TYCHO DESCUBRE UNA ESTRELLA NUEVA (NOVA)

Table 34. Baseline and targets for Knowledge Management and Research

EXPECTED OUTPUTS / OUTCOMES BASELINE 2011 TARGETS 2015 TARGETS 2018

% GOR budget dedicated to research

0.4 1 2

According to the recently developed Health Sector Research Policy (HSRP, February 2012), research in Rwanda is benefiting from strong political commitment within the MOH and in the country at large. In the MOH there is the department of medical education and research, responsible for policy development. There are several high-level research institutions with wide international networks, such as the Institute of HIV/AIDS, Disease Prevention and Control (IHDPC) within the Rwanda Biomedical Center (RBC), with its mission to promote treatment and research in HIV/AIDS, malaria, tuberculosis and other diseases; the School of Public Health; and the two academic hospitals (CHUK and CHUB). Within RBC, the Division of Medical Research has been established to coordinate the various research activities. There is also a TWG specifically for health sector research, next to other TWGs (Annex 7). Among MOH staff there is increasing interest in the development of evidence-based policy-related research.

The HSRP aims to fortify and expand upon the stated political commitment of the GOR in terms of guiding research in the health sector in Rwanda. It defines research as:

Any activity intended to increase the stock of knowledge related to health that can be generalized and used to draw conclusions, devise new applications, and guide decision-making.

This definition includes the following kinds of research:

 Basic scientific research related to health, including investigation into fundamental scientific phenomena without a particular application in view;

 Applied/operational research, which is any generation of new knowledge with a specific practical aim;

 Experimental research, intended to develop new or significantly alter and improve materials, products, systems and services;

 General-purpose data collection, including population- or facility-based surveys (DHS, FSS, DHSS) and censuses.

The document defines the mission of Rwandan health research as:

To promote research which improves the availability of high quality information and its effective use in decision-making at all in a manner that ultimately enables Rwanda to continuously improve the health status of its people.

The goals of the Rwanda Health Research Policy are to:  Promote a culture of research in Rwanda;  Ensure facilitation of health research in Rwanda;

 Reflect the guiding principles for health research in Rwanda;  Coordinate research in health sector and protect the population.

5.9.1 Health management and research challenges

Several challenges are impeding a rapid expansion of research, such as:

2. Insufficient research infrastructure, including limited effective coordination mechanisms; 3. Insufficient funding12 to carry out all necessary and desirable research.

There is a need to increase publication in international peer-reviewed journals. Importantly, a research agenda for the country has not (yet) been defined, resulting in insufficient priority setting on the issues that are most pressing to address to improve the health of all people in Rwanda.

Taking into account the existing structures for review of health research proposals, there is also a need to increase the number of committees that are able to review research proposals for both scientific and ethical quality. This will reduce the burden on existing committees, and will help to build and expand capacity for research at a variety of institutions. Scientific review committees and ethical review committees are needed at all institutions that have health research in their mandate. It is important to coordinate all these committees centrally, so as to prevent duplication of research efforts and to ensure that the committees are using identical standards and procedures.

9.9.2 Health management and research strategies and Interventions

Against this promising (but limited) background, HSSP III will focus on the following strategies:

1. Build human resource capacity: The MOH will hire more staff for data management and dissemination, and for operational research, and will strengthen research staff capacity (capacity- building, PhD).

2. Strengthen coordination among research institutions: The MOH will strengthen research coordination mechanisms and develop an agreed-upon and prioritized research agenda. The agenda will help both domestic and international investigators to guide design of new research proposals in a way that is aligned with the real research needs of the country. The MOH will also support efforts for publication of research results in international peer-reviewed journals.

3. Initiate new research activities: The MOH, in coordination with the staff of the various research institutions, will stimulate the development of national research proposals (Rwandans being the first authors) that will be submitted for funding to the relevant technical and ethical committees. 4. Provide financial resources: To the extent possible, the MOH will increase funding for relevant

research initiatives that contribute to evidence-based policy development.

12

The WHO recommends that Ministries of Health allocate two percent (2%) of their annual budgets for funding health research.

C

6.

HSSPIIIC

3:H

S

D

Overall Objective of Component 3:

Strengthen policies, resources and management mechanisms of health services delivery systems to ensure optimal performance of the health programs (output, input, and process levels)

The way in which health services are organized and managed has a significant effect on how well they serve the needs of the population. Service delivery can be defined as the way that inputs are combined to allow the delivery of a series of interventions or health actions. Service delivery is the chief function that the health system needs to perform (WHO World Health Report, 2000). The service delivery system is where the forces of supply and demand for health care meet, and the point at which all the resources and norms come together to be transformed into curative, preventive, promotive, and rehabilitative services. Rwanda has established a strong foundation for service delivery. A developed network of public sector health facilities with defined service packages, guidelines, and protocols at each health facility level exists to meet the health needs of Rwanda’s population. This network is structured as a pyramid with five referral hospitals at the apex followed by 40 district hospitals, of which 5 will soon be upgraded to provincial hospitals, and 450 health centers. The health centers, in turn, supervise health posts and community health workers, and other community-based associations for community outreach activities. In addition, at the central level there are specialized programs and technical working groups to provide high-level policy and technical guidance coordinated by the Rwanda Biomedical Center to further enhance effectiveness of the existing health facility service-provision system. Ministry of Health structures and departments oversee and support the different service provision levels to ensure accountability and delivery of real-time, quality health care services.