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Bisate Health Center, Musanze District Comprehensive Community Health Initiatives and Programs (CCHIPS)

12 Month Progress Report In Collaboration with the Ministry of Health, Government of Rwanda

Report Prepared by: Laura Clauson Director, CCHIPS 12/21/2007


Table of Contents

Summary I.

II.

III.

IV.

3

Data Bisate Health Data Oct 2006-Oct 2007 Bisate Financial Data Oct 2006-Oct 2007

5 7

Infrastructure Placenta Pit Toilets/ Biogas Soak-Away Pit Standing Water Solutions

8 9 10 11

Human Capacity Building Mental Health Assessment Health Animator Training School Hygiene Outreach Visiting Volunteers Micro Business: A Soap Story Aesthetics & Team Building

12 13 14 15 16 17

Financials

18

Attachments October 2006-October 2007 Bisate Health Records

1

October 2006-October 2007 Bisate Financial Records

2

BioGas Digester Report-Design & Implementation

3

Soak Away Pit: Dimensions, Notes & Considerations

4

Mental Health Needs Assessment: “The head is on the top!�

5

Project Proposal: Integrating Mental Health at Bisate Clinic

6

Health Animator Training Hand Outs: CPN, The Ear, Parasites, Mental Health

7

Soap Making Training Manual

8

CCHIPS May-November 2007 Detailed Financial Accounts

9


Summary of Activities May - October 2007* Mission:

Working in partnership with the Ministry of Health, the CCHIPS project was sponsored by Dian Fossey Gorilla Fund International (DFGFI) to pilot a cost efficient and sustainable solution to improving primary health care at Bisate Health Center. The goal is to develop a model that has a proven impact on the health of rural communities and can be realistically replicated in other rural areas.

One Year Summary:

A strong foundation has been built in the first year. Dramatic improvements have been made in all three core areas of activities: infrastructure, capacity building and community participation. There is a clear understanding of what future interventions will have a high impact on improving health and consequently lead towards realization of the HSSP’s goals.

Success:

Bisate Health Center routinely continues to be #1 in hygiene, vaccination and family planning. Family planning has increased by 966% since the project’s inception. Of particular reward has been the training of health animators. In this reporting period the Bisate animators have been trained on parasites, ear infections, mental health and pre-natal care. Training sheets are created to assist the animators with disseminating their knowledge to their communities and thereby enacting the GoR’s Information, Education, Communication (IEC) policy. The newly constructed meeting area serves as a useful training space.

Progress:

Since the last formal report submitted in May 2007, significant emphasis has been on sanitation and training. A placenta pit was constructed to both meet the MoH’s standard for bodily waste disposal and to rectify a current health hazard. Standing water solutions and a soak away pit for laboratory liquid waste were also built to ensure a safe environment for patients and staff. Nine toilets and a shower room were installed. As part of CCHIPS’s mission to seek appropriate technology solutions for issues raised in Rwanda’s Vision 2020, an innovative biogas digester was designed and constructed for the health center. If successful, it will both process human waste into useable fertilizer and produce free cooking gas to replace the scarce resource of firewood.

*For activities carried out October 2006-April 2007, please refer to the “6 Month Report.”


In response to the MoH’s target to provide mental health services to the populous, a feasibility assessment was carried out and project planned. The local community has expressed a deep need and interest in this issue. During the last six months, five volunteers have donated approximately 1288 hours to the health center in assessment, training and project implementation. For medical volunteers, this includes in-patient rounds, patient consultations and on-site training. The volunteer engineers designed and built the biodigester. The health animators are a critical link between the community and the health center. To encourage their participation and recognize their volunteer status a soap making micro enterprise was initiated. This has the benefit of being both a profit generating business and a producer of a product necessary for a healthy community. The animators are now successfully making and selling soap. Continued Leadership:

CCHIPS continues to monitor health and financial recording which the health center staff has greatly improved. Health center revenues continue to rise due to increased quality of care and high mutuelle coverage. The pharmacy maintains its full stock and the clinic has never been without water since the tanks were installed. The community has remained engaged with the rehabilitation and most recently joined together to wash the building exterior in preparation for painting. With the continued hard work of the Bisate staff and community, we believe that the steady improvements to local health services that have characterized the first year of CCHIPS will continue.

Financial Since May 2007, CCHIPS has spent 9,915,682.26 RWF at Bisate Health Center. Expenditures: CCHIPS continues to subsidize staff salaries. Long Term Goals:

CCHIPS will continue to provide MoH with 6 month progress reports. Our primary goal, through our reporting process is to provide MoH with useful information from our rehabilitation of their rural health center in Bisate which will help them reach their HSSP.

Bisate Health Center, Musanze District, Rwanda


Bisate Health Data CCHIPS, along with clinic staff, continues to collect accurate health data. We now have a year’s worth of data. This allows us to: 1. Evaluate project impact in 2008; 2. To make informed decisions, based on real data, on where the biggest impact can be made going forward. Hospitalization: Top 4 Diagnoses Based on Monthly Average

Consultation: Top 6 Diagnoses Based on Monthly Average Ear, Nose, Throat 8%

6%

8%

Parasites 39%

11%

20% 30%

Skin Problems Physical Trauma

Low Respiratory Problems Physical Trauma OB/GYN

23%

28%

Diarrhea Without Blood

Diarrhea Without Blood

27%

Teeth & Mouth Problems

Bisate’s #1 Success: Family planning utilization has dramatically increased. This is due to increased sensitization by the MoH, but most significantly to the allocation of a specific room for family planning. Patients can now go directly to family planning without waiting for a consultation.

Nb of Women

Total Number of Women Utilizing a Family Planning Method 800 700 600 500 400 300 200 100 0 10-06 11-06 12-06 1-07

2-07

3-07

4-07

5-07

6-07

7-07

8-07

9-07 10-07

Month

Bisate continues to be number one in the District for rates of vaccination and hygiene. These annual numbers are currently being reviewed by CCHIPS’ medical team to assess quality medical interventions and appropriate health training for 2008. The following page illustrates several health indicators and discusses lessons learned regarding positive change.

[Bisate Health

Data Oct 06– Oct 07 - Attachment 1]


Nb of People

Total Consultations 1400 1200 1000 800 600 400 200 0 10-06

11-06

12-06

1-07

2-07

3-07

4-07

5-07

6-07

7-07

8-07

9-07

10-07

Month

With the exception of January, when there was a big dip due to patients enrolling in mutuelle insurance (insurance can not be used for one month after purchase), the number of patients has fluctuated with the seasons. The busiest months are during the rains when respiratory aliments and parasites increase. These numbers are not likely to change without intervention. With one consultation room and one nurse to staff it, only so many patients can be seen. Anecdotal evidence shows that patients sometimes choose to walk to the Kinigi Health Center rather than wait at Bisate. CCHIPS believes that with the increase in mutuelle enrollment many more people can be served if a new consultation room is built.

% of Women

Pre-Natal Care Indicators 140% 120% 100% 80% 60% 40% 20% 0%

% of Women Utilising Pre-Natal Care % of Women w ith Adequate PreNatal Care (4 Visits)

10- 11- 1206 06 06

107

207

307

407

507

607

707

807

9- 1007 07

Month

According to national averages, Bisate’s service area should have 54 women giving birth every month. Because Bisate is in the most densely populated area of the country, this number should actually be higher. These annual numbers show the fluctuation in birth that also follows the seasons. A very high percentage of women are receiving some pre-natal care, usually with visits in the 2nd trimester and the 7th/8th month. However, only about a 1/3rd of women are delivering at the clinic. The delivery numbers have increased through a refurbishment of the delivery room, community education and incentives (baby clothes) for the new mothers. CCHIPS does not believe that these numbers will increase further without attention to the major reasons cited for not delivering at the clinic. 1. The baby came very quickly after labor started and the clinic was too far away to walk to. 2. Indigent women do not have insurance and cannot afford to deliver at the clinic.

% of Women

% of Women within Service Zone Delivering at Clinic 80% 70% 60% 50% 40% 30% 20% 10% 0% 10-06

11-06

12-06

1-07

2-07

3-07

4-07 Month

5-07

6-07

7-07

8-07

9-07

10-07


Bisate Financial Data CCHIPS continues to rigorously monitor the financial reports. Accurate reporting and financial accountability are seen as a key component in the Health Center’s successful journey to sustainability. One of the most frequent reasons for the non-utilization and failure to meet health services is the high cost of health care. During 2007, there was a rapid increase in the number of inscribers to the mutuelle insurance system. This has provided a large part of the community with a solution to the problems of financial accessibility to health care and protection against financial risks associated with disease. As seen below, the Health Center’s financial situation has improved dramatically. This is due to the well functioning insurance reimbursement system and thereafter to the proper management of funds. The erratic nature of the graphs illustrates that the reimbursements are not yet paid monthly. However, the overall increase is apparent and is ensuring a consistent drug supply for patients. Total Am ount Received from Population

Month

10 -0 7

807

607

407

207

12 -0 6

10 -0 6

2,500,000.00 2,000,000.00 1,500,000.00 1,000,000.00 500,000.00 0.00

10 -0 7

807

607

407

207

12 -0 6

RWF

2,500,000.00 2,000,000.00 1,500,000.00 1,000,000.00 500,000.00 0.00

10 -0 6

RWF

Money Available in Clinic Account at Month End

Month

The cash box continues to be monitored; bank statements are reconciled monthly and insurance reimbursements are requested in a timely manner. With a year of accurate financial data, it is now possible for the health center to prepare a realistic budget for 2008. The below graphs illustrate an analysis of Bisate Health Center’s basic operating revenue and expense. Operating Revenue:

Operating Expense: Expense %

(Excluding State & CCHIPS Intervention)

(Excluding State & CCHIPS)

Insurance: Drugs

Drugs and consumables bought Salaries (+ taxes & social security) Transportation

Co-pay

13%

9%

9%

5% 4%

Drugs and consumables sold Insurance: Curative and preventive treatment Loan reimbursements

23% 6% 4% 2%

Treatments

2%

2%

Other receipts (medical booklets/ fines) Curative consultations

0%

Hospitalization

2%

54%

63%

Lab tests

[Bisate Financials October 2006-October 2007-Attachment 2]

1% 1% 0%

Perdiem, work mission fees Furniture, office supplies Water, electricity, gas… Mail, phone, communications Cleaning material and products


Sanitation — Placenta Pit Medical waste management is a significant concern for health personnel. Biological wastes, such as placentas and human body parts, were not being appropriately disposed of at Bisate Health Center. After delivery, the placenta, blood and excrement were being washed into a hole in the floor of the delivery room. This hole was connected by pipe to a pit approximately 10m away. The pit had become a breeding ground for a growing population of rodents and flies, infesting both the delivery room and the ward for new mothers and babies. Furthermore, the smell of rotting tissue was overwhelming. Based on the health hazards presented by the existing placenta pit, building a new pit following established standards was a high priority. The newly constructed pit is cemented from bottom to top and covered with a concrete slab. A ventilation pipe is installed which is higher than the roofline of the nearest building. The cover has a small removable hatch to allow for the disposal of placentas. When the pit is full (in an estimated 15 years) it will be closed and another one built. This new pit will prevent the breeding of flies and rodents. It also satisfies the Rwandan cultural demand that human body parts be respected and handled appropriately. The Placenta pit design follows the standard developed by MSF and the Rwandan Government.

Cost to Build Placenta Pit 1 truck stones 1 truck sand 15 sacs cement

50,000.00 50,000.00 165,000.00

1 truck gravel

50,000.00

6 12cm steel

36,000.00

3kg iron wire

3,600.00

1 metal cover

30,000.00

1 vent pipe

13,000.00

1 T joint

3,500.00

5kg brads

5,000.00

1 piece 3 story flat 10 trees transport for materials Labour

5,000.00 10,000.00 50,000.00 124,400.00 595,500.00

595,5000 RWF @545 =

$1092.66


Sanitation - Toilets and BioGas Digester On November 21st, 2007 the UN launched the International Year of Sanitation. Clean toilets are critical to good health and the multiple benefits that stem from better sanitation and hygiene are advocated for under the Millennium Development Goals (MDG7). Sanitation plays a great role in protecting health. Without a clean environment and without the sanitary disposal of human excreta, the risk of illness from intestinal worms (helminths) and insect vectors rises precipitously. CCHIPS installed 9 new Roto Sarl toilets and built an innovative washroom fulfilling WHO standards of sanitation. This project suffered delays due to the scarcity of cement and to the business practices of the Aqua San company which initially supplied the toilets. These toilets were returned and much higher quality ones purchased from Roto Sarl, Kigali. The toilets are now functional. *For more information on sanitation at Bisate Health Center, refer to CCHIPS’ “6 Month Report .”

Installing 9 Roto Sarl toilets and building “poop-shoots” for the bio digester.

New washroom constructed using low cost building technology

Self cleaning toilets empty into holding tank for composting waste into fertilizer

Bio gas is effectively being used in Rwanda to process human waste and to produce a cheap, clean energy source. The Ministry of Infrastructure is promoting its use. Visiting engineers from the Humanitarian Engineering Leadership Projects (HELP) at Dartmouth College’s Thayer School of Engineering designed and built an innovative digester over a two month period. This pilot bio gas system at Bisate Health Center is intended to improve sanitation by processing the human waste from 1000+ people a month into useable fertilizer and to provide daily cooking gas for in-patients as well as for cooking demonstrations and a soap making project. [BioGas Digester Report: Design & Implementation-Attachment 3]


Sanitation — Soak Away Pit During the daily operation of medical activities, mass immunization campaigns and even in emergency situations, good health care waste management (HCWM) is crucial to prevent the exposure of health-care workers, patients, waste handlers and the community to infections, toxic effects and injuries. Poor management of health-care waste may also damage the environment. (WHO, 2007). In developing countries, HCWM is still poor. Approximate % of waste type per total Often, accurate materials, knowledge, and skills of how proper HCWM can be implemented is waste in primary health care centers: lacking. In addition to the waste types mentioned Non-infectious waste: in the chart to the right, wastewater, especially Pathological waste and infectious waste: laboratory wastewater, is also important to con- Chemical or pharmaceutical waste: sider. Most of the chemicals used for cleaning Sharps waste: materials, sterilizing, disinfecting products and Pressurized cylinders, broken therpermuted substances, etc. are mixed with the mometers, etc… wastewater from the laboratory and ultimately discharged in public drainages, land fields, etc (WHO, 2007).

80% 15% 3% 1% <1

In Rwanda, laboratory wastewater at the Health Center level has to be drained to a soak away pit for filtration before it is discharged underground. This is to minimize health risks that may be associated with poor handling of laboratory wastewater (Ministry of Health, 2007). Bisate Health Center has the advantage of being located in area where there is a high percolation and a deep aquifer (estimated to be at 750 m deep). These geological characteristics favor evacuation and filtration. The installment of the soak away pit helps to ensure proper health facility hygiene and safety of the health care staff and the local community.

Cost of Soak-Away Pit Soak Away Pit Design - General Quick Steps: 1. Dig the soak pit 500 Fired Bricks 15,000 2. If the soak pit area is very sandy, the hole may need to be lined with bricks 5 Rebar 12mm 30,000 for additional wall support. 2 Steel Wire 2,400 3. Lay a 4 cm layer of sand on the bottom of the pit. 1 Truck Sand 50,000 4. Lay a 4 cm layer of gravel over the sand layer. 4 PVC Pipes 110mm 40,000 5. Fill the hole with rocks up to the height of the end of the pipe from the 4 PVC Coude 110mm 10,000 wash area. 1 Te PVC 2,500 6. Under the end of the pipe (which should reach the radius/center of the top 47,500 view), place a good, flat rock in order to encourage the spread of the out- 5 Sacs Cement Labor 39,000 flow of the pipe throughout the rocks in the soak pit. 236,400 7. Leave an empty space around the flat rock and end of pipe, creating a “hole” surrounded by rocks. 236,400 RWF @545 = $433.00 8. Continue to completely fill the rest of the soak pit with rocks. Place rocks over the pipe, but not touching, to protect it from upper pressure and cover your middle “hole” with a top rock as well. 9. Cover soak pit with sticks, rice sack or plastic, and mud. Make sure mud area is compacted and strong. Note: This is the “village,” cheap way. 10. If soak pit area is in a high traffic zone (i.e. cars, donkey carts, heavy items), you may need to cast a concrete slab with rebar to cover it, instead of sticks and mud.

[Soak Away Pit: Dimensions, Notes & Considerations-Attachment 4]


Sanitation - Resolving Standing Water Water stagnation and the consequent multiplication of vectors increase the risk of vectorborne diseases. (WHO) Storm water was creating a potential health hazard at Bisate Health Center. The ground was unable to absorb the torrential rains resulting in standing pools of water in the central courtyard. There were two options for rectifying this problem: Cost of Water Trench 1. To replant the ground with layers of stone, soil, 5 sacs Cement @ 7200 36,000.00 and then grass. This allows the water to quickly 8 Rebar 48,000.00 permeate the ground. 2 metal saw 1,200.00 5kg nails 5,000.00 2. To build a trench in order to redirect the water. 1 Truck Sand 50,000.00 Both options were implemented and offered a 1 Truck Stones 50,000.00 complete solution to the standing water issue. Labor 114,000.00 304,200.00 304,000 RWF @545= $557.79

Redirecting storm water to prevent it from damaging the buildings and from stagnating.

Driveway: BEFORE

Grass planted by hand.

Loosening ground

5cm of small rock

10cm of soil

AFTER: Standing water resolved. The ground now absorbs storm water.


Mental Health Assessment ―Umutwe ni wo w’ibanze!‖ or ―The head is on the top!‖ A health worker says that in Bisate neighbors help neighbors, but when he tries to talk to a friend with an alcohol abuse problem, he doesn’t know what to say. If the friend becomes violent while drinking, the police are called and he is given a fine, but there is nothing done to address the underlying problems. All the health workers agree that they are interested and willing to take on the task of counseling in the community. However, they find it hard to go to a family and counsel them because they don’t have the skills.

The Government of Rwanda in its February 2005 “Health Sector Policy” included mental health as one of its seven “priority interventions.” The government plans to develop standards and guidelines for the “integration of mental health into primary health care….” In the government’s Health Sector Strategic Plan 2005-2009, the government emphasizes Rwanda’s history of trauma with respect to the 1994 genocide and how the genocide has “greatly magnified the problem of mental trauma and places a huge burden on health services in the country.” They emphasize the impact on children by citing a UNICEF study that reveals: 80% lost at least one family member 90% felt in danger of dying 95% had witnessed scenes of violence “Anecdotal evidence from health facilities suggests that psy-

In June 2007, Dr. Kathleen Allden conducted a chological distress is widespread and accounts for a signifinumber of consultations, particularly during the months mental health needs assessment of the Bisate Clinic cant of April and May (the anniversary of the genocide).” region. Through a key informant survey of all the stakeholders she identified numerous mental health and psychosocial problems in the region. The focus of concerns and priorities, however, varied from informant to informant, depending on their work context and/or social environment. Nevertheless, there was a great deal of overlap among those interviewed and a general consensus on three key issues: 1. There are significant consequences of post genocide violence in the region. As a result, there are numerous child headed households, teenage pregnancies (among orphan teens), widows and female headed households, polygamous marriages with problems related to polygamy, and many people suffering from psychological trauma. 2. Alcohol abuse is common among men in the community. Alcohol abuse contributes to poverty when earnings are diverted from family needs to alcohol. Domestic violence is common when men abuse alcohol. There is no intervention or precedent for intervention for maintaining sobriety, alcohol “rehabilitation,” or self-help groups for those trying to remain sober. 3. As in much of Rwanda, poverty affects the health and mental well-being of many, if not a majority of families and individuals in the region. The combination of poverty and the consequences of post-genocide violence have for some, created a deep and overwhelming sense of hopelessness. Hopelessness affects motivation for education, enterprise, and social development in general. During Dr. Allden’s visit, she and Claudine Mukamana conducted two training sessions, one for the Bisate Clinic Health Animators and one for Bisate Clinic Staff. The themes of the training sessions were how to identify mental health problems in the community and basic components of counseling. The content of the Health Workers, Dr. Kathleen Allden and Claudine training sessions was devised after meeting with Bisate Mukamana discuss mental health issues faced by the community. health animators. The content was based on problems the animators identified and information they requested. The training sessions demonstrated the hunger for information on mental health among clinic staff and among health animators. Both groups stated that in their opinion, the top priority for training and staff development is mental health. They highlighted their priority by teaching Dr. Allden a Rwandan saying that, while obvious, has multiple levels of meaning: “Umutwe ni wo w’ibanze!” or “The head is at the top.” [Dr. Allden’s Mental Health Assessment / Trip Report-Attachment 5] [Project Proposal: Integrating Mental Health at Bisate Clinic-Attachment 6]


Human Capacity Building â&#x20AC;&#x201D; Health Animators The Ministry of Health maintains that the promotion of information, education and communication (IEC) for behavioral change as well as a healthy environment are two essential components that must be integrated into every disease program. Ultimately, the success of the national health policy depends on the degree of community mobilization and participation. The Government of Rwanda has stated that one of the main causes of poor health conditions is the low level of education and information. CCHIPS has continued to effectively implemented the GoRâ&#x20AC;&#x2122;s IEC policy by fostering an engaged and commitment group of health animators and training them. The level of participation by the animators (between 30-40 at every training) has shown both their eagerness to learn and their commitment to their communities. As planned CCHIPS has begun having Bisate Health Center staff conduct trainings as well as the visiting medical personnel. A training take home sheet is produced for every training in KinyaRwandan in order to aid information dissemination. Trainings, during this reporting period, have been conducted on Parasites, Mental Health, The Ear, and Delivery.

The information from all trainings is posted at the Clinic for community education. Bisate Lab Tech, Jean Baptist, Training about Parasites

Dr. Mary Training on the Ear How do you prevent ear infections and eventual deafness?

Bisate A2 Nurse, Chantal, Training on Delivery Why should women deliver at the clinic?

Training on Mental Health How do you talk to a neighbor who has problems with domestic abuse, alcoholism, depression?

[Health

Animator Training Hand Outs-Attachment 7]


School Hygiene Outreach “The principal causes of mortality and morbidity in Rwanda are communicable diseases. For the most part, these illnesses can be prevented through better hygiene and behavioral change.” (National Health Policy)

1700 children attend the Bisate Primary School which is adjacent to the Bisate Health Center. Children’s school attendance creates a simple opportunity for reaching children through preexisting infrastructure. Targeting schoolchildren can be a cost-effective approach to delivering health interventions. Health interventions at schools also complement their educational mission because good health and nutrition are prerequisites for effective learning. Since May 2007, in collaboration with Bisate Primary School, a Bisate A2 nurse, Jacqueline NIYITEGEKA, has been delivering hygiene education every Friday at the school. Visiting medical volunteers also participate in these training sessions.

A2 nurse, Jacqueline NIYITEGEKA, teaches Bisate Primary School children about hygiene. Bill Wyman, CCHIPS’ founder and funder, quizzes the children on what they have learned from Jacqueline.

Visiting medical volunteers help Jacqueline teach about hygiene.


Volunteer Information Approximate Work Hours of CCHIPS Volunteers since June 2007: 1288 hours

1.

Title/Name: Dr. Kathleen Allden Arrived: 6/15/07 Departed: 6/30/07 Working Days: 10 Working Hours: 80 Description: Assessed mental health problems and priority psychosocial issues in Bisate. Evaluated the feasibility of establishing a mental health program. Performed clinical consultations, two trainings and made home visits. [Mental Health Needs Assessment-Attachment 5] [Mental Health Project Proposal-Attachment 6]

2.

Title/Name: Andrew Johnston Thayer School of Engineering, Dartmouth College Arrived: 6/15/07 Departed: 8/19/07 Working Days: 45 Working Hours: 360 Description: Designed and built a mechanically robust, minimal maintenance anaerobic biogas digester. [BioGas Project-Attachment 3]

3.

Title/Name: Benjamin M. Koons Thayer School of Engineering, Dartmouth College Arrived: 6/15/07, 12/18/07 Departed: 8/14/07, 12/25/07 Working Days: 40 +5 Working Hours: 320 + 40 Description: Designed and built a mechanically robust, minimal maintenance anaerobic biogas digester.

4.

Title/Name: Harold E. Johnson III (JJ), Thayer School of Engineering, Dartmouth College Arrived: 6/15/07 Departed: 8/11/07 Working Days: 40 Working Hours: 320 Description: Designed and built a mechanically robust, minimal maintenance anaerobic biogas digester.

5.

Title/Name: Dr. Mary Horder (3rd Visit) Arrived: 9/29/07 Departed: 11/3/07 Working Days: 21 Working Hours: 168 Description: Daily in-patient rounds, and patient consultations with staff nurses. Clinic staff training and Health Animator training.


A Soap Story: Improving Health, Generating Income Health workers, called Animators in Rwanda, are elected volunteers. They are the critical link between the health center and the community. The Bisate Animators have worked tirelessly to encourage their neighbors to help rebuild the health center. CCHIPS wanted to recognize this invaluable contribution by providing resources and training for an income generating project with one stipulation - the business had to help improve the health of their community. The Animators’ choose a soap project which went hand-in-hand with the clinic’s hygiene initiative. They prepared a budget, needs list and training schedule. Josephine MUHUTUKAZI (3rd from left below), a trainer certified by the Kigali Institute of Science & Technology (KIST) came to Bisate to give the course. Several new hotels are being built to accommodate tourists who visit the famous mountain gorillas and the soap team is hoping to sell to them as well as the local community. Many conversations were required before the animators understood and accepted that this was their project; they owned it. When some complained that the trainings were too long and that they were tired, they were told that they could have as little or as much training as they desired as it was their project. With beaming smiles, they said, “It is really ours!’ They immediately changed the timetable to all day with only a brief break for lunch. Cost of Starting Soap Making Business Table 166*85*90 (inside shelf)

65,000.00

Table 166*85*90 (no inside shelf)

60,000.00

2 padlocks for soap making tables Supplies: 2 * 2 1/2m chain (3000/m) to lock tables 2 padlocks (2200/each) Trainer room(5000), food (3000), transport(2000) Scale for soap making 13 face masks 5 plastc basins (2500/each) 1 jerry can palm oil 1 Sac Caustique 5 plastic cups (150/each) 3 green plastic buckets (1700/each) 3 red plastic buckets (2000/each) 5 cooking pots @ 4000/each) Cutting soap thread 3 Rocket Stoves (17170/each) 3 metal supports (790) Rocket Stoves: labor for carrying to car 500/each) 1/2 kg nails

2,400.00 15,000.00 4,600.00 10,000.00 8,000.00 6,500.00 12,500.00 9,800.00 40,000.00 750.00 5,100.00 6,000.00 20,000.00 350.00 53,880.00 2,000.00 450.00

3/4 sac charcoal

5,000.00

wood

5,000.00

5 wooden spoons (150/each) Trainer: 3000(food 1st week), 2000 transport 13th,16th) 40 liters palm oil

750.00 5,000.00 20,000.00

Trainer: 2nd week food

3,000.00

Trainer Salary: July 2 Planning Meeting

3,000.00

Health Animator, Pelagie, receiving her Trainer Salary: July 6 Purchase Supplies Trainer Salary: July 9-13, 16-20 training certificate and soap manual. Trainer Transport: July 9, 20 (1000)

3,000.00 70,000.00 2,000.00

Soap Manuals: 10 photocopies *28pgs each

8,400.00

Soap Manuals: 10 bindings

4,000.00

3 plastic covers 2 jerry cans oil (10,600/each) 4 wooden soap forms

300.00 21,200.00 8,000.00 480,980.00

480,980 RWF @545 =

[Soap Making Manual - Attachment 8]

$882.53


Aesthetics & Team Building The importance of general aesthetic improvements to bolster staff pride in their workplace and to create a welcoming atmosphere for patients, cannot be overlooked. Visual enhancements have a great impact on the communityâ&#x20AC;&#x2122;s perception of progress at their health center.

Solar Powered Light Bulbs: Wound Care & Maternity Rooms

Plants & Flower Pots Incentives for Mothers to Deliver at the Health Center

Bisateâ&#x20AC;&#x2122;s Benches

Education on the Walls

Staff English Lesson


CCHIPS Financials May 2007窶年ovember 2007 The core of the CCHIPS mission is to develop a replicable model which can be scaled up. It is critical that expenses are carefully tracked for future budgeting and for donor transparency and as a tool for discussing priorities. All expenditures are recorded with QuickBooks. A monthly accounting of all receipts is submitted to the Bisate Titular and FOSA. Significant funds, not included below, that are expected to be dispersed shortly are $35,000 for a complete solar power solution and a $10,000 allotment to initiate a mental health program.

Sanitation (Toilets, Bio Gas, Placenta Pit, Soak Away, Water Trench) Salary Subsidies Outside Expertise Building Upgrade (New Meeting Area, Painting, etc) Meetings & Animator Trainings Micro-Business: Soap Making Furniture Small Equipment (Cleaning, Grounds, etc) Medical: Equipment/Drugs Total Expense May 2007 - November 2007

RWF 4,606,900.00 2,033,462.26 1,087,000.00 676,040.00 533,980.00 480,980.00 229,400.00

USD $8,453.03 $3,731.12 $1,994.50 $1,240.44 $979.78 $882.53 $420.92

140,050.00 127,870.00

$256.97 $234.62

9,915,682.26

$18,193.91

NB. These are unaudited expenses at Bisate Health Center only ie. does not include CCHIPS project house in Musanze or USA expenses and does not include in-kind donations in support of Bisate Health Center activities ie. otoscope, thermometers, delivery incentives etc.

Distribution of Funds Spent at Bisate Health Center

[CCHIPS May 2007窶年ovember 2007 Detailed Receipts-Attachment 9]


Infirmière A2

Pharmacie

Maternité & Planning familiale

Jacqueline NIYITEGEKA

Chantal UWIBAMBE

Titulaire Consultation

Jacqueline NYIRABYIMANA

Telesphore MANIRIHO

Felicien NDABATEZE

Mutuelle de Santé

Laborantin A2

THANK YOU BISATE HEALTH CENTER STAFF Chantal KALIRE

Bosco HARERIMANA

Auxiliaire de Santé

Jean Baptist NDIKUBWIMANA

Infirmière A3

Heath Animators

Vaccination

Theogene KALIGIRWA

Jean Damacene AFRICA ZAIRE Travailleur

Veilleur

Accueil & Injections

Soins

Leonard SEBIJUMBA

Emmanuel MPABWANIMANA

Alexis KIRAGA

Hygiène

Joseph SHYIRAMBERE

Leodomil NHIMIYIMANA


Bisate Health Clinic: 12 Month Progress Report