Reflections from Rwanda: Accountability for high quality health services in the right places

By Nosipho Gwebu Storer, Technical Director/Deputy Chief of Party, Pact Swaziland

I landed in Kigali just after midnight. I was taken by the colourful lights that welcomed us to the cleanest city in Africa. The DPMI experience to me was one of many levels of learnings. I met graduate students and professionals who were all drawn to the course because of its offerings of contextual insight into development work. In this blog, I will share two insights that have left an imprint with me.

One key reflection that has stayed with me was the model of implementation used by Partners in Health (PIH) in Rwinkwavu, an extremely rural area east of Kigali where the DPMI course was held. Their approach was premised upon bringing all health services offered to the communities in most need, and removing the need for community members to travel to them wherever they were located. The PIH training center, its staff, its students and its central hospital were located in the heart of Rwinkwavu, easily accessible to members of the community. They complemented their services with an outreach arm for hard to reach areas and also linked with other clinical facilities. PIH offered admission services with 400 beds, and over 20 doctors. This is a model I believe can be replicated when approaching interventions for working in local communities. In many African countries in this region, approaches to “bringing services to people most at need,” still entails services providers primarily being located in the main towns and cities, and vehicles then being deployed to reach the patients.  Looking at this modality, many resources are often spent on keeping cars fuelled, and on long distances reaching project recipients.

Another learning was how the leadership of Rwanda instilled a very high level of accountability amongst health professionals. The many anecdotes we hear in this region are often of patients avoiding health services because of negative health worker attitude, and poor levels of accountability. These have been a major deterrent that has seen patients delaying in seeking health services, low levels of retention and high levels of care lost to follow-up. In Rwanda, on the other hand, patients in health facilities had free access to communications to the Minster of Health and to senior health officials to report poor health service delivery or ill treatment when seeking services. The results of these patient reports to the Ministerial officials would include public investigation, reprimand or even redistribution of staffing. The few patient responses that we received during the course reported to be closely engaged with health facility services, proactively requesting comprehensive services; they were very aware of their patient rights and they upheld the medical professionals with high reverence.

As much as this may be a long shot to duplicate, the principle remains- bringing services to the people in a holistic manner demonstrates deeper commitment to services, and easier access to help and support for those in most need. It enhances reach of services and prolongs long term engagement and follow-up. Ultimately, this approach brings great promise of reaching those who most need it.