Achieving Universal Health Coverage is feasible for countries at every income level. It is also the right thing to do. Strong political leadership will certainly be necessary at every stage. All around Africa, and beyond, whenever countries have put universal, community-based primary health systems in place, the results have been good-President Paul Kagame.
For someone to reach 36 years in 1995 would be a miracle, in fact you would be whom God favoured and an elder worth for pension, 24 years later, it is no longer a miracle. But for Gaspard Iyakaremye 44, losing his child to Malaria ten years ago due to lack of treatment at the right time is a fate he reckons every day.
And Marie-Louise Mujyawamariya, 55 recalls how it was a blessing to deliver at a health facility, spending long hours to reach, even giving birth with no complication would be a celebration, rarely did most women survive.
Like a cloud swept by a heavy wind, all these scenarios have seized to happen, thanks to the government’s efforts to increase Universal health coverage-UHC and facilitating access to adequate health services.
The government’s plan as ministry of health says is to ensure that people access health services in a 30 minutes’ walk, rather than the current 2-3 hours mainly in hard to reach areas. This implies that government will ensure there is a health post equipped to almost to health centre at every cell.
This approach to bring health services closer to people was emphasized by President Kagame in his 7 year bid after re-election in 2017, which cements the efforts to ensure no citizen uses many hours to reach a health facility by 2024.
“It is great thing and we believe as ministry of health that we don’t need to wait up to 2024,” said Dr Diane Gashumba, Minister of health during the opening of second generation health posts in Bugesera district last month.
The President wish is to have a model health centre in each cell across the country, educating people on improved health- prevention of diseases; malaria, prevention of malnutrition, hygiene and sanitation promotion, antenatal care as well as primary health care.
The Minister says that the country cannot develop when people are still taking long distances to access health services, “it is tiresome, especially to pregnant women,” she adds calling on leadership at the province to ensure that district add increasing health posts in their performance contracts.
According to the country’s current health system structure, there are services such as trsting for HIV,Hepatitis and maternity services among others that are not provided at the health post(at cell level), which means people would still walk long distances to the health centre.
To address this challenge, the government together with partners embarked on building second generation health posts, which will be able to give some of the services that the health centre provides.
The Second Generation Health Posts referred to as ‘Icyuzuzo’(adding to what is exists in health coverage), a new model for decentralizing health care intended to improve patient outcomes and quality of life, while reducing the workload at higher levels of care, such as health centres and district hospitals.
“Am aware that other countries in Africa are doing well in terms of access to health services, but Rwanda’s approach is unique because it provides a long term approach to health services,” said Damian Halloran is Abbott’s vice president of infectious disease in emerging markets and rapid diagnostics.
So far, a pilot project for 8 second Generation heath posts has been completed in Bugesera district and will provide services such that have been at health centers such as testing for HIV, Hepatitis, kits for emergency deliveries as well as maternity wards.
The project expected to cover the whole country is supported by Society for Family Health-SFH and Abbot. So far, SFH has already built 171 health posts and Gihana Wandera its country Director says they will continue supporting the country in building these health posts.
SFH Rwanda’s major interventions are centered on promotion of behavior change practices through improved communication techniques and social marketing of health products and services related to HIV and AIDS, Malaria control and prevention, Family Planning, Water, Sanitation and Hygiene (WASH) Maternal and Child Health (MCH) and Nutrition.
Moreover, the government together with USAID initiated a five year Rwanda Health Systems Strengthening (RHSS) Project which has, as Leslie Marbury, USAID Mission Director says been integral in laying the foundations for a successful and sustainable health system in Rwanda.
The project focused on effective leadership and governance, sustainable health financing and private sector engagement, improved quality of care, evidence based decision making, and a mobilized, skilled workforce.
Accordingly, Rwanda ranks 11th out of 51 countries in Africa that are achieving the UNs’ Sustainable Development Goals aimed at improving health, as well as fighting poverty, protecting the environment and reducing inequality. Its life expectancy increased significantly from 36 years in 1995 to 67 years by 2017 and expanded access to healthcare.
With these initiatives, Rwanda has been able to record a positive outlook in the health sector with under-five mortality rate declining to 42 per 1,000 thereby achieving the Millennium Development Goal (MDG) 4 on child health, whilst maternal mortality stands at 29 deaths per 10,000 live births