DOCSLIB.ORG

Systematic Review 27 Factors Affecting Uptake of Voluntary and Community-Based Health Insurance Schemes In

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Systematic Review 27 Factors Affecting Uptake of Voluntary and Community-Based Health Insurance Schemes In Pradeep Panda Factors affecting uptake of Iddo H Dror voluntary and community-based Tracey Perez Koehlmoos S A Shahed Hossain health insurance schemes in low- Denny John and middle-income countries Jahangir A M Khan David M Dror A systematic review June 2016 Systematic Health Review 27 About 3ie The International Initiative for Impact Evaluation (3ie) is an international grant-making NGO promoting evidence-informed development policies and programmes. We are the global leader in funding, producing and synthesising high-quality evidence of what works, for whom, why and at what cost. We believe that better and policy-relevant evidence will make development more effective and improve people’s lives. 3ie systematic reviews 3ie systematic reviews appraise and synthesise the available high-quality evidence on the effectiveness of social and economic development interventions in low- and middle-income countries. These reviews follow scientifically recognised review methods, and are peer- reviewed and quality assured according to internationally accepted standards. 3ie is providing leadership in demonstrating rigorous and innovative review methodologies, such as using theory-based approaches suited to inform policy and programming in the dynamic contexts and challenges of low- and middle-income countries. About this review Factors affecting uptake of voluntary and community-based health insurance schemes in low- and middle-income countries: a systematic review, was submitted in partial fulfilment of the requirements of grant SR5.1253 issued under Systematic Review Window 5. This review is available on the 3ie website. 3ie is publishing this report as received from the authors; it has been formatted to 3ie style. This review has also been published by the EPPI-Centre and is available here. Major funding for this systematic review was provided by UK aid, the Bill & Melinda Gates Foundation and the Hewlett Foundation. A complete listing of all of 3ie’s donors can be found on the 3ie website. All content is the sole responsibility of the authors and does not represent the opinions of 3ie, its donors or its board of commissioners. Any errors are also the sole responsibility of the authors. Comments or queries should be directed to the corresponding author, Pradeep Panda, [email protected]. Suggested citation: Panda, P, Dror, IH, Koehlmoos, TP, Hossain, SAS, John, D, Khan, JAM and Dror, DM, 2016. Factors affecting uptake of voluntary and community-based health insurance schemes in low-and middle-income countries: a systematic review, 3ie Systematic Review 27. London: International Initiative for Impact Evaluation (3ie). 3ie systematic review executive editors: Edoardo Masset and Beryl Leach Managing editor: Deepthy Menon Technical editor: Birte Snilstveit Production manager: Pradeep Singh Cover design: John F McGill and Akarsh Gupta © International Initiative for Impact Evaluation (3ie), 2016 Factors affecting uptake of voluntary and community-based health insurance schemes in low- and middle-income countries: a systematic review Pradeep Panda Micro Insurance Academy and International Institute of Health Management Research Iddo H Dror Micro Insurance Academy Tracey Perez Koehlmoos Uniformed Services University of the Health Sciences S A Shahed Hossain icddr,b Denny John People's Open Access Education Initiative, India Jahangir A M Khan icddr,b and Liverpool School of Tropical Medicine David M Dror Micro Insurance Academy 3ie Systematic Review 27 June 2016 Acknowledgements The authors gratefully acknowledge funding provided by the International Initiative for Impact Evaluation (3ie). The authors would like to express their sincere appreciation to Kanika Garg, Anuj Pratap Singh, Tanuka Endow, Sunetra Ghatak, Isha Chaudhry, Sachin Hans and Shraddha Srivastava, researchers at the Micro Insurance Academy, Delhi, for their immense contributions to various drafts of this report. We also thank Atanu Majumdar (Senior Researcher, Micro Insurance Academy) for his excellent research assistance in meta- analysis. We would like to thank Hugh Waddington, Birte Snilstveit, John Eyers and Ami Bhavsar of International Initiative for Impact Evaluation (3ie) and Mukdarut Bangpan and Carol Vigurs of EPPI Centre, for guidance and technical assistance at every step during the completion of this report. We thank our Advisory Board members for having guided the formulation of this report. Last but not the least; we thank the external peer reviewers for their valuable comments that have enriched the report. MIA is involved in the implementation of CBHI schemes. In order to ensure that the review process, results and reporting are objective and unbiased, we followed the following steps: (a) we followed a protocol with explicit inclusion criteria and did not make inclusion based on study findings, (b) drafts of protocol and review were externally peer reviewed and approved, and (c) drafts of review were also peer reviewed by an eminent advisory group. i Summary Background Most healthcare expenditures in developing countries are borne through out-of-pocket (OOP) spending payable by healthcare-seekers at the time and place of treatment. In India, 70 percent of total health spending is borne by private sources, 86 percent of which is through OOP spending (World Bank, 2009; Selvaraj et al., 2012). This inequitable and inefficient health financing situation persists in other low-income countries as well. The solution proposed by WHO and other international bodies has been to strive towards universal health coverage (UHC), notably through prepayment and risk pooling mechanisms. Very few low-income countries (e.g. Armenia, Moldova, and Mongolia) have so far been able to mandate the entire population to pay premiums for UHC (Stuckler and Feigl, 2010). Attempts to subsidize large segments of the (below poverty line) population have also been rare, and fell short of UHC as coverage has been partial (Dror and Vellakkal, 2012). One way to enhance coverage, it was suggested, would be through community-based health insurance (CBHI) schemes; we refer here to the earliest suggestion (Dror and Jacquier, 1999) which flagged the mutual operational model. In this model, the community plays an important role in mobilizing, pooling, allocating, managing and/or supervising health-care resources. CBHI schemes have been shown to be effective in reducing out-of-pocket payments of their members, and in improving access to health services (Tabor, 2005). However, many schemes also reported low enrollment rates. If CBHI should move from niche to scale as a social protection mechanism, they need to attract more members and retain them. Hence, we focus on analyzing the factors that affect joining on a voluntary basis and retaining members. Stated differently, we seek to understand the demand and supply- side factors that affect uptake and renewal of community-based voluntary health insurance schemes in low- and middle-income countries. Objective The objective of this systematic review is to review and analyze the literature reporting empirical evidence on voluntary uptake in CBHI schemes in low- and middle- income countries, and identify factors influencing such uptake and renewal. Methodology This systematic review is delineated by the databases included and the specific search terms applied. The following important datasets were used: EconLit and similar: MEDLINE and similar; Google and similar; Global Health and similar; ProQuest and similar; Scopus and similar; and Cochrane and similar. In addition, grey literature was also consulted. Five basic exclusion criteria were followed: a study was excluded if published before 1990; if it was a policy analysis or an opinion piece; if it was conducted in a country that is not a low or middle-income (following World Bank classification); if the health insurance mechanisms discussed was other than CBHI (private, social, and mandatory); or if the study was only on impact of CBHI. The inclusion criteria were determined by “PICOS”: Participants (that were offered to join CBHI voluntarily, whether they decided to enroll or not) were included provided they resided ii in low- and middle-income countries (World Bank definitions 2012); voluntary, contributory and community-based Interventions were included (when in low- and middle- income countries); Comparisons between individuals were included (joining CBHI schemes and those who do not, those that renew or dropout); Outcomes were included when related to determinants of demand (e.g. socio-economic characteristics, or social capital in the community) or of supply (e.g. scheme-related factors affecting access to CBHI, or the role of institutional factors or other health-related factors that enhances CBHI uptake). The review also included factors affecting renewal (or dropout) in CBHI schemes. Study design also influenced the choice for inclusion (through a process of data extraction and quality appraisal). The main search language was English, but we also included relevant studies in Spanish, French, and German. Moreover, decisions regarding data extraction were guided by the review question. In addition, we conducted preliminary quality assessment following Waddington et al., (2012) and detail appraisal of quality and adequacy of different types of studies (reporting, data collection, presentation, analysis and conclusions drawn) following relevant checklists (Waddington et al. (2012) for quantitative studies, CASP (2006) checklist for qualitative studies, CASP (2013) checklist for cohort studies (2006),
Load more

Recommended publications
  • SURF Strategic Plan
    SURVIVORS FUND (SURF) STRATEGIC PLAN 2021 – 2023 Last updated: 14th Dec 2020 Contents Executive Summary ........................................................................................................................ 3 1. Introduction ................................................................................................................................. 4 1.1 Our Vision .............................................................................................................................. 4 1.2 Our Mission ............................................................................................................................ 4 1.3 Our Guiding Principles ........................................................................................................... 4 1.4. Our Key Themes and Targets ............................................................................................... 4 2. Organisational structure .............................................................................................................. 4 2.1. The SURF Strategic Plan ...................................................................................................... 5 3. Factors affecting & influencing SURF's work ............................................................................... 5 3.1 Challenges resulting from genocide ....................................................................................... 6 3.2 Country overview ..................................................................................................................
    [Show full text]
  • Mothers' Perceptions and Experiences Of
    Western University Scholarship@Western Electronic Thesis and Dissertation Repository May 2015 Mothers’ Perceptions and Experiences of Accessing Maternal Health Care : Exploring the Role of Community Health Workers and Continuing Professional Development in Rwanda: Germaine Tuyisenge Department of Geography Supervisor Isaac Luginaah The University of Western Ontario Graduate Program in Geography A thesis submitted in partial fulfillment of the equirr ements for the degree in Master of Arts © Germaine Tuyisenge 2015 Follow this and additional works at: https://ir.lib.uwo.ca/etd Part of the Human Geography Commons Recommended Citation Tuyisenge, Germaine, "Mothers’ Perceptions and Experiences of Accessing Maternal Health Care : Exploring the Role of Community Health Workers and Continuing Professional Development in Rwanda:" (2015). Electronic Thesis and Dissertation Repository. 2832. https://ir.lib.uwo.ca/etd/2832 This Dissertation/Thesis is brought to you for free and open access by Scholarship@Western. It has been accepted for inclusion in Electronic Thesis and Dissertation Repository by an authorized administrator of Scholarship@Western. For more information, please contact [email protected]. Mothers’ Perceptions and Experiences of Accessing Maternal Health Care: Exploring the Role of Community Health Workers and Continuing Professional Development in Rwanda (Thesis Format: Monograph) by Germaine Tuyisenge Graduate Program in Geography A thesis submitted in partial fulfillment of the Requirements for the Degree of Master of Arts The School of Graduate and Postdoctoral Studies The University of Western Ontario London, Ontario, Canada © Germaine Tuyisenge 2015 Abstract Reducing barriers to accessing maternal healthcare and training health professionals in emergency maternal health care are critical components of improving overall maternal health.
    [Show full text]
  • Brief: Rwanda – DRC Cross Border Dynamics, April 2019
    Social Science in Humanitarian Action www.socialscienceinaction.org Brief: Rwanda – DRC cross border dynamics, April 2019 This brief summarises key considerations concerning cross-border dynamics between Rwanda and the Democratic Republic of Congo (DRC) in the context of the outbreak of Ebola in North Kivu and Ituri provinces. It is the second in a series of four briefs focusing on the at risk border areas between DRC and the four high priority neighbouring countries (including Uganda, South Sudan and Burundi).1 As of April 2019, there had been no case of Ebola imported from the DRC into Rwanda, although alerts had been triggered on the roads leading from North Kivu towards neighbouring Rwanda and at least one high-risk contact was described as being a Rwandan national. Cross-border movement has been identified as a significant risk to transmission. This brief provides details about cross-border relations, the political and economic dynamics likely to influence these, and specific areas and actors most at risk. The brief is based on a rapid review of existing published and grey literature, previous ethnographic research in Rwanda and DRC, and informal discussions with colleagues from the Rwanda Ministry of Health, UNHCR, UNICEF, WHO, DFID, IOM, USAID, CDC and others. The brief was developed by Hugh Lamarque (The University of Edinburgh’s Social and Political Science Department - Centre for African Studies) with support from Ingrid Gercama, Emelie Yonally and Juliet Bedford (Anthrologica). Additional review and inputs were provided by Patricia Stys (London School of Economics), Jean-Benoît Falisse (University of Edinburgh), Benjamin Chemouni (University of Cambridge), David Peyton (Northwestern University), Papy Muzuri (London School of Economics) and colleagues from DFID (Rwanda Country Office) and UNICEF (Rwanda Country Office and East and Southern Africa Regional Office).
    [Show full text]
  • RWANDA BIBLIO 2019 Pages
    François Lagarde R W A N D A 2 0 1 9 B I B L I O G R A P H I E The University of Texas at Austin 5 janvier 2020 Présentation Sur le modèle des précédentes, cette bibliographie recense les publications portant en tout ou en partie (conséquente), sur le Rwanda qui ont paru pendant l’année 2019. Elle est organisée par sujets ou disciplines: Histoire, Population, Agriculture, Environnement, Economie, Politique, Droit, Société, Arts et Lettres, Santé Publique. Un dernier chapitre recense les travaux de recherche universitaire (PhD et Masters), tous sujets confondus, et les book reviews. Les publications sont scientifiques, universitaires, para-universitaires, officielles (gouvernementales, non-gouvernementales, institutionnelles) ou littéraires mais pas journalistiques, faute de place. Les publications des éditions EUE, LAP et Scholars’ Press sont classées à part (10.5); ce sont pour la plupart des travaux de licence ou de maîtrise, rarement de doctorat. A priori, et sauf pour quelques livres et chapitres de livres qu’il faut se procurer sur papier, pratiquement toutes les entrées citées ici sont accessibles, avec ou sans paywall, sur Internet. Une bibliographie s’efforce d’être complète mais ne pourra jamais l’être tout à fait, à l’heure des digital databases. Les publications en kinyarwanda ou dans des langues autres que le français et l’anglais nous échappent en grande partie. Il reste que la masse des publications est écrite en anglais. On aura négligé d’insérer tel rapport d’institution ou d’ONG ou telles pages de ce qu’on appelait “la littérature grise” et qui aujourd’hui abondent sur Internet.
    [Show full text]
  • Recommendations for Ongoing Social Impact Reporting
    Recommendations for Ongoing Social Impact Reporting CHRISTINA HARRIS & HALEY HARADA THE ISSUE Rural women’s poverty in Africa is a significant issue. In Rwanda, more than half of the population lives on less than $1.25 a day. THE CONTEXT • Rwanda has been on the climb under the leadership of President Paul Kagame in the recent years. After the genocide, Kagame worked towards creating an environment of opportunity for social entrepreneurs, especially women. • In Africa, women support around 5.7 dependents, therefore leaving them with the potential to impact large communities. • In most places around the world, women are an untapped economic resource. THE COMPANY SOCIAL IMPACT All Across Africa (AAA) is a B-corp that facilitates female potential and works to ASSESMENT alleviate poverty by employing 3,200 local artisans in Rwanda, Ghana, Kenya, Uganda, and Burundi. As artisans, who want or need employment, women weave decorative baskets and other home goods for more reliable incomes. As a result, AAA creates a transformative difference for her lifestyle, her family, and the community’s wellbeing. Unlike other socially oriented businesses, AAA actively transforms livelihoods through a continuous flow of income and employment opportunity, instead of one-time transactions. The success of All Across Africa is measured not by a single product or service delivered, but by how the lives of the artisans improve over time. Tracking the degree of this profound change in multiple aspects of artisan lives will ultimately allow AAA to develop yearly impact reports and better serve its beneficiaries. 2 TABLE OF CONTENTS 4 Executive Summary 5 Objective 6 Research 7 Survey Administration Methods 9 The Survey (with annotations) • Personal Information • Education • Income • Savings • Healthcare • Housing • Nutrition • Social (Empowerment) 34 Recommended Medium 39 Appendix 1 3 EXECUTIVE SUMMARY Objective The objective was to design and test a survey to measure and track AAA’s social impact on an ongoing basis.
    [Show full text]
  • Role of Insurance in the Demand for Healthcare in Rwanda: a Household Level Investigation
    East Africa Collaborative Ph.D. Program in Economics and Management East Africa Research Papers in Economics and Finance Role of Insurance in the Demand for Healthcare in Rwanda: A Household Level Investigation Charles Mulindabigwi RUHARA and Urbanus Mutuku KIOKO East Africa Research Papers in Economics and Finance EARP-EF No. 2016:03 Jönköping International Business School (JIBS), Jönköping University, P.O. Box 1026, SE-551 11 Jönköping, Sweden, Web: http://www.ju.se/earp, E-mail: [email protected] Preface East Africa Research Papers in Economics and Finance is a series linked to the collaborative PhD program in Economics and Management among East Africa national universities. The program was initiated and is coordinated by the Jönköping International Business School (JIBS) at Jönköping University, Sweden, with the objective of increasing local capacity in teaching, supervision, research and management of PhD programs at the participating universities. The program is financed by the Swedish International Development Cooperation Agency (SIDA). East Africa Research Papers is intended to serve as an outlet for publishing theoretical, methodological and applied research covering various aspects of the East African economies, especially those related to regional economic integration, national and regional economic development and openness, movement of goods, capital and labor, as well as studies on industry, agriculture, services sector and governance and institutions. In particular, submission of studies analyzing state-of-the-art research in areas of labor, technology, education, health, well-being, transport, energy, resources extraction, population and its movements, tourism, as well as development infrastructure and related issues and discussion of their implications and possible alternative policies are welcome.
    [Show full text]
  • Rwanda Journal of Medicine and Health Sciences
    Rwanda Journal Series F:Medicine and Health Sciences Vol 4 No.1, 2017 Rwanda JournalRwanda of Medicine Journal o andf Medicine Health Sciencesand Health Vol. Sciences 2 No.3, V Septemberol 1 No.1, 2012019 Volume 2 Issue No. 3 September 2019 Print ISSN: 2616-9819 Online ISSN: 2616-9827 Rwanda Journal of Medicine and Health Sciences 20711 Rwanda Journal of Medicine and Health Sciences Vol. 2 No.3, September 2019 208 Rwanda Journal of Medicine and Health Sciences Vol. 2 No.3, September 2019 Volume 2 Issue No. 3 September 2019 Print ISSN: 2616-9819 Online ISSN: 2616-9827 Rwanda Journal of Medicine and Health Sciences 209 Rwanda Journal of Medicine and Health Sciences Vol. 2 No.3, September 2019 RWANDA JOURNAL OF MEDICINE AND HEALTH SCIENCES Editor in Chief Jean Bosco Gahutu, MD, PhD, FHEA (UK), Professor, University of Rwanda Deputy Editors Holli DeVon, PhD, Professor, University of Illinois at Chicago, USA Manasse Nzayirambaho, PhD, Associate Professor, University of Rwanda Managing Editor Emile Nisingizwe Editorial Board Jan Philippé, MD, PhD, Professor, University Hospital Gent, Belgium Brenda Asiimwe-Kateera, MD, MPH, University of Rwanda, Rwanda David K Tumusiime, PhD, Senior Lecturer, University of Rwanda Paulin Basinga, MD, PhD, Bill and Melinda Gates Foundation Nigeria Calvin Wilson, MD, Professor, University of Colorado Anschutz School of Medicine, USA Deborah Ann Chyun, PhD, Professor and Dean, University of Connecticut School of Nursing, USA International Advisors Jeannine Condo, MD, PhD, Professor, Director General of the Rwanda Biomedical Center, Rwanda Timothy Erickson, MD, Professor, Harvard University, USA Richard Hurrell, PhD, Professor, Swiss Federal Institute of Technology Zurich, Switzerland George Karani, PhD, Professor, Cardiff Metropolitan University, UK Egide Kayitare, PhD, Associate Professor, University of Rwanda, Rwanda Tom Lissauer, MD, PhD, Pediatrician, Hon.
    [Show full text]
  • RWANDA 2014 Superclassée
    RWANDA, 2014 BIBLIOGRAPHIE François Lagarde The University of Texas at Austin 10 février 2015 TABLE DES MATIÈRES Introduction 4 1 Recherche 6 1.1 Bibliographie 6 1.2 Méthodes 6 1.3 Thèses de doctorat; mémoires de maîtrise 7 2. Histoire; Témoignage 12 2.1 Histoire 12 2.2 1990-1994; génocide 13 2.3 France/Rwanda 17 2.4 Témoignages; mémoires 18 2.5 Témoignages: critique 19 3. Politique 21 3.1 Politique 21 3.2 Ethnicité 24 3.3 Mémoire 25 3.4 Réconciliation 26 4. Économie 28 4.1 Démographie 28 4.2 Questions foncières 28 4.3 Ressources naturelles 29 4.4 Agriculture; floriculture; sylviculture; élevage 31 4.5 Caféiculture 34 4.6 Economie; finance 35 4.7 Tourisme 38 5. Société 39 5.1 Société 39 5.2 Femmes; genre 40 5.3 Enfants; adolescents 41 5.4 Éducation 42 5.5 Langues 44 2 5.6 Médias 44 5.7 Églises; religion 45 6. Santé Publique 46 6.1 Administration; économie 46 6.2 Enseignement 49 6.3 VIH/HIV 50 6.4 Médecine: spécialités 52 6.5 Santé mentale 56 7. Relations Régionales et Internationales 59 7.1 Réfugiés; émigrés 59 7.2 East African Community (EAC) 60 7.3 Relations régionales 60 7.4 Relations internationales; aide 62 7.5 Nations Unies 63 8. Droit 64 8.1 Rwanda: Justice; Gacaca 64 8.2 Droit international; TPIR/ICTR 66 8.3 Gender-based violence; droit du viol 68 9. Arts et Lettres 70 9.1 Roman; conte; théâtre; poésie 70 9.2 Littérature juvénile 71 9.3 Critique littéraire 71 9.4 Film 72 9.5 Critique cinématographique 72 9.6 Beaux arts; photographie; bande dessinée 72 9.7 Architecture 73 10.
    [Show full text]
  • 'There Are No Other Options?': Rwandan Gender Norms and Family Planning in Historical Perspective
    Med. Hist. (2020), vol. 64(2), pp. 219–239. c The Author(s), 2020. Published by Cambridge University Press doi:10.1017/mdh.2020.4 ‘There Are No Other Options?’: Rwandan Gender Norms and Family Planning in Historical Perspective ERIN JESSEE* 409 2 University Gardens, History, University of Glasgow, Glasgow G12 8QH, Scotland Abstract: This article surveys the evolution of Rwandan family planning practices from the nation’s mythico-historical origins to the present. Rwanda is typically regarded as a patriarchal society in which Rwandan women have, throughout history, endured limited rights and opportunities. However, oral traditions narrated by twentieth-century Rwandan historians, storytellers and related experts, and interpreted by the scholars and missionaries who lived in Rwanda during the nation’s colonial period, suggest that gender norms in Rwanda were more complicated. Shifting practices related to family planning – particularly access to contraception, abortion, vasectomies and related strategies – are but one arena in which this becomes evident, suggesting that women’s roles within their families and communities could be more diverse than the historiography’s narrow focus on women as wives and mothers currently allows. Drawing upon a range of colonial-era oral traditions and interviews conducted with Rwandans since 2007, I argue that Rwandan women – while under significant social pressure to become wives and mothers throughout the nation’s past – did find ways to exert agency within and beyond these roles. I further maintain that understanding historical approaches to family planning in Rwanda is essential for informing present-day policy debates in Rwanda aimed at promoting gender equality, and in particular for ensuring women’s rights and access to adequate healthcare are being upheld.
    [Show full text]
  • One Family Health Rwanda: Achievements and Challenges 2012 2 IPIHD Case Study #101
    IPIHD Case Study #101 One Family Health Rwanda: Achievements and Challenges 2012 2 IPIHD Case Study #101 ©2013 IPIHD. All rights reserved worldwide. Liz Charles, Jeffrey Moe, and Richard Bartlett Published by the International Partnership for Innovative Healthcare Delivery Durham, NC (USA) Cover image courtesy Duke Global Health Institute, www.globalhealth.duke.edu. One Family Health Rwanda: Achievements and Challenges 2012 3 Executive Summary One Family Health (OFH) operates a franchise network of health posts in urban, peri-urban, and rural Rwanda. The health posts operate as entry-level clinics in the formal public healthcare sector and provide care for common conditions such as malaria and diarrhea. The result is an increase in access to basic healthcare and a concomitant reduction in cases referred to the comprehensive community health centers, increasing their capacity to treat more acute cases. The vision is to establish 500 posts by 2018 supported through a partnership between OFH and the Rwandan Ministry of Health, with GlaxoSmithKline providing loan financing to OFH to establish and manage the OFH network and Ecobank providing loan financing to the franchisees. Each post is run by an experienced nurse given access to financing and training in business, post operations, and clinical skills. The franchise approach allows the nurse operator to earn a living operating a small business while increasing access to essential medicines and basic healthcare for underserved communities. After a short grace period, the posts begin paying back the loans and operating on a self-sustaining basis. The physical structures for the health posts are provided by the local communities.
    [Show full text]
  • The Unity of Rwandans Before the Colonial Period and Under The
    REPUBLIC OF RWANDA OFFICE OF THE PRESIDENT OF THE REPUBLIC THE UNITY OF RWANDANS - BEFORE THE COLONIAL PERIOD AND UNDER THE COLONIAL RULE - UNDER THE FIRST REPUBLIC Kigali, August 1999 1 TABLE OF CONTENTS PREFACE .........................................................................…………………………... l CHAPTER I. RELATIONS BETWEEN RWANDANS BEFORE THE COLONIAL PERIOD AND UNDER THE COLONIAL RULE .................................................…………...4 1.1. Unity before the Colonial Period ...........................................…………………4 l. l. l. Who were constituting unity ?.............................................. ………………….4 1.1.2. Unity characteristics (unity stocks)......................................………………….. 4 1.1.3. Obstacles to unity...........................................................……………………... 7 1.2. Unity under the Colonial rule................................................ ………………….7 1.2.1. Monarchy...................................................... ……………………7 1.2.2. Colonial administration.....................................……………….. 10 1.2.3. Religions ....................................................... ………………….14 1.2.4. Schools......................................................... …………………..16 CHAPTER II. FORCED LABOUR UNDER THE BELGIAN COLONIAL RULE.............................................. …………………..20 2.1. Forced labour ......................................................... ………………….20 2.2. Corvée ..............................................................……………………….22 2.3. Cultivating fallow
    [Show full text]
  • 2019 Health for Humanity Report
    2019 Health for Humanity Report Progress in Sustainability Contents About Johnson & Johnson 3 At-A-Glance 3 Message from Our Chairman and CEO 6 2019 Year in Brief 7 Our Approach 9 Health for Humanity Strategy & Progress 9 2020 Goals Progress Scorecard 10 UN SDG Commitment Progress Scorecard 15 Sustainability Governance 19 Sustainability Priorities 20 Better Health for All 21 Tackling the World's Toughest Health Challenges 23 Enhancing Access to Healthcare 33 Contributing to Community Health 39 Innovating for Better Health 45 Responsible Business Practices 52 Empowering People 54 Product Quality, Safety & Reliability 70 Ethics & Transparency 75 Responsible Supply Base 82 Environmental Health 89 Climate Resilience 91 Water & Waste Management 96 Product Sustainability 99 Data & Downloads 102 GRI Content Index 103 UNICEF, the Government of Vietnam and Johnson & Johnson are partnering on a national program to train more than 500 ethnic minority midwives in remote regions to provide effective maternal and SASB Index 103 child health interventions including early essential newborn care in village clinics and homes. UNGC Communication on Progress 103 Photo by Paul Bettings Data Summary 103 About this Report 104 Independent Assurance Statements 105 Front cover References 120 Volunteers, frontline health workers and government officials at the launch of the Umurinzi vaccination program in Rwanda. In October 2019, Johnson & Johnson committed to donating up to 700,000 regimens of Janssen’s investigational Ebola vaccine to support the Ebola outbreak
    [Show full text]