For a healthy, wealthy, productive population

From the medical insurance scheme, strengthening of health centers, building capacities of medical professionals, empowering community health workers, among other initiatives, the Ministry of health has continued to characterize the epitome of liberation of the people of Rwanda.

From the medical insurance scheme, strengthening of health centers, building capacities of medical professionals, empowering community health workers, among other initiatives, the Ministry of health has continued to characterize the epitome of liberation of the people of Rwanda. After 22 years of building the foundations of a healthy population, it’s worth sharing how the ministry has come thus far.

As Rwanda health sector invents and implements more astounding strategies to enhance health care and service delivery, the “Treat All HIV+” is one of the newest implementations. July, 01, 2016, marked a historical shift in HIV management and a change in Rwanda Health Sector’s HIV guidelines. Immediate antiretroviral therapy (ART) for everyone found to be HIV-positive.

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A CT scan used at referral hospitals countrywide.

When the, the World Health Organization (WHO) recommended the “Treat All” approach in 2015, Rwanda implemented, basing on the evidence that starting eligible HIV-infected patients on ART alleviates their suffering and reduces the devastating impact of the pandemic as well as cutting HIV transmission. 

Concentrating on different HIV interventions comes along with the health sector’s diverse actions to propel quality health care both on private and public avenues. Successful programs range from fighting Non-communicable diseases (NCDS), Maternal and Child health services, to accessibility of drugs, among others.

HEALTH PROGRAMS

Maternal and Child Health Programs

In order to support and maintain the existing workforce and improve neonatal care, 80 health care providers from district hospitals have been trained in emergency new-born care through the Helping Babies Breathe Initiative, and they were provided with new-born care training equipment that will serve as training aids for training others in their respective hospitals and health centres.

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A doctor uses ICT to read a patient's x-ray results.

In acknowledging the need for a systematic approach to audit and review of perinatal deaths in Rwanda, health care providers have been trained in conducting stillbirth audits and these are currently being conducted in all district hospitals, and they are being reported in HMIS.

In addition to existing child and new born death audits which started in 2012,
Maternal Death Surveillance and Response (MDSR) revised tools have been developed, and health care providers have been trained. MDSR are currently conducted in all district hospitals as part of the integrated plan to eliminate preventable maternal deaths.

As an opportunity to ensure health service provisions to particularly vulnerable, hard to reach communities and children, Mother and Child health weeks have been conducted twice. Nearly 5 million were reached by the campaign and benefited from valuable interventions such as immunization to children 0 to 15 months of age, de-worming of children 1 to 15 years of age, distribution of vitamin A supplements for all children under five and breastfeeding mothers and Human Papilloma virus (Cervical cancer vaccination) for eligible girls.

The campaigns also focused on family planning sensitization to males and females in the reproductive age as well as social mobilization and advocacy to promote hand washing, malaria prevention and correct use of mosquito nets, and the importance of antenatal care among others and Community Health issuance.

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A joyful nurse ensures the new born babies are well taken care of.

To reinforce the capacity of health care providers in permanent contraceptive methods, and to bring services closer to the population, two providers from each district hospital have been trained in tubal ligation and vasectomy.

In the fight against gender based violence, 61 service providers have been trained on team work, collecting GBV evidence and confidentiality in keeping records of GBV victims.

To improve the nutritional status of mothers and children: a 1000 days campaign has been sustained and supported throughout the country to strengthen the efforts to elimination of malnutrition among children under the age of two years, pregnant and lactating mothers. The national nutrition screening campaigns have been conducted and 81.2 % of the targeted under-five have been reached.

DISEASE PREVENTION AND CONTROL  PROGRAMS

In the area of disease prevention and control, achievements for the fiscal year 2014-2015 include:

HIV and Other Blood Born Infections

The Country is implementing HIV preventive programs focusing on key drivers of the HIV epidemic.  By end June 2015, 553 sites offer VCT Services while 521 and 517 are respectively offering ART and PMTCT services to the population.

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Apart from vaccination, health providers are keen on under 2 children's weight and height to identify stunting and malnutrition.

As a result, over 3 million tests were performed with only 0.8% testing positive. Since July 2014, Rwanda started to implement the new WHO Guideline for ART, and the total number of patients on ART increased from 133,574 (June 2014) to 153,062 (June 2015). Mentorship and task shifting programs were very key strategies to improve quality of service delivery.

Rwanda continued to implement strategies towards the elimination of mother-to-child HIV transmission (EMTCT) with a target to keep the new paediatric HIV infections below 2%. By June 2014, The Transmission of Mother to child transmission was estimated at 1.83%.

Surveys among key population (MSM and FSW), Population surveys (Rwanda Aids Indicator and HIV Incidence Survey) and Surveillance survey among pregnant women were conducted to allow evidence based interventions.

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Bushenge Provincial Hospital, famous for innovations to ensure in-patients are taken care of.

New guidelines for Hepatitis and STIs were developed and approved.

Tuberculosis and Other Respiratory Diseases Division

Screening and Notification of Tuberculosis

48, 4% of all patients with symptoms suggestive of TB (presumptive TB cases) were brought by Community Health Workers (CHWs) for screening. This move has greatly contributed to easy and rapid access to TB health facilities;

5,833 all-forms TB cases were reported; including 4233 cases that were bacteriologically confirmed (New and relapse).  This confirms previously observed decreasing trend in TB notification.

Efforts were made to find more TB cases in high risk group, among others prisons where 303 TB cases of all forms were notified using active finding cases by mobile chest x-ray.

69 cases with Multi drug resistance TB were put on the 2ndline TB treatment.

Tuberculosis/HIV co-infection

99,4% of all patients with symptoms suggestive of TB (presumptive TB cases) and 99% of all-forms TB reportedcases, had their HIV status known;

98% of HIV+ TB patients were on Cotrimoxazole prophylaxis and 90% on antiretroviral therapy (ARTs) at the end of TB treatment;

Treatment of Tuberculosis

The Treatment success rate for bacteriologically confirmed new and relapse TB case was 89.8% of the cohort of TB cases registered in 2013-2014.

48 % of those TB patients were followed (given TB drugs) by Community health workers (CHWs) near their homes. 95% of TB patients given TB medicines by CHWs were successfully treated;

Over 87 % of MDR-TB cases of the 2012 cohort were successfully treated;

Tuberculosis infection prevention and control

80% of health facilities involved in TB control activities were implementing the full package of minimum TB infection control.

TB Surveillance system among health care providers was initiated in all Health facilities.

Tuberculosis surveillance system

Electronic TB and Leprosy register (e-TB) was initiated and is being implemented in all health facilities. 

Malaria and Other parasitic diseases

Vector control

Indoor Residual Spaying (IRS) campaigns

During this financial year 2014 to 2015 and from July 2014 to June 2015, two IRS campaigns were organized and coordinated in the three targeted districts of Bugesera, Gisagara and Nyagatare. At each IRS campaign and in collaboration with Abt Associates, an operational plan was developed and discussed with representatives of targeted districts.

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Kandagira ukarabe, local handwashing cans have been emphasised by community hygiene clubs in order to avoid diseases related to poor hygiene.

The 12th round of IRS campaign was performed from 08 September to 04 October 2014 in 28 sectors of Gisagara (13 out of 13 sectors), Nyagatare (8 out of 14 sectors) and Bugesera (7 out of 15 sectors) districts. The insecticide used belongs to the class of Carbamates “Bendiocarb 80 WP” and 144,925 sachets have been used at a ratio of one sachet per 1.2 houses.

A total of 173,086 structures were sprayed out of 174,411 structures found by spray operators in the targeted districts, accounting for a coverage rate of 99.2%. In total, 705,048 residents were protected, including 103,408 (14.7%) children under five years old and 11,119 (1.6%) pregnant women. Moreover, 195 dormitories in 43 schools and 4 prisons were sprayed in the target districts protecting 8,443 residents. A total of 370 sachets of insecticide were used.

The thirteen IRS round was carried out at different dates (09 February to 04 March for Nyagatare and Gisagara, and from 30 March to 21 April 2015 in Bugesera) and participation of different partners. The total structures sprayed are 249,312 out of 251,398 targeted structures in 41 sectors of the above three districts. The average coverage achieved was 99,2% and with a usage of 206,815 sachets of Bendiocarb 80 WP. The total population protected was estimated to 1,040,118 people out of 17,753 and 156,142 were respectively pregnant women and children under five years.

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LLINs serve a great purpose in preventing mosquito bites hence protecting mothers, children and the entire population.

In Gisagara district, 76,725 structures from the 13 sectors have been sprayed with fully support of PMI and a coverage of 99, 2% (n=77342) was achieved. In total 66376 of insecticides were used with one sachet for 1, 16 structures. The population protected was estimated to 316396 people.

In Nyagatare, 94,072 structures have been sprayed with a coverage of 99, 3%. The insecticides used covered 75,383 sachets with one sachet for 1.25 structures. In Nyagatare, it was sprayed 13 out of 14 sectors and the he population protected was estimated to 403,823 people. The mixed funds from Global Fund and Government of Rwanda supported IRS for 43,647 structures in 6 sectors with a coverage on 99,4%. The PMI supported 50,425 structures in 7 sectors with a coverage of 99,2%.

In Bugesera district, 78,525 structures have been sprayed with fully support of Global Fund and Government and with a coverage of 99% (n=79281) was achieved. In total 65056 of insecticides were used with one sachet for 1, 21 structures and population protected is estimated to 316396 people out of 5408 and 49797 were respectively pregnant women and children under five years.

The support of Global funds is evaluated to 339,088.36 US$ used to procure 34,814 sachets of Bendiocarb 80 WP and a transfer of 315,807,718 RFW and 180,307,608 Rfw respectively in Bugesera and Nyagatare district hospitals to cover IRS operation. The Government of Rwanda provided a support estimated to 214,280 US$ to procure 22080 sachets of insecticides.

Different activities were achieved in term of vectors surveillance which include vector bionomics, vector resistance to insecticide and bioassays for quality control and status of residual efficacy of IRS campaigns and LLINs.

Prevention

To ensure malaria prevention, Rwanda committed to maintain the LLINs universal coverage using a WHO and RBM strategy which is the distribution to pregnant women and children under one year through the ANC and EPI services respectively at health centre level.

On a monthly basis LLINs are distributed and reported through the HMIS and achievements are illustrated below:

109,414 LLINs distributed to pregnant women from July 2014 to May 2015

348,153 LLINs distributed to children under one year from July 2014 to June 2015

Due to the fact that Rwanda had distributed substandard nets to children under five years in January 2013, the program replaced them in 13 DH located in high malaria burden district and took this opportunity to distribute LLINs households which missed the distribution which occurred from July 2013 to February 2014. This also was a recommendation from District Mayors during a meeting held in the eastern province with them in order to discuss malaria increase and which strategies local leaders need to put in place in order to address that. A total of 1,314,810 LLINs were distributed during the mass campaign from 30th March to 4th April 2015. 

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Such mobile condom kiosks were introduced to ensure the Rwandan population gets access to condoms in a bit to prevent HIV transmission.

Preliminary results of the DHS 2015 published in May 2015 shows that 81% of households own at least one ITN; with only 43% of households having enough ITNs to cover each household member (assuming one ITN is used by two people).

More than two-thirds of children under 5 and 73% of pregnant women slept under an ITN the night before the survey—the groups most at risk from malaria.

Owning a net does not automatically mean families use it. 80% of children under 5 and 88% of pregnant women in households with an ITN slept under an ITN the night before the survey.

Non communicable diseases

As in many developing countries, non-communicable diseases (NCDs) are an emerging problem in Rwanda. NCDs include cardiovascular diseases, diabetes, chronic respiratory diseases, cancer conditions, injuries, disabilities, oral health, ear, nose and throat, and eye diseases. The majority of NCDs are preventable through a broad range of simple, cost-effective public health interventions that target the various NCD risk factors.

During the reporting period, NCD strategic plan was approved to guide interventions. RBC aimed to facilitate NCDs management being integrated in health services at different levels of health care for the year 2014-2015. Currently 97% of public health facilities have at least 2 HCPs trained on prevention and management of NCDs according to national guidelines. One thousand forty seven (1047) health care providers were trained on prevention and management of NCDs including screening, education, and follow up of some NCDs namely Hypertension, Diabetes, Heart failure, chronic kidney and chronic respiratory diseases.

On the side of NCD surveillance system, it was integrated into the health management information system (HMIS), 47 NCD-specific indicators or data elements were defined and integrated in HMIS monthly reporting template.

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The weight should much the height, another discovery that NCDs services give.

The Ministry of Health has conducted a National NCDs Risk Factors Survey as per the World Health Organization (WHO) STEPs standards. This survey determined the NCDs prevalence and their risk factors in Rwanda. The findings guided the development of the National NCDs policy and strategic plan.

Mental Health Services

A meeting was organised with Mental health focal points to prepare international day against drug abuse campaign held 26 June. The theme of campaign was “winning battle against drug abuse require every body’s effort”

Celebration of mental health day and international day against drug abuse

MH division coordinated psychological interventions during commemoration of Genocide. for this purpose  trainings for  interventions teams were performed :

200 AERG members,

250 members of Rwanda red cross members,

100 staff of Rwanda National Police, ,

56 staff of SAMU

50 nurses from district hospitals

Internship of 5 GPs and 5 Nurses conducted at Ndera and CHUK

Psychotropic drug were purchased and distributed to District Hospitals.

A manual for management of common mental health disorders was developed and validated.

250 Nurses were trained on management of basic mental health disorders and follow up of chronic mental health conditions.

86 GPs from district hospitals were trained on diagnosis of mental health disorders and principal of pharmaceutical treatment of mental health disorder in primary health care.

In partnership with Rwanda National Police, Isange Rehabilitation Center was established in Huye District for treatment of drug and alcohol addiction related disorders. It is now open for public.

Epidemic Surveillance and Response

For the period 2014-2015, efforts in epidemics surveillance and response were focused on the implementation of “One Health concept”. This is defined as the collaborative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals and our environment. One Health takes a holistic approach to address human, animal, and ecosystem health. It emphasizes multi-sector, trans-disciplinary action across professions to ensure well-being within human, animal, and ecosystem interfaces. Key achievements registered under this move include:

A 5-year (2014-18) One Health strategic plan has been developed in collaboration between the ministry of agriculture, the Rwanda Development Board, Rwanda Agriculture Board, etc.

Development of Rwanda Epidemic Preparedness and Response plan (EPR), this document provide a clear roadmap on role and responsibility for responding to potential outbreaks and others public health threats.

Migration and integration of the national diseases surveillance system into HMIS

An innovative Electronic Integrated Diseases Surveillance and Response (e-IDSR) system have been rolled out in 71.2 % of licensed private health facilities in the country.

Introduction of new technology (multiplex PCR) for detection of others respiratory pathogens related to influenza virus species

Establishment of functional Ebola prevention and control mechanism countrywide

On weekly basis, an epidemiological bulletin was released for public awareness and update on ongoing epidemic prone diseases trend and response

Renovation  Ebola treatment center  at Rwanda Military Hospital

Avail and maintain the outbreak stockpile materials  Cholera camp composed of 3 tents of 40/10sqm and 3 tents of 9/9sqm Availability of emergency drugs and consumables

142 cholera beds

4000 PPEs available at central level

Medical equipment for field investigations

Availability of contact frame work for emergency supplies for potential outbreaks response

Vaccine Preventable Diseases Program

Preliminary data of the DHS 2015 shows that the proportion of fully immunized children increased to 75 percent in 2005, to 80 percent in 2007-2008, 90 percent in 2010 and stands at 93 per cent in 2015.

Health Products Management

Access to essential medicines and other health technologies is a priority for citizens. It needs to be available at all times in adequate amounts, in appropriate dosage and quality and at an affordable price for individuals and communities.

To ensure that people have access to essential medicines and to preserve the quality of the medicines, a functioning medicine supply chain is required. This includes procurement of medicines and other health commodities, appropriate warehousing, efficient logistics and transportation, rational drug use and monitoring and evaluation of the supply chain processes.

Strategies to improve the availability of the essential medicines and other health commodities have been implemented including the monitoring of the availability of vital commodities at health facilities, capacity building at district pharmacies and other health facilities, monitoring of stock levels for public health program funded products (HIV, TB, Malaria, MCCH), Implementation of the e-LMIS, Development of the supply chain operational manual for the district pharmacies. A considerable number of activities were conducted towards the support of the Legislation andregulatory framework of the pharmaceutical sector in Rwanda and the harmonization of the pharmaceutical services within the East African Community.

Availability of vital commodities:  stock out status reports are sent to the Ministry of health every week. The reporting system concerns the 30 district pharmacies, and the 42 district hospitals. The reports monitor the availability of the 250 health commodities, identified as vital by the Ministry of Health, and that are supposed to be available at all times and in adequate quantities at the level of the District pharmacy and the District Hospital.

The indicator used to monitor the implementation of this Strategy is the number of reporting health facilities that have less than 5% stock out of the vital commodities. In the course of the Year 2014-2015, health facilities reported a stock out rate less than 5% as per the target whereby the average stock out rate was 2% for the district hospital, and 1% for the district pharmacies.

Capacity building in the Supply Chain Management for Health Commodities: trainings organized by the Ministry of Health were conducted for district pharmacies and health facilities staff, with a special program referred to as the Monitoring, Training and Planning Program for the District Pharmacies that is conducted on a quarterly basis. Similar trainings are done by District Pharmacies for health facilities during the supervision on Supply Chain management.

Availability of public health program funded products: the monitoring of the stock levels for public health program funded products is conducted under the supervision of the Ministry of Health, which brings together all the stakeholders that play an important role in the availability of these products. The coordination mechanism aims to pool resources from different funding partners in order to create a common basket fund for the procurement of health commodities including but not limited to ARVs, laboratory reagents, test kits, laboratory consumables, laboratory equipments, Anti-malarials, anti-tuberculosis drugs and the products for the Maternal Child and Community Case Management Health commodities.

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Vaccination is an overall call for the health sector.

During the year 2014-2015, the quantification and forecasting of the HIV, OIs, and HIV laboratory related products, antimalarial products, Maternal, Child and Community Case management health was done. The outcome of this activity is the forecasting and supply of the health products that are needed for the period July 2015 June 2016.For each health program, a quarterly review of the supply plans were conducted to ensure that estimated quantities during the quantification process for the previous period are still in line with the programs objectives and targets

Implementation of the eLMIS: The provision and distribution of drugs, vaccines and consumables constitutes one of the essential support systems for efficient delivery of health services. In this regard, an Electronic Logistics Management Information System (e-LMIS) that provides health commodity logistics data and order processing functionalities was established. Currently the system is successfully implemented in Medical Procurement and Production Department (MPPD), National Reference Laboratory (NRL) and National Center for Blood Transfusion (NCBT), 30 District Pharmacies, 42 District Hospitals, 4 Referral Hospitals and all the Health Centers in the country. At least 2 staffs have been trained in the use of the e-LMIS at each facility implementing the system. The use of the system is however evaluated at 98% of all facilities having the system in place and strategies have been put in place to ensure the remaining 2% of health facilities uses the system as well. The use of e-LMIS has increased the government’s capacity to reliably and consistently deliver high quality products and services at reduced cost, with increased responsiveness to the needs of the target population. 

Development of the supply chain operational manual: A District Pharmacy is an autonomous state entity with the mission to promote health care by ensuring the availability, accessibility and rational use of pharmaceutical products within district-based service delivery points (Hospitals and Health Centers). Key functions of the District Pharmacies are: management of pharmaceutical products (procurement, distribution, rational use, data collection and analysis), finance and administration, storage, technical support to Service Delivery Points in pharmaceutical management, supervision of public and private pharmacies within the district, and ensuring availability of quality, safe, and efficacious pharmaceutical products within the district.

To ensure that inventory control and quality assurance processes at the District Pharmacy are carried out in an effective and standardized manner, the Supply Chain of medicines and other health commodities operational manual was developed by the Ministry of Health in partnership with other stakeholders to document the key processes that lead to the access of quality, safe and effective medicines. Draft documents are available and will be finalized and published to be used by district pharmacies and other stakeholders involved in the monitoring of the pharmaceutical management processes in the District Pharmacies.

Legislation and regulatory framework: the quality of products and services is an essential component of access cutting across all the dimensions, but which specifically applies to products in terms of their safety, efficacy and quality. The entire regulatory framework is supported by policies, laws, and regulations which when supported by the good governance, establish and support the public commitment to essential medicine supply. In the course of the year 2014-2015, a total of 24 ministerial orders implementing the laws on pharmaceutical sector regulation were drafted and are in validation process. The 24 Ministerial orders will help implement the following laws:

Law N°03/2012 of 15/02/2012 Law governing narcotic drugs, psychotropic substances and precursors in Rwanda

Law N° 47/2012 of 14/01/2013 Law relating to the regulation and inspection of food and pharmaceutical products

Law N° 45/2012 of 14/01/2013 Law on organization, functioning and competence of the Council of Pharmacists

EAC Medicines Regulatory Harmonization: The EAC Medicines Regulatory Harmonization (EAC-MRH) initiative works with the East African Community to increase access to good quality, safe and effective medicines through harmonizing medicines regulations, and expediting registration of essential medicines. Through this project and in collaboration with other EAC partner states, the Ministry of Health has conducted many activities; develop many documents, to ensure that Harmonization process happens in Rwanda and the EAC partner states.

Human Resources for Health (HRH)

There is strong evidence that in health system, Human resource for Health is pivot as the health Professionals are the ones who run the system. In the fiscal year 2014/2015 a total of 155 Medical doctors were deployed in different health facilities with 131 general practitioners and 24 specialists. Currently 294 medical doctors are being trained in different specialization programs as well as 275 nurses and 76 midwives were deployed in public health facilities.

Service delivery

In order to improve the geographic accessibility to health care services and ensure universal coverage to the Rwandan population, the Ministry of Health is initiating a national program of setting up a Health post at cell level where the population still has to walk more than 5 km to reach the nearest health facility.

Although much has been done, 95 minutes used in average by Citizens to reach a Health center in 2006 and 60 minutes in 2010( EICV 2 and 3); there is a portion of the population which still have to walk more than 60 minutes to reach the nearest health facility.

Almost all sectors have now at least one health center except 18. The Ministry of Health is committed to ensure the equity in terms of geographic accessibility to health care services.It is in the same line of improving geographical accessibility to health care that the Ministry of Health  is promoting the lowest  layer of health facility at cell level which is health post which will be at cell level administratively but technically supervised by health center.

In addition to that, considering the long waiting time observed in Health centers, Health post come as an answer as they will be offering preventive, promotional and some curative services.

Lastly, following the Ministerial instruction stopping the recruitment of A2 nurses at different levels of care, those nurses will be serving the population in health post as they are skilled and experienced.

Currently we have 2 models of health posts including the formal classic health post satellite of health centre and public private partnership health post managed by One Family Health. There are 230 health posts affiliated to health centers to serve remote population. Most of them report through the health centers but a certain number (60) report directly into HMIS .Those ones who report directly to HMIS has started in the framework of outreach services and grown over time offering now the package of services of a Health center.

The Ministry of health is introducing a new model of Public Private Community Partnership (PPCP) which will be adapted for all health post later with the advantage of shared responsibility between the community, the local leadership, private nurses and the Ministry of Health itself. Local leadership and community own the premises and big equipment as well as facilitate the nurse to collaborate with the District Pharmacy and CBHI. Ministry of Health has defined the service packages, standard list of equipment and drugs and the procedure manual.

Current figures on health posts:

230 health posts are public and serve for outreach services mainly primary Health care services

87 Health posts managed by One Family Health (OFH) which is a private NGO and collaborate with Districts and use the franchise model

51 new Health posts built in collaboration with Ministry of Defense will operate in a Public Private Community partnership

Hygiene and sanitation

In order to protect the consumers against food borne disease, educative inspections were conducted in 93 Food establishments   in City of Kigali during Nation Events.  Criteria considered during inspection were; (i) Food safety, (ii) Status of rooms, (iii) Sanitation and (iv) cleanliness.

30/93 (32%) were found satisfactory and recommended in all aspects;

56/93 (60%) are recommended or recommended with follow up,

37/93 (40%) are rated satisfactory for food safety

62/93 (67%) are rated satisfactory forstatus of rooms

63/93 (68%) are rated satisfactory for cleanliness

Food Safety Testing Kits were distributed to 15 District Hospitals especially for  milk and juice in order milk and Juice sold in public places is safe for human consumption; 47 Environmental Health Officers also were trained on how there are  used;

The efforts were made also to implement drinking water quality surveillance and 44 motorcycles were and distributed in 42 DHs and 2 HCs in order to support drinking water quality from the water sources.

To ensure proper management of medical waste in the prevention of nosocomial infections, and promotion of hospital hygiene, sufficient equipments and supplies were distributed to the health facilities to promote hospital hygiene.  On site mentorship supervision and capacity building of Health Care Providers on injection safety and health care waste handing were also provided.

Community Health Clubs (CHC) will respond to disease burden by empowering the Communities to identify the hygiene and sanitation problems and come up with solutions which will lead to sustainable behavioural change:  The Districts reports show that fully functional hygiene clubs have increased from 20% to 27% (Nyabihu, Bugesera, Rulindo, Burera, Musanze, Rubavu, Rusizi, Gatsibo, Kayonza, Huye, Gicumbi, Karongi, Nyamagabe, Kicukiro, Gakenke, Nyaruguru, Kamonyi and Gasabo Districts. A total of 62 ToTs were trained and 308 CHC facilitators were trained on CHC approach.

Health Information System

The HMIS has made a significant improvement in both data quality and System integration.
In Data Quality, the 2015 DHS data key indicators are identical to R-HMIS data.
In the system integration, the e-IDSR (electronic Integrated Diseases Surveillance and Repost) system and HIV model have been integrated into R-HMIS.

Knowledge Management and Research

In the Fiscal Year 2014-2015, two important population-based surveys were concluded and their preliminary results are now available: The Rwanda Demographic and Health Survey 2015, and the Rwanda AIDS Indicator Key Findings 1 and HIV Incidence Survey. Key findings from the DHS 2015 show that Rwanda has achieved all MDGs related targets.

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