Advancing Health Management

Since 2006, the Access Project has been working in partnership with the Rwanda Ministry of Health (MOH) to provide hands-on technical assistance and supportive supervision to improve the management of health centers – where 85% of healthcare services in rural Rwanda are delivered. Starting in three districts in 2006 and scaling up to six districts in early 2008, the Access Project now works with 86 health centers serving close to two million people. Five years of experience working at the health center and district levels has proven that improving skills and processes in key management domains leads to expanded, higher quality care for the population, including those suffering from HIV and AIDS, tuberculosis and malaria.

Management Domains and Evaluation

The Access team works with district and health center staff to implement improved systems in eight management domains: human resources, infrastructure, finance, mutuelle (community health insurance), pharmacy, data management, planning and coordination, and information technology.

The eight management domains were developed by Access Project technical specialists in collaboration with health center administrators on the ground, and are designed to work within the constraints faced by most Rwandan health centers (e.g., limited power supply, health center staff with limited education and experience, inadequate physical infrastructure). Though many of the interventions are relatively simple, they have a major impact on quality of health services and health outcomes. For example,drug stock-outs used to be common but instituting a simple drug inventory monitoring and re-ordering process at the health centers has resulted in zero stock-outs of essential drugs at two-thirds of health centers in districts in which the Access Project works.

With the help of a specially designed quantitative instrument, the Access Management Evaluation Tool, the Access team performs initial and follow-up assessments that provide a roadmap to guide improvement at each health center in each of the eight management domains. These periodic assessments are coupled with intensive ongoing mentoring by district-based advisors, and specialized training by experts in each management domain.