HSSP III also addresses thematic areas that represent risks to the harmonious development of Rwandan society. Foundational sectors such as health and education can be influential in both limiting those risks and facilitating positive implications.
Rapid economic growth can have a down side and negatively affect aspects as crucial as equity, vulnerability, and resilience. On the other hand, great progress can be associated with economic transformation in terms of poverty reduction, peaceful coexistence, and environmental protection. Mainstreaming of social investment to the specific thematic areas must be a priority to limit the potential negative consequences. This also requires different sectors to improve coordination and to play a synergistic role in ensuring protection against potential negative effects.
A major shift is expected in the comparative role of the private sector in health interventions. The relative share of private investment in the health sector is expected to rise spectacularly from 10 percent during EDPRS I to as much as 70 percent by the end of EDPRS II (2018). The increased participation of the private sector in health service provision as a driver of the health sector’s contribution to rapid economic growth can potentially be a factor leading to increased inequities. The Rwandan regulatory framework has to adapt to this new situation and ensure that the private sector respects the same quality standards as the public sector in terms of drug production and utilization, infrastructures, and of service provision. Adequate supervision and quality assurance mechanisms have to be in place to control private as well as public services.
3.4.2 Rural development
With the drive to encourage the rural population to reside in centers where they will have better access to public services, there will appear increasing differences between health facilities established close to those centers, and therefore serving a larger population, and others health facilities located in isolated areas, where the population will become scarcer. The health sector will have to meet the challenge of adapting available services to this population shift, while at the same time preserving the equity principle that has inspired health care system development in the past. This will require flexibility in the size of facilities and the number of staff allocated to areas with varying demographics. Retention measures will have to be established to maintain an adequate number of staff in isolated areas that are often neglected by the workforce. Underequipped districts or sectors already suffering from a deficit in infrastructures and human resources will have to be the subject of special attention to ensure that their situation does not worsen.
3.4.3 Productivity and youth employment
The changes in lifestyles and in social environment will bring new health risks. Young people should be educated about these risks and informed of preventive strategies they can adopt to protect themselves. Noncommunicable, degenerative, and chronic diseases will represent a growing part of the burden of diseases in Rwanda. Those are well known to be linked to unhealthy life habits (e.g., poor nutrition, tobacco and alcohol use, lack of physical exercise) and young people will have to be warned about these factors and taught healthy choices so they can remain well and productive. Urbanization is also likely to be accompanied by an increase of social issues usually associated with the urban environment: criminality, drugs, and precarious habitat/slums. Health educators and health care providers have an important role to play to educate and advise young people about these dangers.
The growing economy will require an increased workforce that is competent and adequately trained, and the health sector will be called upon to play an important role in the education of health care workers to meet this qualitative and quantitative need. Technical schools as well as higher education institutions will have to adapt their curricula and increase enrollment to meet the growing needs of the health care system. A continuous and regular dialogue will have to take place between the health and education sectors, as well as with the authorities overseeing the recruitment and retention of new workers in both the public and private sectors. New types of competencies needed by the fast-developing medical technologies will have to be transmitted and made available and will represent a respectable contribution to the enrolment of youth into productive economic activities and employment.
3.4.4 Accountable governance
Several existing mechanisms for increasing active participation on the part of the general population in decision-making and priority identification have to be strengthened, for example Joint Action development Forums (JADFs), the boards of directors of health facilities at all levels, public accountability days. Board
prepared to participate in public meetings and raise the health issues they are facing, either in terms of accessibility and quality of services, or of living conditions that are conducive to illnesses (water and sanitation, nutrition, etc.). This is a new way for the general population to interact with local authorities and government representatives, it and requires a learning process that public servants, including health care providers, need to participate in actively. A multisectoral approach is needed, as this is a change in mindset and communication skills that concerns all domains of activities.