A family is widely recognized as the central and important social institution for healthy children and adults' growth and development. Improved nutritional status and health, access to clean water, basic toilets, adopting good hygiene practices, the inclusion of children with disabilities, and the wellbeing of children in general, and women of reproductive age are significant support families deserve to achieve a healthier society.
However, diseases associated with inaccessibility to Water, Sanitation, and Hygiene (WASH), malnutrition such as stunting, waterborne diseases including diarrhea, remain the main threat for children to thrive and the families’ improved well-being.
The recent Rwanda Demographic and Health Survey (DHS 2019/2020) indicates that around 33% of children are stunted. Other surveys highlighted the existing gaps in access to quality rehabilitation and assistive technology services for people with disabilities.
With the country's efforts for achieving universal coverage in WASH services for the Rwandan population, 20% of households in Rwanda lack access to an improved water source, and 28% of households don’t have access to improved sanitation, adds the DHS.
Domestically, 52% of children under age 5 have symptoms of diarrhea according to the same study; and it wouldn’t be implausible to link this situation to scarcity of clean water, sanitation, and hygiene services for families, especially in rural areas.
The United States Government (USG) through USAID, and the Government of Rwanda have officially launched two new five-year programs on March 17, 2022, namely Gikuriro Kuri Bose and Isoko y’Ubuzima, aimed respectively to improve the health, functioning, nutritional status and wellbeing of women of reproductive age and children under six years of age as well as improve Water, Sanitation, and Hygiene (WASH) services for Rwandans. The USAID’s total investment in the two projects over the next 5 years is $ 59 million.
"A healthy and prosperous Rwanda is a driving force behind all progress for the Government of Rwanda and we welcome the commitment by the United States Government to continue supporting and accompanying us in this development journey.” said the Minister of Health, Dr. NGAMIJE Daniel, while officially launching the two new projects.
The two programs are aligned with Rwanda national policies and strategies, and will work to prevent malnutrition, provide water access, sanitation, and disability care for better health outcomes of the Rwandan people.
Gikuriro Kuri Bose and Isoko y’Ubuzima will build on previous USAID funded projects that ended in 2020, to strengthen governance, coordination, early childhood development, nutrition, and disability inclusion in all sectors, cells, and villages of the ten districts where each program will be implemented.
Gikuriro Kuri Bose will contribute towards significantly reducing stunting and improving nutritional outcomes of children under six years of age with emphasis on the 1000-day window of opportunity. / Photo: Catholic Relief Services
The US Government’s commitment through Isoko y’Ubuzima and Gikuriro Kuri Bose activities is aligned with Rwanda's national policies and strategies to promote nurturing care, comprehensive health and nutrition outcomes of children, women, and families.
Toward reducing stunting and combating malnutrition
USAID in the past five years funded the Gikuriro program which aimed to improve outcomes in nutrition for women of reproductive age and children under the age of five years by blending initiatives in agriculture, health education, savings, lending, and water access. Over the past five years, the program successfully rehabilitated more than 12,000 children under five years of age from both acute and moderate malnutrition, around 192,896 under-five year children were reached with growth monitoring and promotion and other nutrition-specific services, constructed 509 community water supply infrastructures (60 boreholes, 104 water kiosks, 315 water springs, 9 community water supply extension lines) among other achievements. This contributed to the reduction of diarrheal disease prevalence from 22% to 12.7% in five years.
The Government of Rwanda has put in place several policies, strategies, systems, and structures to fight malnutrition through early childhood development, adolescent, and maternal nutrition interventions.
However, in the 10 target districts where Gikuriro Kuri Bose will be implemented, the current context indicates that stunting range between 10.7% in Kicukiro to 46.7% in Nyabihu; and as such, the program will leverage a $ 43.7 million budget to contribute to the significant reduction of these rates in the coming five years by reaching 4,592 villages in 10 districts and working with over 30,000 frontline providers to reach 820,000 women of reproductive age and 725,000 children under five and their families.
"Joining hands with our development partners, like USAID, and mobilizing our own resources, Rwanda is determined to reduce all forms of malnutrition, including decreasing stunting from 33% in 2020 to 18% by 2024”.
Gikuriro Kuri Bose will support households to deliver high-quality, integrated, and inclusive nurturing care services. These services include health, adequate nutrition, responsive caregiving, safety and security, and opportunities for early learning. This activity will benefit all children including those with disabilities through rehabilitation and Assistive Technology (AT) services.
The project will be implemented by a consortium led by the Catholic Relief to improve the health, functioning, nutritional status, and wellbeing of women of reproductive age and children under six years of age, with an emphasis on the 1,000-day window, strengthen the inclusion of children and adults with disabilities, and improve positive parenting and child development.
Other members of the consortium are Humanity and Inclusion, UMUHUZA, University of Global Health Equity, Three Stones International, and four implementing partners namely African Evangelical Enterprise (AEE), Caritas Rwanda, DUHAMIC ADRI, and Young Women Christian Association (YWCA) operating in the selected 10 districts of the program including Kayonza, Ngoma, Nyabihu, Nyanza, Kicukiro, Nyarugenge, Rwamagana, Burera, Rulindo, and Nyamasheke.
Improved WASH services
For 5 years from 2016 to 2020, USAID funded the Isuku Iwacu project to improve WASH services. Through Isuku Iwacu, more than half a million Rwandans were supported to access basic sanitation services.
Despite these positive gains, critical challenges still exist. The 2021 Ministry of Infrastructure WASH Management Information System Report indicates that 23.7% of households have no access at all to water supply services, while 24.3% on average are households with access to only basic hygiene services.
Based on the 2021 Water and Sanitation Corporation (WASAC) customers categories and the monthly consumption block, the average applicable water tariff was RWF 701.625/m3. The latest Rwanda Utilities Regulatory Authority Annual Report puts the quantity of water produced last year at 59,524,525 m3. This implies that Private Operators in the water sector expected revenue above RWF 41.7 billion.
However, this revenue was not generated as almost half of produced water, 42%, didn’t reach the consumers according to the same report, thus was not paid for. This water loss is attributed to leakages in the pipe networks, water theft, improper metering, and billing errors. In terms of revenue loss, the number talked about here is 17.6 billion.
And how much does the revenue loss translate into water systems? The Water For People organization in Rwanda estimates that building one kilometer of a water system costs on average around RWF 25 million. And the lost water revenue, if invested, could fund more than 704.9 km of new systems and increase the quantity of water generated, and ultimately the number of households accessing water supply services.
These occurrences are in part linked to low access and willingness to invest in improvements of WASH facilities, low demand for improved sanitation and willingness to pay, lack of WASH coordination between central and local governments, absence of District WASH Investment Plans, and skilled WASH staff.
Isoko y’Ubuzima with a $ 21 million budget will leverage achievements under former USAID Isuku Iwacu project to improve access to and encourage correct, consistent use of household WASH services to decrease diseases related to the lack of proper water, sanitation, and hygiene services.
The project will strengthen the capacity of the government and private sector to sustain water systems for 20 years, even 40 years, build the capacity of private operators to identify water losses and stop them and contribute to the reduction at a 25% rate the revenue loss due to non-revenue water over the next 5 years.
This will ensure that more Rwandans have improved sanitation and hygiene, and therefore greater protection against water-borne diseases, improved nutritional status, improved household economy - fewer days lost from work and less spent on hospitals - improved school attendance. It will increase and sustain equitable access to and use of safe drinking water and sanitation services. This will also reduce families’ health, economic, and social burdens due to the lack of WASH services.
Over the next 5 years, 120,000 people will gain access to basic drinking water services, 100,000 people will have increased access to basic sanitation services, while 96,000 will receive improved service quality from an existing basic or safely managed drinking water service in Rwamagana, Kayonza, Ngoma, Kirehe, Nyagatare, Ruhango, Nyanza, Nyamagabe, Ngororero, and Nyabihu
The program is being implemented from July 2021 by a consortium led by Water For People to improve WASH governance, drinking water services, and sanitation and handwashing services and products. Other members of the consortium are IRC, Vitens Evides International, CARE International, and African Evangelistic Enterprise.