The Access Project focuses on increasing the quality and accessibility of health care for the poor. To help Rwanda’s population improve its health, the devastating impact of AIDS, TB and malaria must be addressed. Advancements must also be made in all aspects of health--infectious diseases, health of mothers and children, vaccination, family planning, emergency care, and in all areas of life.
Accomplishing this does not require complex technology or massive sums of money - it requires skills and strategy. The key is access: to ensure that adequate health resources are accessible to the people who need them most.
In Rwanda, that means…
- making ARVs available for Nyiramuhire Assinath, a widow living in the shadow of Mt. Sabyinyo, a full day’s walk from the nearest hospital;
- and making prenatal care and voluntary AIDs testing a viable option for Letitia and Uwizeyimana, a young couple celebrating their daughter’s birth - and determined to make a future for their family.
Access Project is working closely with government of Rwanda to equip the existing health system with the management support that it needs to effectively deliver and sustain essential health services throughout the country.
Access Project: National Involvement
The Access Project has been working in Rwanda since 2003. After helping the country successfully develop Global Fund proposals (resulting in more than $100 million in approved funding), Access Project provided technical support to assist the Ministry of Health with implementation of its Global Fund programs, which included projects to fight AIDS, TB and malaria, and to strengthen the overall health system.
The results of the Access Project support included a significant expansion of sites for Voluntary Counseling and Testing for HIV/AIDS, as well as improved monitoring of HIV/AIDS and other diseases with the introduction of an integrated cell phone based reporting system. Access Project advisors also worked with the Ministry of Health to coordinate programs and people, including donors, NGOs and government agencies, focused on combating AIDS, TB and malaria.
With Access Project’s help, ARV coverage soared from 846 people in 2003 to 12,806 in 2004. By November 2007, the nationwide figure stood at more than 46,000.
Access Project: District level
In 2006, the government of Rwanda embarked on a bold and progressive decentralization initiative – shifting management, fiscal and decision-making power from central bureaucracies to local leaders in the country’s 30 districts.
Responsibility for public health was given to authorities at the district level, and the Access team was asked to assist the transition - to help ensure that it would lead to improved patient outcomes and better health for the people of Rwanda.
Access began by initiating a series of comprehensive assessments of district level health service operations. Analyzing the results, it was determined that the best way to scale-up HIV/AIDS programs and other critical health services was to intervene at the local level, where isolated health centers are most people’s first, and only, health access point
Access Project: Health Center
85% of all Rwanda’s medical consultations take place in health centers. Although hospitals exist in every district, most Rwandans can’t afford the taxi or bus fare needed to get to the hospital or pay for the services they might provide. With average incomes of less than $1 a day, walking is often the only option, so their local health center is their only hope. For many, the effectiveness of these health centers is the difference between life and death.
Unfortunately, many of Rwanda’s health centers suffer from significant challenges including:
- frequent shortages of critical drug treatments
- lack of plumbing or electricity
- insufficient or untrained staff
Plagued by these problems, most clinics cannot sustain HIV/AIDS treatment programs or even deliver basic health services.
But with the right systems, all of these barriers can be overcome. Access works with health centers to assess their specific obstacles, then recommend, prioritize and help implement the solutions that equip them to deliver appropriate, timely and vital care in their communities.
This approach leads to immediate improvement in health services, and consequently more people seeking care. It also shows local health authorities the importance of hands-on management in the health centers, encouraging more involvement, and triggering sustainable improvements that help the poor access the services they desperately need.
