DOCSLIB.ORG

Understanding Variation in Maternal Health Service Coverage and 2 Maternal Health Outcomes Among Districts in Rwanda

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Understanding Variation in Maternal Health Service Coverage and 2 Maternal Health Outcomes Among Districts in Rwanda bioRxiv preprint doi: https://doi.org/10.1101/516112; this version posted January 9, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 1 Understanding variation in maternal health service coverage and 2 maternal health outcomes among districts in Rwanda 3 4 Felix Sayinzoga1 5 Maternal, Child and Community Health Division 6 Rwanda Ministry of Health/ Rwanda Biomedical Center 7 Kigali, Rwanda 8 E-mail:[email protected] 9 PO Box 84 Kigali 10 Phone:+250788517814 11 12 Tetui Moses2 13 Makerere University School of Public Health 14 PO Box 7072, Kampala, Uganda 15 E-mail: [email protected] 16 17 Koos van der Velden3 18 Department of Primary and Community Care 19 Radboud University Medical Centre 20 Nijmegen, The Netherlands 21 E-mail: [email protected] 22 23 Jeroen van Dillen4 24 Department of Obstetrics and Gynaecology 25 Radboud University Medical Centre 26 Nijmegen, The Netherlands 27 E-mail: [email protected] 28 Leon Bijlmakers5 29 Department for Health Evidence 30 Radboud University Medical Centre 31 Nijmegen, The Netherlands 32 E-mail: [email protected] 33 Tel: +31 243613337 34 Corresponding author 35 1 bioRxiv preprint doi: https://doi.org/10.1101/516112; this version posted January 9, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 36 Abstract 37 Objective: To identify factors that explain variations between districts in maternal 38 health service coverage and maternal health outcomes. 39 Methods: Individual key informant interviews and focus group discussions using 40 structured topic lists were conducted in May 2015 in four purposively selected 41 districts. 42 Results: The solidarity support for poor people and the interconnectedness between 43 local leaders and heads of health facilities were identified as enablers of health service 44 utilization. Geographical factors, in particular location close to borders with mobile 45 populations and migrants, and large populations with sparsely distributed health 46 infrastructure, exacerbated by hilly topography and muddy roads were identified as 47 barriers. Shortages of skilled health providers at the level of district hospitals were 48 cited as contributing to poor maternal health outcomes. 49 Conclusion: There is a need to take into account disparities between districts when 50 allocating staff and financial resources in order to achieve universal coverage for 51 high-quality maternal health services and better outcomes. Local innovations such as 52 the use of SMS and WhatsApp text messages by health workers and financial 53 protection schemes for poor patients improve solidarity and are worth to be scaled up. 54 55 Keywords: Rwanda, maternal health, district performance, disparities, local 56 innovations 57 2 bioRxiv preprint doi: https://doi.org/10.1101/516112; this version posted January 9, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 58 Introduction 59 Worldwide in 2015, an estimated 303,000 women died due to complications of 60 pregnancy or childbirth [1]. Most of them died because of severe bleeding after 61 childbirth, infections, hypertensive disorders or unsafe abortions. Low and middle 62 income countries account for 99% of these deaths, with sub-Saharan Africa alone 63 accounting for roughly two-thirds (201,000 deaths in 2015) [1]. Maternal mortality is 64 one of the health outcomes that typically show very wide gaps between rich and poor 65 populations [1]. 66 The 2014/15 Demographic and health survey (DHS) in Rwanda estimated the 67 maternal mortality ratio (MMR) at 210 deaths per 100,000 live births [2], which is 68 significantly less than the ratios reported in the 2010 DHS (476 per 100,000) and the 69 2000 DHS (1071 per 100,000) [3,4]. Although everything points to significant 70 improvements, deaths related to pregnancy and childbirth are still too common and 71 will need to be reduced further in order to reach the SDG target MMR of 70 per 72 100,000 by the year 2030. 73 Globally, health service coverage rates have increased but many countries are still a 74 long way from universal coverage for most essential reproductive, maternal, newborn 75 and child health (RMNCH) interventions. Furthermore, intra-country variations in 76 service coverage rates are reducing in most countries but the pace is slow. The main 77 impediments to the delivery of high-quality services are a combination of health 78 sector specific and non-health sector drivers [5]. Reliable and timely information is 79 required for effective remedial action at local, regional and national health sector 80 management levels, in order to address intra-country inequalities in maternal health 81 care. 3 bioRxiv preprint doi: https://doi.org/10.1101/516112; this version posted January 9, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 82 The present study was conducted to obtain an in-depth understanding of the factors 83 that explain variations between districts in maternal health outcomes, including 84 certain emergency obstetric care indicators, and identify the prevailing barriers and 85 enablers to improve maternal health. 86 Materials and Methods 87 Study setting 88 We performed a mixed-methods study combining individual interviews and focus 89 group discussions that were conducted in May 2015 in four districts: Bugesera, 90 Gicumbi, Nyagatare and Rwamagana. These districts had a combined population of 91 around 1.65 million people [6-9; see Table 1]. 92 93 Table 1: Demographic and geographic information Bugesera Gicumbi Nyagatare Rwamagana Province Eastern Northern Eastern Eastern Area 1,288 km2 829 km2 1,741 km2 682 km2 Population in 2013 361,914 395,606 466,944 313,461 Population density 280/km2 480/km2 243/km2 460/km2 # of health centres 16 24 21 15 # of hospitals 1 1 1 1 Distance to Kigali 35 km 55 km 161 km 60 km 94 95 96 The districts were chosen on the basis of their performance on a set of key maternal 97 health indicators, which included four service coverage, four service process 98 indicators and four health outcomes, according to data reported in 2013 through the 4 bioRxiv preprint doi: https://doi.org/10.1101/516112; this version posted January 9, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. 99 national health formation system (Table 2) [10]. Bugesera district was selected 100 because of its relatively good performance on all three types of indicators. Gicumbi 101 district was chosen because of its good performance on health outcome indicators, but 102 poor performance on service coverage indicators, which seemed rather contradictory. 103 For Rwamanaga it was the reverse: high service coverage rates, but poor health 104 outcome indicators. Nyagatare was included in the study because of its relatively poor 105 overall performance in 2013. 106 107 Table 2: Selected key indicators for the four districts in 2013 and the national 108 average (rank numbers indicated in brackets, <1> indicating the best performing 109 district, and <30> the worst performing district).* National Bugesera Gicumbi Nyagatare Rwamagana average district district district district (range) Service coverage indicators Pregnant women with 1st antenatal 51% 34% 46% 69% 45% care visit in 1st trimester of <11> <22> <12> <3> (15-84) pregnancy Pregnant women with four or 42% 27% 22% 62% 35% more standard antenatal care visits <9> <20> <24> <3> (9-74) 4.5% 3.1% 9.1% 4.4% 4.5% Deliveries at home <17> <11> <28> <15> (0.6-10.3) Women who delivered and 65% 60% 63% 63% 58% attended at least one postnatal <11> <18> <13> <14> (22-86) care visits Process indicators 2-5 Tetanus toxoid vaccinations 66% 67% 59% 70% 74% received <26> <24> <30> (18> (59-100) High-risk pregnancies detected 3.9% 9.4% 6.1% 6.9% 9.4% during antenatal care visits <n/a> <n/a> <n/a> <n/a> (3.9-32.3) High risk pregnancies referred 76% 20% 27% 26% 43% during antenatal care visits <1> <27> <22> <24> (7-76) Women with (pre-)eclampsia who 77% 28% 80% 71% 95% received magnesium-sulphate <16> <27> <14> <18> (0-100) 14% 11% 11% 16% 14% Caesarean sections <n/a> <n/a> <n/a> <n/a> (3-34) Health outcomes Still births fresh, ≥22 weeks or 0.7% 0.9% 1.2% 1.1% 0.9% >500 grams <7> <16> <27> <23> (0.4-1.5) Still births macerated, ≥22 weeks 1.0% 0.8% 1.3% 1.2% 1.0% or >500 grams <17> <8> <28> <26> (0.5-1.5) 5 bioRxiv preprint doi: https://doi.org/10.1101/516112; this version posted January 9, 2019. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license.
Load more

Recommended publications
  • Rwanda Irrigation Master Plan
    Rwanda Irrigation Master Plan The Government of Rwanda, Ministry of Agriculture & Animal Resources Ebony Enterprises Ltd The World Agroforestry Centre (ICRAF) Rwanda Irrigation Master Plan The Government of Rwanda, Ministry of Agriculture & Animal Resources Ebony Enterprises Limited The World Agroforestry Centre (ICRAF) i Rwanda Irrigation Master Plan The Government of Rwanda, Ministry of Agriculture & Animal Resources Ebony Enterprises Limited The World Agroforestry Centre (ICRAF) Coordinators of IMP Study: NGABONZIZA Prime MAIMBO Mabanga Malesu Supervisor of IMP study: DVOSKIN Dan Authors: MAIMBO Mabanga Malesu ODUOR Alex Raymonds KIPRUTO Cherogony NYOLEI Douglas GACHENE Charles BIAMAH Elijah Kipngetich O’NEIL Mick MIYUKI Ilyama JEPHINE Mogoi Steering Committee Members: SENDEGE Norbert NGABONZIZA Prime NZEYIMANA Innocent MUSABYIMANA Innocent MUSABYIMANA J. Claude AZENE BEKELE Tesemma KAGABO Desire HARINDINTWALI Reverien BAYOULI Amor MOULAYE Abdou Enterprises Ltd. Republic of Rwanda Ministry of Agriculture and Animal Resources, MINAGRI ii Acknowledgement The World Agroforestry Centre greatly appreciates the opportunity accorded by the Managing Director of Ebony Enterprises Limited, Brigadier General (Rtd) Danny Kassif, to participate in the Rwanda Irrigation Master Plan through a sub-contractual agreement signed in March 2009. Upon inception of Phase I study, a number of Ebony personnel provided administrative and logistical support which cannot go unrecognized. These include Pini Moria, Ram Lustgarten, Arik Almog, Adina Avisar and Avi Evron. Cognizance is also extended to the Ministry of Agriculture and Animal Resources for providing technical backstopping and logistical support while carrying out the study in Rwanda. The following Officers are highly appreciated for their contributions to ensuring that Phase I of the study was a success: The Permanent Secretary – MINAGRI, Mr.
    [Show full text]
  • RWANDA Poverty Assessment
    RWANDA Poverty Assessment April 2015 Public Disclosure Authorized Poverty Global Practice Africa Region Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized April 2015 1 ׀ RWANDA Poverty Assessment April 2015 ׀ RWANDA Poverty Assessment 2 RWANDA Poverty Assessment Poverty Global Practice Africa Region April 2015 3 ׀ RWANDA Poverty Assessment Table of Contents ABBREVIATIONS AND ACRONYMS ................................................................................................10.... I ACKNOWLEDGEMENTS ........................................................................................................................... VIII11 EXECUTIVE SUMMARY ..............................................................................................................................12 IX 1. A Snapshot of Poverty in Rwanda ..........................................................................................................................12ix Rwanda‘s Poverty Profile: The Expected… ............................................................................................................13 x And the Rather Unexpected … .............................................................................................................................15 xii Inequality is high, driven by location, education, and occupation .......................................................................16 xiii Strong performance in health and basic education ................................................................................................17
    [Show full text]
  • The Study on Improvement of Rural Water Supply in the Eastern Province in the Republic of Rwanda
    MININFRA EASTERN PROVINCE REPUBLIC OF RWANDA THE STUDY ON IMPROVEMENT OF RURAL WATER SUPPLY IN THE EASTERN PROVINCE IN THE REPUBLIC OF RWANDA FINAL REPORT MAIN REPORT November 2010 JAPAN INTERNATIONAL COOPERATION AGENCY JAPAN TECHNO CO., LTD. NIPPON KOEI CO., LTD. GED JR 11-022 UGANDA RWANDA D.R.CONGO MUSHELI MATIMBA Northern Province 0 5 10 25km Eastern Province RWEMPASHA Western Province KIGALI RWIMIYAGA TABAGWE Southern Province NYAGATARE KARAMA RUKOMO TANZANIA BURUNDI KIYOMBE GATUNDA NYAGATARE KARANGAZI MIMULI KATABAGEMU MUKAMA NGARAMA RWIMBOGO NYAGIHANGA KABARORE GATSIBO GATSIBO GITOKI SUMMARY OF STUDY KAGEYO MURUNDI Study Area : 95 Secteurs of 7 Districts in Eastern Province REMERA RUGARAMA Design Population : 2,641,040 (2020) MUHURA Planned Water Supply Scheme : 92 KIZIGURO (Piped scheme : 81, Handpump scheme : 11) Planned Pipe Line 3,000 km MURAMBI RUKARA GAHINI Replace existing pipe 170 km GASANGE KIRAMURUZI Intake Facilities (spring) 28 MWIRI Intake Facilities (river) 3 FUMBWE Handpump (borehole) 37 MUHAZI KAYONZA MUSHA GISHARI MUKARANGE Existing Facilities (Out of Scope) MUNYIGINYA Existing Pipe Line GAHENGERI NYAMIRAMA RWINKWAVU Existing Water Source KIGABIRO Existing Handpump (working) MWULIRE NDEGO MUYUMBURWAMAGANA RURAMIRA NZIGE KABARONDO MUNYAGA NYAKARIRO MURAMA RUBONA REMERA MWOGO KABARE KARENGE MPANGA RURENGE NTARAMA JURU MUGESERA KAREMBO NASHO KIBUNGO NYAMATA RUKIRA ZAZA RILIMA RUKUMBERI GASHANDA MUSENYI NGOMA MUSHIKIRI KAZO MURAMA NYARUBUYE GASHORA SAKE SHYARA BUGESERAMAYANGE KIGINA KIREHEKIREHE MAREBA MAHAMA MUTENDERI JARAMA GATORE NYARUGENGE NGERUKA RUHUHA RWERU NYAMUGALI MUSAZA KIGARAMA GAHARA KAMABUYE THE STUDY ON IMPROVEMENT OF RURAL WATER SUPPLY IN THE EASTERN PROVINCE TARGET AREA MAP TABLE OF CONTENTS Target Area Map List of Tables List of Figures Abbreviations Page CHAPTER 1 INTRODUCTION 1.1 Study Background ………………………….……...…………………………..
    [Show full text]
  • Resettlement Action Plan Estimates/ Budget
    Resettlement Action Plan For Selected Feeder Roads in the District of Karongi in Rwanda - Project ID: P 126498 REPUBLIC OF RWANDA Public Disclosure Authorized Public Disclosure Authorized MINISTRY OF AGRICULTURE AND ANIMAL RESOURCES (MINAGRI) RWANDA FEEDER ROADS DEVELOPMENT PROJECT (RFRDP) FINAL REPORT Public Disclosure Authorized UPDATED RESETTLEMENT ACTION PLAN FOR SELECTED FEEDER ROADS OF KARONGI DISTRICT Prepared in November 2013 and Revised in February 2017 Public Disclosure Authorized | P a g e PROJECT BASIC DATA No Description Impacts in Quantity 1 District Karongi 2 Province Western Province Construction/Rehabilitation/upgr ading of Roads, Drainage and 3 Planned Civil works Bridges 4 Cost of Civil works (priority roads for 72.25 km) 6,816,881 million $ 5 Cost by km 92,495 USD 6 Cost of RAP 151,534,305 Frw 7 Number of households to be physically displaced 38 8 Private fences affected in meters 13,094 9 Number of institutional buildings affected fully 1 10 Number of institutional buildings affected partially No 11 Number of institutional fences in meters No Loss of agricultural lands permanently in 22.41 12 hectares* 13 Loss of Crops and trees in hectares 19.99 14 settlements in Hectares 2.42 15 Number of households who lose strips of lands in 1,021 RoW 16 Loss of trees in Number 30,000 17 Loss of telephone line affected in meters No 18 Public water taps 2 19 Cemeteries No 20 Partially affected households 983 21 Total number of project affected households 1,021 22 Project Affected Persons (PAPs) 5,105 2 | P a g e EXECUTIVE SUMMARY Rwanda has four provinces (East, West, North and South) and Kigali City1.
    [Show full text]
  • Use of Agroforestry Practices in Soil and Water Conservation
    USE OF AGROFORESTRY PRACTICES IN SOIL AND WATER CONSERVATION A CASE STUDY OF KAGEYO SECTOR, GICUMBI DISTRICT, RWANDA BY MUTONI JOAN BEMJ10006/$1/DU A DISSERTATION SUBMITTED IN PARTIAL FULFILMENT FOR THE AWARD OF A BACHELOR OF SCIENCE DEGREE IN ENVIRONMENT MANAGEMENT OF KAMPALA INTERNATIONAL UNIVERSITY May, 2011 DECLARATION I Mutoni Joan, declare that all that is included in this work is my own effort and has not been presented by any other student for the award of a degree or its equivalent in this institution or any other. Where other individuals, groups, authors, organizations, reports and others have been used has clearly been indicated. STIJDENT: MUTONI JOAN (BEMJI0006/8l/DTJ) SIGNITURE DATE: APPROVAL This research report entitled Use of agroforestry practices in soil and water conservation; A Case Study of Kageyo sector, Gicumbi District, Rwanda”, is submitted to Kampala International University, School of Engineering and Applied Sciences with my approval as the Supervisor. SUPERVISOR: MR.ORJSHABA R. AMMON SIGNITURE DATE’ ii DEDICATION I dedicate this piece of work to my father Kabanda P.Claver and my mother Kabanda Annah whose heartfelt courage, kindness and love enabled me reach this far. iii ACKNOWLEDGEMENTS I would like to express my sincere thanks to Almighty for the gift of life, wisdom and understanding He has given to me throughout my education. On the same note my heartfelt gratitude to my parents, Kabanda P.Claver and Kabanda Annah whose financial, material and emotional support enabled me go through my learning time, with their all seasons combined efforts to make my carrier a success.
    [Show full text]
  • Bugesera District Burera District Gakenke District Gasabo District
    Progress, but more effort Target achieved / on track Not on track N/A No data required Increase from last period Decrease from last period Proportion of Measles & Percentage of Proportion of Percentage of women Percentage of Rubella 2nd Delivery in Percentage of Newborn who new-born not Neonatal teenage receiving ANC 1 during ANC 4th mothers who dose (MR2) facility mother who received PNC 4 breathing service case delivery (19 postpartum 1st trimester standard visit Penta 3 received coverage, all coverage (w/ received PNC 4 Visit at 6 weeks successfully fatality years and Family coverage coverage BCG coverage coverage Iron+folic acid ages (BCG census-based Visit at 6 weeks after birth_new resuscitated rate_new under) planning (based on CBR) (based on CBR) (census-based) (census-based) during ANC denominator) target) 51.7 52.7 50.3 7.9 7.2 41.4 52 42.3 117 118.4 91.5 112.8 108 Bugesera District 76 75.3 84.3 5.3 8.3 71.6 51.7 40.5 84.8 87.4 96.7 121.2 69 Burera District 59.2 59.5 60.3 6.7 10.4 39.6 55.4 37.8 78.7 81.9 99.9 116.8 83 Gakenke District 24.4 24.5 70.7 4.4 3.3 28.3 52.8 35.7 123.2 117 59.6 87.7 124 Gasabo District 78.6 78 73.4 9.1 9.1 55 41.1 38 86.5 98.5 89.7 107.6 84 Gatsibo District 63.1 64.1 82 17.1 6.8 85.4 48.2 39.3 87.4 90.7 99 110.4 91 Gicumbi District 78.4 78.3 85.4 10.5 5.5 46.3 70.2 53.1 100.3 108.7 100 114.4 94 Gisagara District 61.6 63.2 68.2 15 4.4 64.5 50.8 36.1 91.5 89.8 100 101.1 95 Huye District 56 57.2 82.2 14.6 6.9 73.2 34.6 26.4 74.2 79.9 75.7 122.5 59 Kamonyi District 52.9 53 74.4 2.7 5.6 61.2 33.1 24
    [Show full text]
  • TWUBAKANE Decentralization and Health Program Rwanda
    TWUBAKANE Decentralization and Health Program Rwanda QUARTERLY PERFORMANCE MONITORING REPORT #18 APRIL— JUNE 2009 USAID/Rwanda Cooperative Agreement # 623-A-00-05-00020-00 Distribution: USAID/Rwanda Twubakane Team Partners Government of Rwanda Ministry of Local Administration Ministry of Health National AIDS Control Commission Twubakane Steering Committee Members Twubakane Partner Districts NGOs, Bilateral and Multi-lateral Partner Agencies Twubakane Quarterly Report #18, April-June, 2009 TABLE OF CONTENTS ACRONYMS ..................................................................................................................................... 1 TWUBAKANE PROGRAM HIGHLIGHTS APRIL-JUNE, 2009 ............................................................ 2 1. INTRODUCTION .................................................................................................................... 3 2. KEY ACCOMPLISHMENTS AND PROGRESS .......................................................................... 3 2.1 TWUBAKANE PROGRAM FIELD OFFICES ............................................................................ 4 3. PERFORMANCE REVIEW BY PROGRAM COMPONENT ........................................................ 4 3.1 FAMILY PLANNING/REPRODUCTIVE HEALTH ACCESS AND QUALITY .............................. 4 3.2 CHILD SURVIVAL, MALARIA AND NUTRITION ACCESS AND QUALITY .............................. 7 3.3 DECENTRALIZATION PLANNING, POLICY AND MANAGEMENT ....................................... 10 3.4 DISTRICT-LEVEL CAPACITY BUILDING ..........................................................................
    [Show full text]
  • Kivuye in Burera District Final
    REPUBLIC OF RWANDA Ministry of Infrastructure ENERGY WATER AND SANITATION AUTHORITY (EWSA) Electricity Access Rollout Programme (EARP) Head Office: Avenue de l’ Ihema, P.O.Box 537, Kigali-Rwanda Tel: +(250)252573666 Fax: +(250)(0)252573802 E-mail: [email protected] Website: www.ewsa.rw PROJECT BRIEF FOR THE INSTALLATION OF LOW VOLTAGE AND MEDIUM VOLTAGE LINES AND SERVICE CONNECTIONS IN BUNGWE – KIVUYE - GATEBE AREA IN BURERA DISTRICT December 2011 1 LIST OF ACRONYMS ............................................................................................................ 5 0. BACKGROUND .................................................................................................................. 6 I. DESCRIPTION OF THE PROJECT ................................................................................. 8 I.1. INTRODUCTION ........................................................................................................................... 8 I.2. OBJECTIVES OF THE PROJECT ............................................................................................... 8 I.3. PROJECT ACTIVITIES ................................................................................................................ 9 I.4. CONSTRUCTION PROGRAMME ..............................................................................................10 I.5. TECHNICAL DESCRIPTION ......................................................................................................10 Description of Works ....................................................................................................
    [Show full text]
  • Rwanda Economic Activity and Opportunity for Refugee Inclusion
    Report No: AUS0000807 . Rwanda Public Disclosure Authorized Economic Activity and Opportunity for Refugee Inclusion . Public Disclosure Authorized May 23, 2019 . URS . Public Disclosure Authorized Public Disclosure Authorized . © 2019 The World Bank 1818 H Street NW, Washington DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved This work is a product of the staff of The World Bank. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of the Executive Directors of The World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encourages dissemination of its knowledge, this work may be reproduced, in whole or in part, for noncommercial purposes as long as full attribution to this work is given. Attribution—Please cite the work as follows: “World Bank (2019) Rwanda: Economic Activity and Opportunity for Refugee Inclusion. © World Bank.” All queries on rights and licenses, including subsidiary rights, should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: [email protected]. 2 Rwanda: Economic Activity and Opportunity for Refugee Inclusion (P169985) Ministry in Charge of Emergency Management World Bank May 2019 3 Acknowledgements This report was prepared by joint team from the Government of Rwanda’s Ministry in Charge of Emergency Management (MINEMA) and the World Bank.
    [Show full text]
  • Explaining Imihigo Performance in Gicumbi District, Rwanda: the Role of Citizen Participation and Accountability (2009-2014)
    Explaining Imihigo Performance in Gicumbi District, Rwanda: The role of Citizen Participation and Accountability (2009-2014) A Research Paper presented by: Innocent NDAHIRO (RWANDA) in partial fulfilment of the requirements for obtaining the degree of MASTER OF ARTS IN DEVELOPMENT STUDIES Major: Governance, Policy and Political Economy GPPE Specialization: Public Policy and Management Members of the Examining Committee: Supervisor : Dr Helen Hintjens Second reader : Dr Joop de Wit The Hague, The Netherland, December, 2015 Disclaimer: This document represents part of the author’s study programme while at the Institute of Social Studies. The views stated therein are those of the author and not necessarily those of the Insti- tute. Inquiries: Postal Address: Institute of Social Studies P.O. Box 29776 2502 LT The Hague The Netherlands Location: Kortenaerkade 12 2518 AX The Hague The Netherlands Telephone: + 31704260460 Fax: + 31704260799 i Acknowledgements My sincere and deepest gratefulness go to my supervisor Dr. Helen Hintjens and my second reader Dr. Joop de Wit, for their intellectual advice, guidance, encouragement and regular dis- cussions which were very valuable and inspiring in the process of research writing, research un- dertaking and field working. I thank the Government of Rwanda, Ministry of Local Government for supporting me during the period of my master’s programme in the Netherlands. I acknowl- edge NUFFIC for funding this study and for the scholarship for my studies at ISS. My sincere thanks go to the staff of International Institute of Social Studies of the Erasmus University of Rotterdam, GPPE students for all the support during my study period at the ISS.
    [Show full text]
  • Rwanda 2002 -2006’, Kigali, Commission’, Final Report, December 2005
    Annex A DOCUMENTS REVIEWED Askwith, Michael and Claudine Zaninka, Institute for Justice and Reconciliation, ‘Report of the Mid-Term Review Mission ‘Evaluation and Impact Assessment of the UNDP Country Cooperation of the National Unity and Reconciliation Framework for Rwanda 2002 -2006’, Kigali, Commission’, Final Report, December 2005. Rwanda, 2004. International Crisis Group, ‘Rwanda at the Ballabola, Stella, ‘Perceptions about the Gacaca End of Transition: A Necessary Political Law in Rwanda,’ Centre for Conflict Liberation’, Africa Report No 53, Management, Butare, Rwanda. November 2002. Jourdaan, Eduard, ‘Inadequately Self-Critical: Barnett, Michael, The United Nations and Rwanda’s Self-Assessment for the African Rwanda: Eyewitness to a Genocide, Cornell Peer Review Mechanism’, African Affairs, University Press, Ithaca, New York, 2002. Vol. 105, No. 420, April 2006, pp 333-351. Bartholomeeussen, Stan and David Twahira, Kayumbe, Christopher, Jean-Paul Kimonyo ‘Appraisal of the Decentralisation Process in and Noel Twagiramungu, ‘Supporting the Rwanda’, The Hague, September 2003. Post-Genocide Transition in Rwanda,’ Clay, Daniel, Thomas Reardon, and Jaakko Netherlands Institute of International Kangasniemi, ‘Sustainable Identification in Relations Conflict Research Unit, the Highland Tropics: Rwandan Farmers’ December 2004. Investments in Land Conservation and Soil Kairaba, A, ‘Integrating Land Issues into PRS Fertility’, Economic Development and and the Broader Development Agenda— Cultural Change, Vol. 46, No. 2, January Rwanda Country Case Study’, paper 1998, pp 351-377. presented at regional workshop on land issues in Africa and the Middle East, The East African Centre for Constitutional Kampala, Uganda, 29 April - 2 May 2002. Development, Searching for Sense and Humanity: Civil Society and the Struggle for Kituo Cha Katiba – East African Centre for Constitutional Development, ‘Searching for a Better Rwanda, Kampala, 2004.
    [Show full text]
  • World Bank Documents
    REPUBLIC OF RWANDA Public Disclosure Authorized MINISTRY IN CHARGE OF EMERGENCY MANAGEMENT P.O. Box: 4386 KIGALI Public Disclosure Authorized SOCIO-ECONOMIC INCLUSION OF REFUGEES AND HOST COMMUNITIES PROJECT (SEIRHCP) Public Disclosure Authorized ENVIRONMENTAL AND SOCIAL MANAGEMENT FRAMEWORK (ESMF) FINAL REPORT Public Disclosure Authorized March 2019 EXECUTIVE SUMMARY In the framework of improving the living conditions of refugees and host communities, the Government of Rwanda through the Ministry in Charge of Emergency Management and with the funding from the World Bank is developing the project entitled “Socio Economic Inclusion of Refugees and Host Communities” (SEIRHCP). The project will be implemented in the six Districts hosting refugee camps, namely Kirehe, Gatsibo, Karongi, Nyamagabe, Gisagara, and Gicumbi hosting respectively the refugee camps Mahama, Nyabiheke, Kiziba, Kigeme, Mugombwa, and Gihembe. The project has four components: the first component aims to ensure access to basic services and socio-economic investments. The component is divided into two parts: access to basic services (education, health and water) and socio-economic investments (roads and markets). The key sub- project activities will include construction, rehabilitation, or upgrading school infrastructures, health facilities, water and sanitation facilities, roads, and markets in six districts hosting refugees. The second component aims to ensure economic opportunity with access to finance (grants or loans) and livelihood opportunities to both refugees and host community. The main objectives of this component are to promote entrepreneurship and wage employment through access to finance (grants or loans) and to provide capacity building for improved access to finance to refugees and host communities. Component three aims to rehabilitate the environment in and around refugee camps.
    [Show full text]