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Table 3 Rwanda PHIT Implementation progress: success, challenges, adaptations

From: Comprehensive and integrated district health systems strengthening: the Rwanda Population Health Implementation and Training (PHIT) Partnership

Successes
• By the end of project Year Two (June 2011), all major components of the PHIT intervention were successfully implemented in the intervention area.
• Based on encouraging early evidence, the Rwanda Ministry of Health is considering several components of the PHIT intervention for potential scale up. These include:
o Mentorship and Enhanced Supervision (MESH) program to improve quality of care at health facilities
o Community health household register to track activities and improve reporting
o Electronic medical record for capturing patient visit data and generating alerts and reports to improve quality of care
• Integrated operational research has been implemented within a number of PHIT intervention projects as part of the research agenda and a component of capacity-building activities initiated in partnership with the National University of Rwanda School of Public Health.
Challenges & Adaptations
• Although under-five mortality has decreased from 152 per 1,000 live births in 2005 to 76 in 2010, neonatal mortality has declined only marginally in the intervention area and countrywide.1 We are developing a care delivery value chain for neonatal health to identify gaps and respond accordingly. Incorporation of neonatal death reporting by community health workers and verbal autopsy will allow for real-time monitoring and rapid adaptation.
• In 2012, the Ministry of Health implemented a policy to harmonize MOH staff salaries across the country. The loss of incentives has impacted staff retention in the intervention area.
• Ensuring data quality and use of routinely collected data, while an anticipated challenge, has required more time and effort than originally planned.
  1. 1National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health (MOH) [Rwanda], and ICF International.2011. Rwanda Demographic and Health Survey 2010. Calverton, Maryland, USA:NISR, MOH, and ICF International.