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Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda

Igras, S., Sinai, I., Mukabatsinda, M., et al. , Eds.: Global Health: Science and Practice, (2014)


There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections. Four lessons learned illustrate this crucially important approach. First, ongoing M&E data showed that provider training protocols and client materials that worked in the pilot phase did not work at scale; therefore, we simplified these materials to support integration into the national program. Second, triangulation of ongoing monitoring data with national health facility and population-based surveys revealed serious problems in supply chain mechanisms that affected SDM (and the accompanying CycleBeads client tool) availability and use; new procedures for ordering supplies and monitoring stockouts were instituted at the facility level. Third, supervision reports and special studies revealed that providers were imposing unnecessary medical barriers to SDM use; refresher training and revised supervision protocols improved provider practices. Finally, informal environmental scans, stakeholder interviews, and key events timelines identified shifting political and health policy environments that influenced scale-up outcomes; ongoing advocacy efforts are addressing these issues. The SDM scale-up experience in Rwanda confirms the importance of monitoring and evaluating programmatic efforts continuously, using a variety of data sources, to improve program outcomes.
http://www.ghspjournal.org/content/ghsp/2/2/234.fu...


Pathways to progress: a multi-level approach to strengthening health systems

Samuels, F., Amaya, A.B., Rodríguez Pose, R. and Balabanova, D., Eds.: Overseas Development Institute, (2014)


Findings on maternal and child health in Nepal, Mozambique and Rwanda, and neglected tropical diseases in Cambodia and Sierra Leone | This report synthesises findings from five country case studies from the health dimension of this project, which focus on maternal and child health (MCH) (Mozambique,Nepal, Rwanda) and neglected tropical diseases (NTDs)(Cambodia, Sierra Leone). MCH was selected given its centrality in two of the Millennium Development Goals (MDGs) and its ability to act as a proxy for strengthened health systems. NTDs, while until recently relatively neglected in global policy debates, are now attracting more interest, not least because they are viewed as diseases of the poor whose treatment could positively impact on most of the other MDGs.
https://www.odi.org/sites/odi.org.uk/files/odi-ass...


Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000–2010: a systematic review

Maurice Bucagu, Jean M. Kagubare, Paulin Basinga, Fidèle Ngabo, Barbara K Timmons & Angela C Lee, Eds.: Reproductive Health Matters, (2012)


From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public health system, with the aim of reducing maternal and newborn deaths in line with Millennium Development Goal 5, among many other improvements in national health. Based on a systematic review of the literature, national policy documents and three Demographic & Health Surveys (2000, 2005 and 2010), this paper describes the reforms and the policies they were based on, and provides data on the extent of Rwanda’s progress in expanding the coverage of four key women’s health services. Progress took place in 2000–2005 and became more rapid after 2006, mostly in rural areas, when the national facility-based childbirth policy, performance-based financing, and community-based health insurance were scaled up. Between 2006 and 2010, the following increases in coverage took place as compared to 2000–2005, particularly in rural areas, where most poor women live: births with skilled attendance (77% increase vs. 26%), institutional delivery (146% increase vs. 8%), and contraceptive prevalence (351% increase vs. 150%). The primary factors in these improvements were increases in the health workforce and their skills, performance-based financing, community-based health insurance, and better leadership and governance. Further research is needed to determine the impact of these changes on health outcomes in women and children.
https://www.tandfonline.com/doi/pdf/10.1016/S0968-...


Identifying characteristics associated with performing recommended practices in maternal and newborn care among health facilities in Rwanda: a cross-sectional study

Sipsma, H.L., Curry, L.A., Kakoma, J.P., Linnander, E.L., & Bradley, E.H., Eds.: Human Resources for Health, (2012)


This study examined the quality of facility-based maternal and newborn health care by describing the implementation of recommended practices for maternal and newborn care among health care facilities to determine whether increased training, supervision, and incentives for health workers were associated with implementing these recommended practices.
https://human-resources-health.biomedcentral.com/t...


Using Performance Incentives to Improve Health Outcomes

Gertler, P. & Vermeersch, C., Eds.: The World Bank, (2012)


Policy Research Working Paper 6100 | Impact Evaluation Series No. 60 | This study examines the effect of performance incentives for health care providers to provide more and higher quality care in Rwanda on child health outcomes. The authors find that the incentives had a large and significant effect on the weight-for-age of children 0–11 months and on the height-for-age of children 24–49 months. They attribute this improvement to increases in the use and quality of prenatal and postnatal care. Consistent with theory, They find larger effects of incentives on services where monetary rewards and the marginal return to effort are higher. The also find that incentives reduced the gap between provider knowledge and practice of appropriate clinical procedures by 20 percent, implying a large gain in efficiency. Finally, they find evidence of a strong complementarity between performance incentives and provider skill .
http://documents.worldbank.org/curated/en/40236146...


Rwanda: National Integrated Child Rights Policy

Ministry of Gender and Family Promotion, Government of Rwanda, (2011)


It is the policy of the GoR to ensure that children’s rights are met through the provision of basic needs and services for all children in the country, and protect them from abuse and exploitation. Children are defined as persons below the age of 18 years and the ICRP covers children from the time before their birth until they complete the age of 18 years. The Integrated Child Rights Policy of Rwanda is based on seven key themes: Identity and Nationality; Family and Alternative Care; Survival, Health and Standards of Living; Education; Protection; Justice; and Child Participation.
http://www.ncc.gov.rw/fileadmin/templates/document...


Rwanda: EARLY CHILDHOOD DEVELOPMENT POLICY

Ministry of Education, Rwanda, (2011)


The Early Childhood Development Policy and its Strategic Plan seek to provide a framework to ensure such a holistic and integrated approach to the development of young children. International research has demonstrated the high economic returns on ECD investment and its positive impact on health and education outcomes as well as the overall economic development of a nation. The implementation of the ECD Policy will thus provide Rwanda with the basis for achieving the objectives and goals of the EDPRS and Vision 2020.
http://www.ncc.gov.rw/fileadmin/templates/document...


Rwanda: National Policy for Orphans and Other Vulnerable Children

Ministry of Local Government, Information and Social Affairs (Rwanda), (2003)


The following document outlines the principles, objectives and strategies of a national policy for the protection of orphans and other vulnerable children in Rwanda. The propositions constitute a first step towards a comprehensive framework, which will assist the Government and its partners to plan, implement and monitor projects and programmes in favour of orphans and other vulnerable children.
http://www.ncc.gov.rw/fileadmin/templates/document...


Rwanda DHS Analysis of Trends in Use of Modern Contraception

Track20, Avenir Health (analysis); DHS (data), (2018)


Accessed Online June 2018 | Single-page summary highlighting trends in modern contraceptive prevalence in Rwanda using data from the Demographic & Health Surveys.
http://www.familyplanning2020.org/entities/81


Exploring Opportunities for mCPR Growth in Rwanda

Track20, (2018)


Accessed Online June 2018 | When assessing potential opportunities for family planning, it is important to consider a wide range of areas related to demand for contraception, availability and access to services, quality and equity, and the enabling environment. This opportunity brief brings together a range of data sources to allow for exploration of these key areas. This brief is meant to provide an overview of key data and population segmentations to spark conversations about prioritization and potential impact. Further analysis, including additional segmentation by residence or region may reveal additional nuances.
http://www.familyplanning2020.org/entities/81


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