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TWUBAKANE Decentralization and Health Program Rwanda TWUBAKANE Decentralization and Health Program Rwanda QUARTERLY PERFORMANCE MONITORING REPORT #17 JANUARY - MARCH 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 #17, January-March, 2009 TABLE OF CONTENTS ACRONYMS ..................................................................................................................................... 1 TWUBAKANE PROGRAM HIGHLIGHTS, JANUARY-MARCH, 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 ...................................... 11 3.3 DECENTRALIZATION PLANNING, POLICY AND MANAGEMENT .................................................. 13 3.4 DISTRICT-LEVEL CAPACITY BUILDING ....................................................................................... 16 3.5 HEALTH FACILITIES MANAGEMENT AND MUTUELLES .............................................................. 19 3.6 COMMUNITY ENGAGEMENT AND OVERSIGHT ............................................................................ 21 4. MONITORING AND EVALUATION .......................................................................................... 23 5. CHALLENGES AND OPPORTUNITIES ..................................................................................... 23 6. PERSPECTIVES FOR NEXT QUARTER .................................................................................... 25 ANNEX 1: TWUBAKANE PROGRAM RESULTS FRAMEWORK ...................................................... 26 ANNEX 2: TWUBAKANE’S INTERVENTION ZONE ......................................................................... 29 ANNEX 3: SHORT-TERM TECHNICAL ASSISTANCE PROVIDED AND OTHER TRAVEL ................ 30 ANNEX 4: DISTRICT ACTIVITIES SUPPORTED BY DISTRICT INCENTIVE FUNDS ......................... 31 ANNEX 5: SYNTHESIS OF PAQ TEAM ACTIVITIES AND ACHIEVEMENTS ...................................... 35 ANNEX 6: PERFORMANCE MONITORING BY PROGRAM COMPONENT ....................................... 37 Twubakane Quarterly Report #17, January - March, 2009 ACRONYMS AMTSL Active Management of Third Stage of Labor MIGEPROF Ministry of Gender and Family Promotion ANC Antenatal Care MINALOC Ministry of Local Government ARBEF Association Rwandaise du Bien-Etre de la MINISANTE Ministry of Health Famille CHIS Community-Based Health Information System MIS Management Information System CHW Community Health Worker MPA Minimum Package of Activities CNLS Commission Nationale de lutte contre le SIDA MSH Management Sciences for Health COPEGOL Compétition pour l’Excellence dans la MTEF Medium Term Expenditure Framework Gouvernance Locale CS/M/N Child Survival/Malaria/Nutrition NDIS National Decentralization Implementation Structure CTAMS Cellule Technique aux Mutuelles de Santé NHA National Health Accounts CYP Couple Years of Protection OJT On-the-Job Training DDP District Development Plan PAC Postabortion Care DED Deutscher Entwicklungsdienst/German PAQ Partenariat pour l’Amélioration de la Qualité Development Service DIF District Incentive Fund PBF Performance-Based Financing DIP Decentralization Implementation Plan PMI President’s Malaria Initiative EGPAF Elizabeth Glaser Pediatrics Aids Foundation PMTCT Prevention of Mother-to-Child Transmission EONC Emergency Obstetric and Neonatal Care PNBC Community Based Nutrition Program EPI Expanded Program of Immunization PNILP Programme National Intégré de Lutte Contre le Paludisme FARN Foyers d’apprentissage et de réhabilitation PNP Policies, Norms and Protocols nutritionnelle FC Field Coordinator RALGA Rwandese Association of Local Government Authorities FHI Family Health International RH Reproductive Health FP Family Planning RPRPD Rwandan Network of Parliamentarians for Population and Development GBV Gender-Based Violence RTI Research Triangle Institute HBM Home-Based Management SWOT Strengths Weaknesses Opportunities and Threats HEARTH Hearth Nutrition Model TWG Technical Working Group HF Health Financing UNFPA United Nations Population Fund HIV Human Immunodeficiency Virus UNICEF United Nations Children’s Fund HMIS Health Management Information System USAID United States Agency for International Development IEC Information, Education and Communication USG United States Government IMCI Integrated Management of Childhood Illness VCT Voluntary Counseling and Testing IUD Intrauterine Device VNG Netherlands International Cooperation Agency JADF Joint Action Development Forum WB World Bank LGA Local Government Authority WHO World Health Organization - 1 - Twubakane Quarterly Report #17, January - March, 2009 TWUBAKANE PROGRAM HIGHLIGHTS, JANUARY-MARCH, 2009 Component 1: Family Planning/Reproductive Health/Gender Formative supervision of providers trained in emergency obstetrics and neonatal care (24 in Kayonza, 22 in Kicukiro, 29 in Ngoma) On-the-job FP training of 90 providers in Ruhango District; preparation for OJT in Nyaruguru and Nyamagabe districts Training of 14 medical doctors from 10 district hospitals on short- and long-acting FP methods Component 2: Child Survival/Malaria/Nutrition Training of 668 Community Health Workers on the Integrated Community Health Package in Ruhango District Clinical IMCI training of 25 providers from Kirehe and Ngoma districts; supervision visits of Muhanga providers trained in clinical IMCI Support for harmonization of National Malnutrition Care and Treatment Protocol as well as national nutrition communication and educational tools Training of 29 trainers on community-based nutrition and HEARTH model in Nyaruguru District Component 3: Decentralization Policy, Planning, and Management Health sector decentralization technical working group established and functional Policies, Norms and Protocols for health services final draft posted to MINISANTE website for final review by stakeholders District management assessment (modified SWOT analysis) carried out in Twubakane-supported districts Health governance assessment conducted on impact and best practices of Twubakane Program Component 4: District Capacity Building On-going implementation of the District Incentive Fund (DIF) grants; closeout of 2008 DIF grants and start-up of 2009 DIF grants On-going strengthening of district auditors and on-the-job supervision of trained auditors Component 5: Health Facilities Management and Mutuelles Support to strengthen health facilities managment, focusing on effient accounting practices. Mutuelles survey carried in three districts on effectiveness of the capitation system of payment. Supervisions and the roll out a a new mutuelles database.to strengthen mutuelle management Component 6: Community Engagement, Participation, and Oversight Training of 59 trainers from Kigali districts (Gasabo, Kicukiro and Nyarugenge) in integrated community health package Support to MINISANTE for the training of 20 trainers for Maternal Community Health Workers (animatrices de santé maternelle) in partnership with JHPIEGO/ACCESS PAQ team exchange workshop for 36 representatives in Rwamagana on accomplishments, experiences and sustainability strategies - 2 - Twubakane Quarterly Report #17, January - March, 2009 1. INTRODUCTION The Twubakane Decentralization and Health Program is a five-year, more than $30+ million program funded by the U.S. Agency for International Development (USAID) and the Government of Rwanda. The goal of this USAID/Rwanda partnership is to increase access to and the quality and use of family health services by strengthening the capacity of local governments and communities to improve health service delivery. The program is implemented by IntraHealth International, Research Triangle Institute (RTI) International and Tulane University in partnership with the Government of Rwanda. Twubakane also works with the RALGA, EngenderHealth, VNG (Netherlands International Cooperation Agency) and Pro- Femmes. The Program has six integrated components: 1) family planning (FP) and reproductive health (RH); 2) child survival, malaria and nutrition; 3) decentralization policy, planning and management; Twubakane Program 4) district-level capacity building; 5) health facilities Participating Districts management and mutuelles; and 6) community 1) Nyarugenge, Kigali engagement and oversight. 2) Kicukiro, Kigali 3) Gasabo, Kigali Twubakane’s strategy focuses on improving the 4) Ngoma, Eastern Province capacity to offer decentralized services but also 5) Kayonza, Eastern Province includes selective support for the development of 6) Kirehe, Eastern Province health and decentralization policies, protocols and 7) Rwamagana, Eastern Province 8) Kamonyi, Southern Province strategy guidelines at the national level. Working 9) Muhanga, Southern Province
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