El templo de la Luna

3.5.1 Gender

In spite of the positive results achieved during EDPRS and HSSP II, mainstreaming of gender equity as a crosscutting issue remains a priority goal for the health sector during HSSP III. The health delivery system cannot be satisfied by ensuring gender neutrality of access to health services as it contributes to the inequalities and inequities in health outcomes for men and women. Also, there is still a weakness in the collection of sex-disaggregated data for appropriate planning and evaluation of health service delivery. Women and men have specific health needs at all stages of life that are related to both physical differences and their societal roles. A gender approach is clearly needed for sexual and reproductive health—family planning, general knowledge about reproductive health options and opportunities, men engagement—but also for other key health programs (Malaria, HIV, SGBV, Nutrition, Mental Health). Traditional gender norms play an important role the causal chain in all those areas, sometimes positive, but often detrimental. These norms must be addressed in the strategies to promote gender equity and link it to improvement of the health status of the Rwandan population.

Among the key gender issues that affect the health sector, the following are specifically addressed in the HSSP III strategic objectives and related indicators and priority actions:

 High levels of teenage pregnancy and related risks, for example high abortion rates and maternal mortality;

 High fertility rate, especially among rural, poor women;  Gender disparities with regard to HIV/AIDS;

 Nutritional disorders, especially among children and women;

 Gender and mental health problems due to pathological reasons, e.g., marital and other social factors;

 High rate of gender-based violence cases;

 Implication of traditional and cultural gender issues on health.

More details on the indicators and policy actions of the HSSP III aiming at improving gender equity can be found in the Annex 8 about crosscutting issues.

3.5.2 Capacity-building

The GOR considers capacity to be the ability of people, organizations and society as a whole to manage

their affairs successfully and capacity-building as processes of capacity creation, utilization, and

retention at the three levels (individual, organizational, and institutional). Capacity-building, therefore, needs to be considered at the sector strategy level to ensure efforts are focused on national and sector priorities (Vision 2020, Government 7 year Action Plan, EDPRS, and HSSP III). Achievement of national and sector development targets depends on both individuals and institutions having the capacity to deliver. Better coordination of capacity-building is needed to mitigate duplication, overlaps, wastage of resources, and inefficiency; this requires clarity of roles and responsibilities. A good monitoring and evaluation system is also needed to effectively measure the impact of capacity-building investments. Under the general orientations of the National Health Policy (2005), the health policy environment provides a robust framework for strengthening the health sector, not only in terms of capacity-building of the health workforce, with the recently developed HRH Policy (2011), but also at organizational and institutional levels. The HSS sub-TWG within the Governance TWG has the mandate to coordinate all

stakeholders’ efforts to improve the capacities of the health sector. HSSP III gives a general framework in which all the different programs’ capacity-building plans are integrated. Based on the capacity-building needs assessment, numerous indicators and policy actions of the health services provision programs (MCH and Disease Prevention And Control) present specific capacity-building interventions in their programmatic area.

To give a more global and comprehensive picture of the sector’s capacity-building priorities, the main policy actions are presented according to the HSSP III health support systems categories:

 For HRH, pre-service and in service training of health care workers, community health workers and other persons involved in health services provision, with certain types of service providers being particularly targeted, according to needs and strengthening of professional bodies and teaching institutions;

 The production, procurement, storage and distribution of Medical Products, as well as the establishment of a regulatory body and of quality control mechanisms;

 For Health Technologies, improvement of infrastructures (laboratory at central and peripheral levels), quality control mechanisms, procurement system and appropriate training of lab technicians;

 Development of Health Infrastructure and Medical Equipment to ensure geographic accessibility and quality of services provided;

 In the field of Health Care Financing, strengthening of financial management system at central, district and HF level for CBHI, PBF, HRT, and improved data collection and data management for evidence-based decisions;

 Establishment of regulations, of a generalized accreditation process and of an institutionalized continuous quality improvement (CQI) system to ensure Quality of Services;

 For Planning and Information Management, establishment of guidelines, procurement of necessary equipment (for example for EMR) and training of the staff in charge of these tasks; strengthening of a harmonized and integrated M&E system, with systematic data quality assessment mechanisms and data dissemination and use;

 And finally for Governance, strengthening of decentralized coordination and financial management, improvement of partners’ coordination and of intersectoral interventions.

3.5.3 Regional Integration

The progressive development of regional integration through the establishment of the East African Community (EAC) will eventually lead to free movement of goods, people, labor, services, and capital between the countries of the region, which will have important impacts on the health sector in Rwanda and in the region. Several policy documents have already been produced regarding health management from a regional perspective. In the Treaty for the Establishment of EAC, partner states agreed to take joint action toward prevention and control of diseases in the region. The Protocol on EAC Regional Cooperation on Health, EAC Regional Health Sector Strategic Plan (2012–2016), and Health Sector Budget for FY 2012/2013 provided orientations for the implementation of this shared objective.

Regional integration: issues and related actions

The main issues and the related actions identified in these documents are as follows:

 Harmonize standards for high quality health care and effective institutional arrangements, and for policy and budget alignment;

 Train workers to ensure mutual recognition of skills in order to benefit from free movement of workers in the region;

 Establish a framework to ensure equal treatment and movement of patients within the region;  Establish a regional Health Insurance Policy and mechanisms to facilitate free movement of

labor and people at the regional level;

 Strengthen the health systems according to regional and international standards (accreditation);  Harmonize regional regulations in the pharmaceuticals and food safety areas;

 Harmonize traditional medicine to promote effective methods of treatment as alternatives to modern medicine;

 Integrate disease surveillance and response to prevent propagation of epidemics;

 Build the capacity of human capital in the health sector by harmonizing medical education to facilitate mutual recognition and the movement of health professionals throughout the region;  Pursue a common strategy and communication policy for behavior change in relation to the

adoption of healthy lifestyles for the prevention of communicable and noncommunicable diseases;

 Stimulate e-health for capacity-building and management of health information;  Cooperate to harmonize policies for research in the health sector;

 Develop an environmental health policy for promotion of hygiene, safe water, and sanitation, and to address health issues caused by the environment across the region.

Regional integration policy areas

The main policy areas of focus in the HSSP III framework that are related to regional integration are as follows:

 Immunization: Collaboration with neighboring countries to organize immunization campaigns across borders (synchronized immunization campaigns);

 Integrated disease surveillance and response (IDSR): Cross-border collaboration with EAC partner states (annual coordination meetings);

 HIV: Harmonization of treatment guidelines for truck drivers and other mobile workers;  Environmental health: Implementation of Libreville Declaration on Health and Environment;  Health financing (HF): Harmonization of SHP (sustainable health programming) policies in EAC

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4.

HSSPIIIC

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Overall Objective of Component 1:

Improve access and quality of essential health services: Maternal, Neonatal and Child Health; Family Planning and Reproductive Health; Nutrition Services; Communicable Diseases (STD/AIDS, TB, Malaria), IDSR and Disaster Preparedness and Response (DP&R); Noncommunicable Diseases; Health Communication; and Environmental Health. Figure 2. Component 1 objectives, strategies, and outputs