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

• 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.