Voices from the Field

“I’m very thankful to the medical staff from the hospital,” says Verene Nyirahabufite, 22. “They have been very supportive and stayed with me until I gave birth. I was afraid of having a caesarean [section], but I realized it was well done without any complications.”

Nyirahabufite’s first child had been stillborn—she did not reach the hospital in time for the delivery. For her second pregnancy, she decided to go to the health center early. This time, she was transferred from Mucubira Health Center to Gitwe Hospital in time to deliver a healthy boy.

Training health care providers to save mothers’ and children’s lives

In Rwanda’s Ruhango District, Gitwe Hospital is one of 14 district hospitals that received support from the USAID-funded Twubakane Decentralization and Health Program, led by IntraHealth International. In late 2007, Twubakane supported training ten of Gitwe’s doctors, nurses and anesthetists in emergency obstetrics and neonatal care, along with 26 health care providers in other health centers in the district.

After the trainings, providers and their supervisors noted remarkable improvements in the quality of care, both at the hospital and health centers.

“Before the training, we could register two to three newborn deaths every month; now with improved care, treatment and follow-up, we can go for three months without a single mother or newborn dying,” notes Dr. Valens Habimana, Gitwe Hospital’s director.

From 2005 through 2009, Twubakane trained a total of 462 health care providers in 12 districts. Every health facility in these districts now has at least two providers trained in emergency obstetrics and neonatal care.

Equipping hospitals to better serve—and attract—patients

Gitwe Hospital opened its doors in February 2007 and is one of the country’s newest district hospitals. It serves a population of about 300,000 people, and 13 health centers in the district refer patients to Gitwe.

In additional to technical support, Twubakane provided grants—called district incentive funds—ranging from $75,000 to $150,000 per year to Ruhango and other program-supported districts. Ruhango District used some of the financial support to equip the maternity ward of Gitwe Hospital and other health facilities.

The hospital received an ultrasound machine, caesarian kits, resuscitation materials, an operating table, two delivery tables, delivery kits, infant cradles, and mattresses.

“This equipment has made our work much easier and more professional,” Dr. Habimana emphasizes. “We are very proud of that.” He explains that the training and the equipment together allowed the hospital to attract more clients and increase revenues.

As evidence, Dr. Habimana says that community-based insurance—called mutuelles in Rwanda—used to pay the hospital an average of 2 to 3 million Rwandan francs each month ($3,500 to $5,300). With increased capacity and more services offered, the hospital now receives between 6 and 7 million Rwandan francs a month ($10,000 to $12,500).

“The Twubakane Program’s support has let us build a strong foundation of high-quality services,” adds Dr. Habimana. “Even after the project [ended], the hospital will be able to procure equipment and materials through our own revenues.”

Accomplishing its goals of supporting family health services

A five-year program, Twubakane concluded in January 2010. Its goal was to increase accessibility, quality, and use of family health services by strengthening the capacity of local governments and communities to improve health service delivery.

Two of its legacies are that in fewer than three years (from 2005 to 2007/2008, according to the Rwanda Demographic and Health Survey/Rwanda Interim Demographic and Health Survey):

• The proportion of deliveries assisted by trained personnel in Rwanda increased from 39% to 52%.
• In the 12 Twubakane-supported districts, facility-based deliveries increased by 75%, from 52,519 in 2006 to 92,156 in 2008.

The program was implemented by IntraHealth International, RTI International, and Tulane University in partnership with the Government of Rwanda. The name Twubakane, “let’s build together” in the Kinyarwanda language, reflected the efforts of partners to join forces to build a solid base for an effective decentralized health care system in Rwanda.