1. 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

2. “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,

3. 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

4. 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 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).

5. 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, ; 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.

6. 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.

7. 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

8. 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

9. 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