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Rwanda

Demonstrating the Potential of Mutuelles to Improve Child Health

Jointly with the Point-of-Service Water Disinfection and Zinc Treatment (POUZN) project, Health Systems 20/20 launched a pilot program February 13, 2008 in Nyagatare District to promote and distribute the Sûr’Eau water product in the Eastern Province of Rwanda, capitalizing on well established community-based health insurance (CBHI or mutuelle de santé) organization channels and membership in the area. The CBHI 2007 enrollment rate in the District of Nyagatare is 81%.

CBHI is believed to be a potentially powerful, but untested, distribution and communications channel to promote and deliver preventative health products like Sûr’Eau, a point-of-use (POU) water disinfection product, to vulnerable populations.

In Rukomo, one of 19 sectors in Nyagatare District and where the official project launch took place, frequent outbreaks of cholera have historically been linked to a lack of potable water. The last outbreak was reported exactly one year ago, as the POUZN project (in collaboration with the Ministry of Health and Population Services International) was initiating the pilot phase of distribution and promotion of Sûr’Eau through CBHI channels.

Unsafe or inadequate supplies of water, and poor hygiene and sanitation are major contributors to diarrheal disease in Rwanda. Only 40% of rural populations and 60% of urban populations have access to safe water sources, and a mere 2.5% of the population has access to piped water in their homes; 27% obtain drinking water from unsafe sources.

The POUZN pilot program aims to:


• Reduce morbidity and mortality due to diarrheal disease in children under five.
• Increase the use of Sûr’Eau point-of-use safe water system (SWS), especially amongst rural and poor populations enrolled in mutuelles. This was achieved through provision of information on the importance of safe water and good hygiene practices for the prevention of diarrhea and the inclusion of Sûr’Eau at a discounted price in the mutuelle de santé system in three pilot districts.
• Contribute to the financial sustainability of mutuelle organizations by increasing membership (through Sûr’Eau promotional sales) and/or reducing mutuelle spending on diarrhea services.

The Sûr’Eau product, available in commercial markets and health centers for 300 RWF (US$0.54), will be offered to CBHI members at the discounted price of 200 RWF. At the pilot launch ceremony, each household that had reenrolled in their mutuelle received a free promotional bottle of Sûr’Eau. Newly trained CBHI committee members in the Nyagatare District are busy promoting and selling Sûr’Eau to CBHI members. This project also includes Rubavu District in the Western province of Rwanda.

This demonstration will generate measurable results to be shared with POU water product suppliers, policymakers, and MHO leaders throughout Africa who might consider replicating the approach.

National Health Accounts

In 2009, Health Systems 20/20 received field support from USAID/Rwanda to work with the Government of Rwanda to implement National Health Accounts in Rwanda. Rwanda has implemented 5 rounds of NHA to date (1998, 2000, 2002, 2003, and 2006) and was the first country to pioneer subaccounts for HIV/AIDS, Malaria and Reproductive Health (RH). All past estimations were joint ventures involving numerous development partners, including the Government of Rwanda, USAID, USAID-funded Health Systems 20/20, the World Health Organization, and the National University of Rwanda School of Public Health. The Rwandan Ministry of Health has effectively used the NHA findings to shape policy priorities, to negotiate with the Ministry of Finance and other donors for funding, and to guide their programming.

The current round will include both general NHA estimation as well as subaccounts for HIV/AIDS, Malaria, RH, and Child Health for 2009. The Ministry of Health has made institutionalizing the NHA within the Government of Rwanda and affiliated institutions a key priority for this round. To achieve this end, Health Systems 20/20 will work with all partners to

• Build the capacity of government officials and the School of Public Health team to undertake the NHA,
• Harmonize NHA estimation with other resource tracking exercises and systems like the National AIDS Spending Assessment and the Public Expenditure Review, and,
• Expand the usage of NHA data for policy analysis and program planning.

In 2009, Health Systems 20/20 is conducting a training workshop on NHA classification and methodology for representatives from the Ministry of Health, Ministry of Finance, CNLS, WHO, UNFPA, the Clinton Foundation, and the School of Public Health. The core NHA team will be constituted in early 2010, after which data collection will commence.