Rwanda
Empowering Rwanda to Lead Fight Against HIV
Guest blog post by Helen Blakesley from Catholic Relief Services.
Cécile is talking to Séraphine about her medicine. Séraphine is HIV positive. She lost her husband to the virus and is now bringing up their six kids in Bungwe, a village high in the hills of northern Rwanda.
A senior nurse at Bungwe Health Center, Cécile used to have to wait for a doctor to come to start people on antiretroviral therapy and conduct more complex medical evaluations—and those visits are only once a week. But now she can handle it by herself. She’s had the training courtesy of the Ministry of Health.
It’s just one of the changes since the center became an AIDSRelief site in 2005. Catholic Relief Services leads the consortium that runs the AIDSRelief program, which is funded by the President’s Emergency Plan for AIDS Relief (PEPFAR), a US Government initiative set up to help save the lives of those living with HIV/AIDS around the world.
“A lot has changed, I’ve learned a lot with the AIDSRelief program,” says Cécile. “It’s helped so much with patient care, with medication, counseling. They’ve trained us, mentored us—really helped us to work as a team. Treating HIV and AIDS is a multidisciplinary affair. None of us can work alone.”
What’s really stuck in Cécile’s mind from this morning’s consultation, though, is Séraphine’s boy, 12-year-old Jean-Claude. Cécile had to break some life-changing news to the child today. Like his mom, he is HIV positive. But Jean-Claude didn’t cry when he heard the news. He kept a bright smile on his face. He’s accustomed to coming to the health center with his mom to make sure she’s okay.
‘It No Longer Means Death’
Cécile has been counseling kids like Jean-Claude who may have been exposed to HIV during their mother’s pregnancy, delivery or breastfeeding. “Before, when you spoke to someone about HIV, it meant death,” Cécile says.“But, now, it no longer means death. We’ve been helped to treat patients as a human being like any other, not like someone who’s going to die.” Jean-Claude told her this morning that he wants to become a doctor.
Throughout Rwanda, AIDSRelief has drawn on three pillars to strengthen existing local health systems. It has looked at the financial side of things—how funding grants are managed. It has shown how the use of data can be vital in tailoring and improving treatment and the overall program. And AIDSRelief has invested in establishing and maintaining high-quality HIV care and treatment services. All of this is against a backdrop of involving the community in care and treatment, such as regular home visits, which help ensure good follow-up.
Nearly 12,000 people receive HIV care and treatment, and almost 7,000 of those undergo antiretroviral therapy The program has achieved outstanding clinical results in remote areas of the country: Only 2 percent of people fail to return for follow-up appointments, and 91 percent of people surveyed who are receiving antiretroviral therapy have a such a low level of the virus in their bloodstream that it’s undetectable.
Long-Lasting Solution
When PEPFAR grants were first awarded in 2004 with the goal of scaling up HIV care and treatment in developing countries, many critics said ‘it couldn’t be done’. But programs like AIDSRelief proved that antiretroviral therapy programs can be successful anywhere in the world.
Over the past few years, though, PEPFAR’s focus has shifted from an external emergency response to an increasing emphasis on strengthening health systems and building a sustainable response owned by each host country.
So, for the past 2 years , AIDSRelief has been accompanying Rwanda’s Ministry of Health, with its district hospitals and health centers, so that it could eventually take the driver’s seat. That transition is now complete. It’s the first time a host government has fully taken over a PEPFAR-funded HIV treatment program.
Alphonse Kayiranga is a nurse educator with the University of Maryland School of Medicine’s Institute of Human Virology, a member of the AIDSRelief consortium. “We’ve tried to do our best to prepare the different health centers and hospitals for transition,” says Alphonse. “We’ve tried to strengthen capacity and share our knowledge. I feel they’re well prepared. There’s also been work with central government to strengthen the national system. I’m confident that it’ll go well.”
For Leia Isanhart Balima, chief of party for CRS-Rwanda AIDSRelief, and her team, the transition has had an interesting twist. “It’s not every day in development that you get to work yourself out of a job,” she says. “It’s been really special to work with the team and watch the way they’ve grown and to watch the sites take ownership of the program and the government really taking on responsibility.”
She adds, “It’s neat to be able to let go and say we’ve put the basic building blocks in place for them, and now they can go on from here”.
Helen Blakesley is CRS’ regional information officer for west and central Africa. She is based in Dakar, Senegal. This blog post first appeared on the CRS Voices Blog.
Photo by Helen Blakesley/CRS
Speed Dating in Rwanda: Technology Meets Development
Guest blog post by Helen Blakesley from Catholic Relief Services.
What brings together more than 170 people, from 5 continents, 34 countries and over 64 organizations, in a room in a hotel in the Rwandan capital of Kigali? Speed dating. Seriously. But all in the name of technology and development.
I feel I should explain. If we were going from table to table listening to someone’s alluring spiel, it was because we were at the 4th CRS Global ICT4D Conference, discovering the latest innovations in Information Communications and Technology for Development.
A woman signs her information form on an smart phone at a CRS seed fair in Kaga Bandoro, Central African Republic. CRS tested a barcode tracking system in June 2011 to see if it was a more efficient and effective way to register and track people helped by the agency. Photo by Sandra Basgall/CRS
I’d been dispatched to the conference with instructions to “unleash my inner geek”. My concern was, did I have one? I own nothing prefixed with an ‘i’. I’m a firm believer that you can’t beat the feel and smell of a real book between your hands and I’ve never downloaded a song in my life. My techie credentials were not looking good. Still, off I went, to explore this new frontier, with absolutely no idea what to expect.
First day of the conference, I’m having breakfast in the hotel restaurant, overlooking Kigali’s thousand hills, when a voice asks to join me. The voice is laced with a European accent, thick with the tones of a James Bond villain. The owner of the voice is wearing a white bow tie with blue dots on it, and proceeds to explain to me the difference between GIS and GPS technology. Gulp. Could the techie clichés be true?
But a few hours later, as the opening speeches proceeded, the revelations began. Four of the five keynote speakers were women. Some, over 60, but still passionately fired up about their subject area. Some were young and petite with funky haircuts and dangly earrings, but who evidently knew what they were talking about. I started to sit up and take notice. This was inspiring stuff.
Partnerships Among Experts
I learned that extreme poverty is often due to extreme isolation, and that technology provides a means of connecting people. I learned that technology can empower people by giving them information and tools to improve their lives. I learned how CRS is using cutting edge technology to increase the impact of our programming around the world, whether it be using GPS to track crop diseases, mobile phones to improve literacy, or using software platforms to rapidly assess needs during an emergency response.
The theme of the conference was “partnership”. Its aim, to bring together the “techies” and the development experts — so they can exchange their needs, share and learn about the latest “geek tech” and find answers to practical problems in the development world.
Partnerships with governments and donors are also at the heart of this work. The conference was officially opened by Rwanda’s Minister of ICT who (rather aptly) read his speech not from paper, but his ipad, the illuminated square reflected in each of his spectacle lenses.
Opportunity to Change Lives
As I sit in the audience listening, with the background noise of people tapping notes onto their laptops and tablets, it strikes me. Here we have a bunch of really smart people who are thinking up ways to more effectively and efficiently help other people. That’s pretty amazing. The words of Carol Bothwell, CRS’s Chief Knowledge Officer, capture my attention. “We have the opportunity to change the lives of millions of people around the world through technology — what could be more exciting than that?”
So back to that speed dating…
There was an eclectic mix of nationalities (Dutch, Kenyan, American, Ivorian…) genders and styles (from gray shirts and matching gray pens to snazzy power dresses). I must admit that I was a little lost at times, when phrases like “web service interface” or “Java enabled” popped up…and I couldn’t suppress a smile at statements such as “the iform platform is mobile data collection on steroids!”
To be honest with you, I did feel a touch sleepy at certain moments, but that was probably due to my lack of tech savvy more than anything else. Because in front of me were state-of-the-art gadgets — most of which I had no inkling about but which impressed me all the same.
To wit: Solar powered iphone chargers for use in remote areas; barcode readers for recording people’s information at seed fairs with just one swipe; portable mini servers so databases can be accessed from virtually anywhere.
The Point of Technology
I heard about mobile phones being used to transfer money to families in need, to text farmers with price alerts or advice on how to tend their crops, mobile phone applications to help health workers chart their patients progress and needs. I saw mini laptops for community workers who can be trained through distance learning. I learned about GPS devices that can be slipped into a pocket, but will provide essential mapping information for planning CRS’ life saving projects.
All this is only possible because technology is evolving so quickly and communities in developing countries have increasing access to it. And amongst all the paraphernalia and data and theory of the conference, we were reminded in the closing speeches of the reason this technology is so important: the people.
As a CRS staffer who uses iphones to collect data on malaria in Sierra Leone told us – “Experiment with amazing technology, yes. But don’t forget why we’re doing this. Don’t forget the people.”
Helen Blakesley is CRS’ regional information officer for west and central Africa. She is based in Dakar, Senegal. This blog post first appeared on the CRS Voices Blog.
AIDSRelief: giving patients hope
Leia Isanhart Balima works for Catholic Relief Services where she serves as Chief of Party for AIDSRelief Rwanda.
Last week, I visited the Bungwe Health Center, a small clinic nestled in the hills about two hours outside Rwanda’s capital city, Kigali. The center is part of AIDSRelief, a program that has been providing HIV care and treatment in Rwanda since 2005 with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). My employer, Catholic Relief Services, is the lead agency for AIDRelief in 9 countries.
During my visit I met a nurse named Cecile and her 12-year-old patient, Jean Claude. His mother is an AIDSRelief patient and Jean Claude had come to the health center to find out his own status. He’s been sick for quite some time.
Cecile counseled and tested Jean Claude, then talked with him about his results. To my surprise, he smiled. When asked what he will do now that he knows his HIV status, he said he will go to school to become a doctor. Jean Claude knows that with antiretroviral therapy and good medical treatment, he can live a long, productive life.
There are thousands of such stories across PEPFAR-supported countries. Through programs like AIDSRelief, PEPFAR is bringing training and materials to health professionals like Cecile, giving patients hope instead of the death sentence they would have faced just a few years ago.
But a unique, and also remarkable, story is how Rwanda’s Ministry of Health has taken ownership of the program. Six years ago, Catholic Relief Services and partners began AIDSRelief with the intention of someday transitioning it to a local entity. The Ministry of Health stepped up and showed it was ready, willing, and capable of taking over the project. After two years of intensive preparation, the transition is complete. The Ministry now directly receives PEPFAR aid, sustaining the work AIDSRelief has begun.
U.S. foreign aid programs like PEPFAR are making a difference in the lives of people all over the world. These programs transition to local ownership in a meaningful, sustainable way and encourage partner countries to share responsibility for building strong health systems.
As our partners step forward, they still need our support. In the coming days and months, Congress faces more painful budget discussions and some people believe that poverty-focused international assistance isn’t worth saving. But now is not the time to dial back successful programs that are building strong national systems to lift millions of people out of poverty and illness.
With sustained U.S. foreign aid, nurses like Cecile will continue to receive training and resources via the Ministry of Health. And Jean Claude will get the treatment he needs to realize his dreams of giving hope to others the way Cecile gave hope to him. And that’s something to celebrate and advocate for.
Rwanda is Proud to Pioneer the Pneumococcal Vaccine
In this guest blog for World Pneumonia Day on the 12th of November Dr. Agnes Binagwaho, Minister of Health, writes on Rwanda’s partnership with the GAVI alliance to pioneer the Pneumococcal Vaccine.
In April 2009, Rwanda became the first low-income country to rollout the pneumococcal vaccine (PCV7) through a partnership with Wyeth. This was a great moment for us, for after having achieved dramatic reductions in malaria incidence, pneumococcal disease had stood as the new leading cause of death among Rwandan children. And it was the dedicated work of our partner, The GAVI Alliance for Vaccines, that ensured the pneumococcal vaccine would be both accessible and affordable for use in our country.
Pneumonia remains the single largest cause of death among children under five around the world. Every 20 seconds, a child dies of this preventable disease.
On November 12, 2011, Rwanda will join other countries in observing the third World Pneumonia Day, a day to celebrate the power of immunization to save lives when access is assured.
The PCV7 vaccine also prevents against pneuomoccal meningitis, a debilitating disease that leaves children who survive it with lifelong mental and physical disabilities.
Certainly immunization is not the only way to prevent pneumonia; breast-feeding, improved nutrition, and the reduction of indoor air pollution are also essential, and children must have access to effective antibiotics when they do fall sick. But immunization removes the burden of hospitalization and treatment on the health system and diminishes the time . This is a major economic advantage in countries like Rwanda, where the time lost by parents lose from work in caring for their children. For immunization to work, it needs to be integrated fully in health and community services. This is what we did in Rwanda.
Last year, the pneumococcal vaccine was scaled up in 16 countries. By 2015, GAVI expects that 58 countries will have introduced the latest generation pneumococcal vaccines nationwide, covering another 90 million children. With sustained commitment among all partners, including both GAVI countries and donor countries, we can achieve remarkable progress in the fight against preventable deaths among children.
The number of lives saved by GAVI is a major contribution towards the world’s pursuit of the fourth Millennium Development Goal, but we must sustain the momentum. In Rwanda today, more than 80% of children have access to the pneumococcal vaccine. The children whose lives are being saved through our partnership with GAVI will help to build a Rwanda where health for all is not simply a dream but one of the foundations of a strong, peaceful nation of tomorrow.
Rwanda takes on cervical cancer
Dr Agnes Binagwaho, Minister of Health of Rwanda and Dr Fidel Ngabo, Director of MCH in the MoH of Rwanda and Ms Cynthia Kamikazi of the GAVI Alliance discuss a comprehensive new program to eliminate cervical cancer in Rwanda.
In 2002, the Rwandan government set up a strategy to tackle priority diseases that were the major killers of both adults (HIV/AIDS, tuberculosis and malaria) and children (gastroenteritis, pneumonia, malaria, meningitis and HIV).
For the past few years, anti-retroviral coverage for HIV patients in need of treatment has increased from 10 percent in 2003 to 82% in 2010. The rate of coverage for prevention of maternal-to-child transmission services has reached 78% of pregnant women. Malaria incidence has declined by 70% between 2001 and 2010. In 2010, the cure rate for tuberculosis treatment was 87%. For multi-drug resistant tuberculosis, the cure rate was 91 percent.
During the same year, 98% of TB patients were tested for HIV. Other indicators of progress include 94% of children vaccinated against pneumococcal disease, and community health workers treating gastroenteritis without delay at village level.
Having met most of the targets set in regards to infectious diseases, as well as achieving improvements in the heath system more generally, Rwanda has noted an increase in life expectancy. As the population has begun to live longer, chronic, non-communicable diseases, such as cancer, rheumatic heart diseases, diabetes and hypertension are becoming more visible. And as a result, the Ministry of Health has initiated a new strategy of tackling priority chronic and non-communicable diseases, so as to continue to provide a better and longer life to the Rwandan population. Cervical cancer is one of such diseases.
According to research conducted in Rwanda, cervical cancer accounts for 27% of all the women’s cancer in the two university hospitals. The World Health Organization has reported that the incidence of cervical cancer in Rwanda is 49 per 100,000 in the population.
Knowing the magnitude of cervical cancer, and the fact that cervical cancer is one of the few cancers that can be fully prevented through vaccination and screening, and treated in its early stages, the Government of Rwanda decided to start their fight with a comprehensive program against cervical cancer.
In light of this, the Ministry of Health, in collaboration with its partners, has developed a national plan for prevention, screening and treatment of cervical cancer in Rwanda. This comprehensive plan includes HPV vaccination of girls aged 11 to 15, early detection of women aged between 35 to 45 years, as well as building in country the capacity to treat any stages of cervical cancer according to different levels of the health system. Through the work of the first lady, the Ministry of Health has negotiated with partners to support this first ever national comprehensive plan for cervical cancer. As a start, MERCK has donated 2 million HPV vaccine doses while QIAGEN has donated 250,000 HPV DNA-tests for screening.
It is in this light that on April, 26, the Government of Rwanda officially launched a Rwandan comprehensive cervical cancer program. The program started with vaccination of school girls in Primary 6, beginning with the Kanyinya sector in Nyarugenge District, followed by 2 days of vaccination in all primary schools in Rwanda, as well as a national summit on women’s cancers.
In collaboration with the MINEDUC, the Ministry of Health has made the HPV vaccine available to all health centers; and because 95% of girls are enrolled in school during the ages targeted, all primary schools have been identified as vaccination sites.
Using the national network of three community health workers per village and the commitment of the local leaders, girls who did not attend schools during the two days of vaccination have been identified at home and vaccinated in the community. As a result, 94% of girls have received their first dose of HPV vaccine while the rest will receive it during the catch-up phase in collaboration with CHWs.
This comprehensive cervical cancer program will avail prevention, screening and treatment for the entire population at risk. All of this will be done for a period of 3 years, while Rwanda works on its sustainability plan after this period.
The parents and community members interviewed during the vaccination days were very happy to have an opportunity to prevent cancer among their daughters, and there was an excellent adherence to this program on a voluntary basis.
Rwanda is the first country in the world to offer a comprehensive plan to eliminate cervical cancer despite social and economic challenges. The Rwandan plan is for the country to be free from cervical cancer within 40 years (by 2050) as a result of consistent vaccination, regular screening and timely treatment.
Tweeting with Paul Kagame
Understandably the last few weeks have seen a surge in debate around the influence of the internet and social media on the popular protests in Tunisia and Egypt. Here in Uganda – when wondering if a similar situation could arise after the Presidential elections on February 18 – people often mention the growing proportion of the population that is online every day.
However, political leaders in Africa are also using the internet to communicate directly with their people and interested observers. One such leader is President Paul Kagame of Rwanda, who is one of very few Heads of State to operate their own Twitter account. Seeing him online last week I decided to contact him. And amid persistent speculation that he would seek to amend the Rwandan constitution to stand for a third term in office in 2017, I asked what plans he had for a successor?
To my surprise he responded immediately over three tweets:
@josephpowell. It s alwz going to be a complicated questn…while I can stand for what I say n do- it s hard to do that for smbody else..
@josephpowell but I want n i kno others want to see things continue in good direction..in Rw. So it s in my interest n duty to work with..
@josephpowell ..with others to manage well that succession process…and we will!
So a clear commitment from one of Africa’s most prominent leaders that he will step down in 2017 and hand over to a successor – a move that would surely cement his legacy in re-building Rwanda from the point of destruction to arguably one of the continent’s better functioning states. And all of this over Twitter. A sign, perhaps, that the increasingly diverse range of communications tools will not just be used for coordinating protest in Africa.
Rwanda becomes top global reformer for making business easier
In the IFC-World Bank Doing Business 2010 report released yesterday, for the first time a sub-Saharan African country—Rwanda—was named the world’s top reformer of business regulations, based on the number and impact of reforms implemented. Doing Business is an annual report that ranks economies based on 10 indicators of business regulation that record the time and cost to meet government requirements for starting and operating a business, trading across borders, paying taxes, and closing a business.
In Rwanda, it now takes an entrepreneur just two procedures and three days to start a business. Imports and exports are more efficient, and transferring property takes less time thanks to a reorganized registry and time limits. Investors have more protection, insolvency reorganization has been streamlined, and a wider range of assets can be used as collateral to access credit.
Mauritius, ranked 17 globally, is the top sub-Saharan economy for the second year in a row in terms of the overall regulatory ease of doing business.
However, despite these advances, more reforms are needed in Africa. The average rank for sub-Saharan African countries remain the lowest of any region.
Globally, the report shows that despite the financial and economic crisis, a record 131 economies reformed business regulations between June 2008 and April 2009. Singapore is the top-ranked economy on the ease of doing business for the fourth year in a row, but most of the action occurred in developing economies. Two-thirds of the reforms recorded in the report were in low- and lower-middle-income economies.
-Mikiko Imai
Meet Catherine Namugala
Two of my colleagues were in Rwanda last week for a conference of African Ministers on climate change and whilst there they caught up with Catherine Namugala, the Zambian Minister of Tourism, Environment and Natural Resources.
She did a little video for ONE, talking about climate change in Zambia. She says that the adverse effects of climate change are definitely being felt in Zambia, most notably for subsistence farmers and others living off the land. Changing rainfall patterns as part of climate change are leading to increased flooding and drought for example.
Namugala goes on to say that even though her country does not contribute significantly to climate change, Zambia is focussing on raising awareness amongst the general population and also looking at ways to adapt to the effects of climate change. Emphasising that it’s a question of morality, Namugala concludes with a call to developed countries to do their bit as the major contributors of global warming.
-Jessica Gomez-Duran
Touring A Rwandan Clinic
Another video and post from ONE’s Tom Gavin from last week’s trip to Rwanda.
Monday, July 21:
The U.S. launched PEPFAR – the American global AIDS strategy – at the Masaka Clinic in 2004, so it made for a good place for the ONE delegation to visit and assess how things are going. Our delegation met with doctors, nurses, local officials, and patients seeking treatment and counsel from the clinic’s staff. We heard, time and again, the difference that America’s partnership in health care was making in Rwanda and throughout Africa.
The DATA Report, which ONE released earlier this year, shows the progress being made. It points out that, across Africa, nearly 2.12 million people were on antiretroviral therapy by last December, a huge jump from the 50,000 people on treatment in 2002. That means 30 percent of Africans in need of treatment are receiving it. But there remains a major challenge ahead. An additional 1.7 million Africans became infected with the HIV virus in 2007.
After touring the Masaka Clinic, some of the ONE delegation discussed the site visit and the overall trip with reporters.
-Tom Gavin
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The International ONE Blog is a daily log of the anti-poverty movement. The site is operated by ONE staff, with guest contributions from ONE volunteers, members and allies.
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TAGS: Africa, Health, HIV/AIDS, Partners, Rwanda