in addition to the 8% goal).

Government of Rwanda Commitment and Actions Government believes population levels must be addressed to tackle poverty FP integrated into GoR development strategies: Economic Development and Poverty Reduction Strategy, 2008-2012; Vision 2020; contracts with districts National Family Planning Policy National Population Policy FP integrated into national PBF indicators The Rwandan Parliamentarians’ Network for Population and Development (RPRPD) established 2002 National TWG for FP Government funds portion of contraceptive procurement Mutuelles de sante increased access to information and services 1st bullet: Family planning, reducing family size, has many benefits that relate to the development of the country and the quality of life of its population 2nd Bullet: In addition to prioritizing family plannings, these documents also consider CPR as a poverty indicator, highlighting its role in poverty reduction National Population Policy: Spearheaded by Minieduc, is currently undergoing revision in committee for resubmission and approval by Parliament.

Multi-Sector and Partner Involvement Office of the President Parliament and Senate Office of the Prime Minister Ministry of Health Ministry of Finance Ministry of Local Administration Ministry of Education Ministry of Gender and Family Ministry of Youth Ministry of Agriculture Non-governmental Partners: Civil Society Partners Profem Rwanda Women’s Network Urunana Network of Rwandans living with HIV NGOs Development Partners UN Agencies Many ministries and sectors in the government support the integration of FP into the economic development strategies. It is not only the Ministry of Health who highlights FP in their activities, but FP, as part of the economic development strategy for Rwanda, is integrated into actions of many Rwandan ministries. Ministry of education supports student clubs and curriculums that integrate family planning messages and education.

District Level Commitment Trainers at district level supporting in-service training in FP FP integrated into District performance contracts, Imihigos: accountability to the President for these efforts District Mayors and Governors are trained and act as FP Champions District Hospitals and Health Centers In regards to Imihigo, while FP is a part of the objectives set for the districts, these are designed to make the leadership accountable for not addressing unmet need for contraceptives in their areas, not to coerce or push women to use FP

Community Level Commitment Decentralization – focus on decisions coming from the community and community-level accountability Performance contracts (imihigo) from district to sector to cell to umudugudu to household levels FP sensitization and education provided to the community through Umuganda (monthly community service days) FP Champions in the community Health Committees at the Sector level unite community members and health facilities Community Health Workers Rwanda has put a strong focus on decentralization, resulting in empowerment and accountability down to the community level for progress towards development objectives and implementation of policy. This can be seen through the empowerment of Umudugudu heads to take leadership in FP as well as the integration of FP in performance contracts between the Umudugudu Head and the Mayor and even between Umudugudu and individual households, which are used as an opportunity to highlight the importance of FP as a mechanism to improve quality of life and develop the country. Imihigos at household level support plannning for family size, etc. There are no punishments associated with “non performance”. Much education occurs at the community level, and Rwanda is able to utilize strong community ties to provide messaging on FP, such as the monthly community service days, Umuganda, where people join together at the cell or Umudugudu level to work on community projects. Strong leadership in the community also impacts FP initiatives positively as community members interact with facilities through community-provider partners, fostering partnership between the health structure and community as well as allowing the community to play a role. Community FP champions include umudugudu mayors, vice mayors, and medical professionals living in the community

Political Commitment… The First Step Commitment is the essential starting point, but it needs to be supported by: Advocacy Supportive policy Resources Evidence-based programming Continuing supervision Training Strong monitoring and evaluation