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ACCESS NEWS May 2011 Volume 1, Number 5

Dr. Felix Kayigamba with Dr. Michel Gasana (MoH)

Message from Access Project Country Director As the new country director for the Access Project, I plan to continue the work of developing health infrastructure and advancing health facilities management. I am excited for the year ahead as we build new health centers in Musanze and Bugesera, launch a new tuberculosis program in Kigali City, and forge new partnerships. We are also preparing to close out the Neglected Tropical Diseases (NTD) Program, which has seen significant reductions in intensity for schistosomiasis and hookworms since the program began four years ago. It is pertinent for our organization to improve health facilities and make them sustainable businesses across all the domains that we manage. At the close of 2010, there were significant achievements in health care infrastructure across all six districts in which Access works. 80% of all health centers now have a reliable source of running water, 78%

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have sufficient electricity for lights and computers, and 70% have an adequate number of rooms for health care services. These successes can be attributed to key partnerships with the Ministry of Health, Rwanda Works (www.rwandaworks.com) and our Peace Corps Volunteers. New partnerships with Emory University and the Global Fund to Fight AIDS, Tuberculosis and Malaria will improve access to clean water, sanitation and hygiene at our health centers and in the surrounding communities. Moving forward, I plan to place special emphasis on supporting performance based financing, mutuelles and data management, by building on the initiatives put in place by the previous director, Dr. Blaise Karibushi. I am committed to the mission of this project and to making 2011 a banner year for improving health services management in Rwanda. 

Message from the Country Director.........................................1 World Water Day Highlights ....................................................1 Landmark International Conference.........................................2

March 22nd is recognized by the World Health

Organization as World Water Day. Currently, more than one billion people in the world do not have access to reliable sources of clean drinking water, and water borne illnesses claim nearly two million lives each year. The water problem is just one infrastructure deficiency plaguing Rwanda’s health facilities. Many health centers across Rwanda operate without electricity or running water. Health centers serve largely rural populations, 34% of which do not have access to safe water. Unsafe water, coupled with poor sanitation and hygiene, spread disease; in addition to the suffering, the sickness lowers productivity among both working adults and students, making it harder for families and communities to escape poverty. Unsafe water has the greatest impact among children under five. Although Rwanda’s child mortality rates have improved over the past five years, one in ten babies born still don’t live to age five. To increase access to public sources of clean water, the Access Project will kick off a three year partnership with the Center for Global Safe Water at Emory University in May of this year. This initiative will evaluate the feasibility of using membrane filtration to purify water sources at health centers. The project will focus on health education training about water storage, hygiene and sanitation. This new partnership ensures the sustainability of existing campaigns to improve hygiene practices to prevent the transmission of water borne diseases and neglected tropical diseases such as intestinal worms. More than halfway through the Water for Life Decade (2005-2015), the future of clean water for Rwanda is bright. Most Access-supported health centers..to page 3 Gataraga - A New Standard for Musanze ...............................3 Other News..............................................................................4 Staff News................................................................................4

www.theaccessproject.com | Kiyovu, Rue du lac Mpanga, No 2106. PO BOX: 7393 Kigali-Rwanda


RWANDA NEWS Landmark International Conference on Community Health by the Access Project Rwanda hosted the first International Conference on Community Health in Kigali in January. The four-day conference, sponsored by Rwandaʼs Ministry of Health, took place at the Kigali Serena Hotel from January 25th-28th, with the theme: “The Role of Community Health In Strengthening Health Systems.” More than 350 participants from 15 countries took part in the conference, which highlighted Rwandaʼs leadership in community health care through presentations, discussions and field observations. Notable speakers included Paul Farmer (Partners in Health), Rory Nefdt (UNICEF Ethiopia), Dr. Storn Kabuluzi (Ministry of Health - Malawi) and Cathy Mugeni, (Ministry of Health-Rwanda). Rwanda has come a long way since the 1994 genocide, in which close to one million people died. This conference paid tribute to Rwandaʼs past by organizing a field trip to the Gisozi genocide memorial site, to remember those who lost their lives. The conference also served as a testament to the present state of affairs in Rwanda, particularly its model for community health. With the decentralization of its health care system to the community level, Rwanda has made record achievements in strengthening its health care system by focusing on community health initiatives and building the capacity of its health care system. Rwanda, like most of the countries represented, employs community health workers (CHWs) to train and educate their citizens on proper disease management and treatment options. In Rwanda, CHWs are trained through a

grated health care services and products and establishment and facilitation of linkages with the formal health care system. So defined, community health in synergy with other intersectoral interventions results in health competent communities and community members achieving and living more fulfilling lives.”

Panelists at Community Health Conference

series of workshops and work in every village throughout the countryʼs 30 districts. There are districts where CHWs receive additional training and are responsible for different aspects of care such as HIV and end of life care. The level of training for CHWs depends on the interventions put in place by the Ministry of Health in partnership with initiatives like the Access Project, which builds health care capacity and management skills at the community level. Over the four days, representatives from countries such as Pakistan, Malawi, Uganda, Cameroon and East Timor presented on advances and challenges in the field of community health for their respective countries. For example, in Pakistan, CHWs are all women who have a year of formal training on patient care and must have a secondary school education. In Uganda, a faith-based model is employed for community health workers to combat HIV/AIDS. The participants developed a consensus statement at the conclusion of the conference, which defines community health as: “All actions occurring at the community level including disease prevention, promotion of healthy behaviors, delivery of basic inte-

Coupled with the consensus statement is a list of action items for improving community health, which includes expanding service delivery through the use of cell phones and Rapid SMS technology. CHWs are widely seen as the most costeffective way to provide basic medical care to community members, especially in rural or geographically isolated communities, as a result, their scope of work now includes tasks related to maternal and child health, nutrition, and health and trauma emergencies. The ideas and strategies that were developed during the conference have far reaching impacts on the role of community health in the future. While the conference leaders emphasized the important role that community health and community health workers play in strengthening national health systems, they also issued a call to action for greater improvements in training for CHWs and expansion of services provided to patients. To facilitate sharing of ideas and practices beyond the conference, a web-based community health forum was developed and remains available at www.icchrwanda.org. ❏

www.theaccessproject.com | Kiyovu, Rue du lac Mpanga, No 2106. PO BOX: 7393 Kigali-Rwanda


SUCCESS STORIES Gataraga: A New Standard for Musanze

by Yolande Morris for four years and her staff of 16 serves approximately 120 patients per day. With over 44,000 people in the Busogo sector, the health center is often overcrowded as patients from their sector as well as Gataraga seek medical care. “The Gataraga Health Center will be very helpful to us in easing overcrowding and helping pregnant women with emergency conditions,” said Marie.

Gataraga Health Center

In the center of Gataraga, construction workers are putting the final bricks on the exterior of a large building, resplendent with a shiny red roof and large columns. Gataraga is a tiny sector in the district of Musanze, famous for its volcanic mountains and gorillas. Perhaps inspired by the 1988 movie “Gorillas in the Mist,” thousands of tourists travel to Musanze each year to see the mountain gorillas, making it Rwanda’s top destination. Yet this new building - which is causing excitement among the people of Gataraga - isn’t a museum or a hotel. It is a health center. Alice Uwabera has worked as a supervisor for the Gataraga sector office for a number of years. She has seen the population of 21,000 people in her sector suffer from a lack of quality health services. Although Rwanda’s Ministry of Health established guidelines stating that every sector should have its own health center, it isn’t the reality in some places like Gataraga. It is one of many sectors throughout Rwanda that operate without a health center, which leads to an exacerbation of many illnesses and injuries. “The problems that arise from the lack of a health center are numerous. When people are ill, they have to go to another sector to receive care, that means walking two hours by foot to the Busogo or Muhoza

sectors,” said Alice. “Someone with malaria or HIV can get another illness as they are walking, or even a pregnant mother can develop complications. The people here sometimes go to see ‘traditional’ doctors or self-medicate because they don’t want to travel so far.” The Gataraga Health Center is scheduled to open this July and the people of Gataraga will not have to travel more than a short distance to receive medical care. The Access Project, which partners with Rwanda Works to develop health care infrastructure, received financial support from the Pace Family Foundation to build the new health center. The construction team handling this project is the same team that built the new Gashora and Ngeruka health centers in Bugesera last year. Like Gashora and Ngeruka, Gataraga will be a model health center for the Musanze district and will provide comprehensive health services to the people in the sector. The main building will have a waiting area, consultation and procedure rooms, a laboratory room, rooms for maternity, hospitalization, voluntary counseling and testing and antiretroviral drug services, an administrative center, a nutritional center and rooms for health education. Three miles away, Marie Musabyimana, the head nurse for the Busogo Health Center, welcomed the news of the Gataraga Health Center. Marie has been at Busogo

Samuel Niyibigira at the Muhoza health center.

Samuel Niyibigira, the head nurse for the Muhoza Health Center, echoed Marie’s statements, as he stood in the middle of the crowded waiting room. “We have a very small building, six offices for consultation and too many patients,” he said. “With a population of 80,600 people in Muhoza and just 20 nurses on staff, we can’t afford any new patients, especially from another sector. A new health center is necessary here in town. We need about three health centers in this area, but the Gataraga health center will help with the overcrowding here,” said Samuel. One health center in the middle of Gataraga will affect the lives of over 145,600 people as it will offer critical services to the patients in its sector, while relieving the burden on two other sectors. ❏

World Water Day...from page 1 now have sinks with running water and serve to demonstrate safe water practices to their surrounding communities. Within the next few years, Access and its partners will continue to ensure running water in our supported health centers and provide training for good

hygiene and sanitation practices. For the next World Water Day, Rwandans can envision a future where water will no longer be a source of contamination and disease, but rather a source of life, health and dignity. ❏

www.theaccessproject.com | Kiyovu, Rue du lac Mpanga, No 2106. PO BOX: 7393 Kigali-Rwanda


OTHER NEWS Rusoro Health Center Outfitted with New Sinks install eight sinks in critical areas of the center, including hospitalization. Their biggest achievement, however, was installing a sink outside of the toilets. The nurses at the health center have taught patients that they should wash their hands after using the bathroom, and now they can actually do it! The total cost of the project was about $940, which was split between the $500 grant awarded by Water Charity and the health center.

Hand-washing at Rusoro

At the Rusoro Health Center in the Gakenke District, the health center manager Zacharie is smiling as he heads to one of the newly installed sinks in the facility. Until recently, the staff did not have access to running water at the center to wash their hands after consulting with patients. “These sinks have drastically improved the hygiene conditions here. This is good for the patients and the staff,” Zacharie said. Kitty Hall, a Peace Corps Volunteer (PCV) with the Access Project in Gakenke, applied for a grant from Water Charity for Rusoro upon seeing the succesful installation of sinks with running water in the Musanze and Bugesera districts. After being awarded the grant, the Rusoro Health Center was able to

Not only can staff members model proper hand-washing techniques to patients, but they can also take care of any plumbing issues that arise. Kitty said “A staff member at the center participated in the training session we had on basic plumbing. He said that he has all the skills to fix any problem that comes up with the eight new sinks.” The staff from the Rusoro Health Center appreciate this wonderful opportunity to improve their working conditions and provide better care to patients. They hailed the efforts of both the Access Projectʼs PCVs and Water Charity in making Rusoro more hygienic. In light of this latest success, plans are underway to install running water in other health centers in Gakenke and other Access supported districts such as Ngoma and Rwamagana. ❏

STAFF NEWS Yolande Morris - joins the Access team as a Pfizer Global Health Fellow. Yolande who has worked for the worldʼs largest pharmaceutical company for the past eight years, will lend her skills to the Communications and Media department where she will develop communications strategy, articles and story ideas for the Access staff. Leoncie Uwamurera - joins the Access team as a Supervisor for the Single Stream Funding /Tuberculosis Program. Leoncieʼs responsibilities include strengthening existing cooperatives and associations of TB patients through hands-on training and monitoring of activities. Violette Mfitumukiza - joins the Access Team as a Supervisor for the Single Stream Funding/ Tuberculosis Program. Violetteʼs responsibilities include empowering communities to actively participate in problem identification, planning and monitoring of community programs. Emmanuel Bagiruwigize – joins the Access team as the District Health Advisor for Musanze and Nyabihu districts. Emmanuel will be responsible for conducting health center management assessments and providing hands-on managerial and technical support to all health centers in both districts.

Credit and Contact Information Written by: Access Project staff Photos: Yolande Morris, Kitty Hall, Rwanda Bureau of Information and Broadcasting Contact: mstricker@ei.columbia.edu (U.S.A.) raissak@theaccessproject.com (Rwanda) Find us online at: www.theaccessproject.com or www.facebook.com/theaccessproject All rights reserved © 2011 www.theaccessproject.com | Kiyovu, Rue du lac Mpanga, No 2106. PO BOX: 7393 Kigali-Rwanda


Access Project Newsletter- May 2011