T
he WHO Country Cooperation Strategy 2014-2018 Rwanda outlines the medium
term framework for cooperation with the Government of Rwanda (GoR) through
five strategic priorities that will guide the work of WHO in the country. The CCS
2014-2018wasdevelopedthroughaconsultativeprocessinvolvingsystematicassessment
of country needs drawn from the key strategic documents including the Economic
Development and Poverty Reduction Strategy II (EDPRS II 2013-2018), the Health Sector
Strategic Plan III (2012-2018), the report on Rwanda’s national consultations on the
post 2015 development agenda 2013 and United Nations Development Assistance Plan
2013-2018. Consultations with key stakeholders in the health sector provided valuable
contributions to the document. In general, the process was guided by the WHO Country
Cooperation Strategies Guide 2010.
It is noteworthy that Rwanda has made outstanding socioeconomic progress. Significant
improvements in health outcomes and other key development indicators including
improvements in livelihood at the community level have been observed. The real gross
domestic product (GDP) growth averaged 8.2% annually during the past 10 years, which
translated into GDP per capita growth of 5.1% per year. Life expectancy at birth has
increased from 51 years in 2002 to 64.5 years (NISR, 2013).
Infant mortality has declined from 86/1000 live births(NISR, 2006) to 50/1000 live births
(NISR, 2010), while child mortality decreased from 153/1000 live births in 2005 (NISR)
to 76/1000 live births (NISR, 2010). Maternal mortality ratio also decreased from 750
per 100 000 live births in 2005 to 476 per 100 000 live births in 2010. HIV prevalence in
Rwanda has remained stable over the last five years with the national prevalence at 3%
among people aged 15-49 years. Malaria as the major cause of childhood mortality has
dropped significantly from the first position in 2005 to the fourth position in 2012.
Government budget allocation to health as percentage of GoR budget allocated to
health increased from 7% in 2006 to 13% in 2010/11, but the total expenditure related
to health as percentage of government total budget was 16.05%. Rwanda has made
tremendous progress in terms of financial access and risk protection by strengthening
pre-payment mechanisms such as community-based health insurance and other health
insurance schemes (MoH, 2012).
The United Nations is very active as a collaborative partner of the Government of
Rwanda and recently signed the UN Development Assistance Plan 2013-2018 to supportthe implementation and realization of EDPRS priorities. WHO plays a leading role in
implementing the health response of the UNDAP in partnership with other UN agencies.
Despite the significant gains and improvements recorded, concerns still exist that
coverage of some essential services is limited for some vulnerable population groups.
Malnutrition isstill an important problem among children aged under five years with the
prevalence of stunting remaining as high at 44.2% (NISR, 2010). The burden of malaria in
Rwanda hastransitioned from a nationwide to a local problem mostly in five high burden
districts along the eastern border which account for over 70% of the malaria burden.
The success achieved in the reduction of communicable diseases is being challenged
by the increasing burden of noncommunicable diseases. Several communities remain
vulnerable to climate change, epidemics and disasters due to floods, food insecurity and
potential displacement.
The country has implemented commendable actions to address issues related to social
determinants of health with reference to the Rio+20 politicalrecommendationsincluding
the development of the social protection action plan 2011. The Ministry of Health
Social Cluster has been actively implementing identified social protection interventions;
however, intersectoral cooperation needs to be improved to generate expected results.
During implementation of HSSP II, the country recorded health system improvements
due to achievement of the following strategic objectives: (i) improvement of accessibility
and quality of MCH services; (ii) consolidation, expansion and improvement of services
for the prevention of disease and promotion of health; (iii) consolidation, expansion and
improvement of services for the treatment and control of disease and by strengthening
the following programme areas: institutional capacity, human resources, financial
accessibility (health insurance schemes), geographical accessibility (construction,
renovation and extension of health facilities), medicines supply (procurement and
distribution), quality assurance of health services, specialized services (MoH, 2011).
Given the review of CCS 2009-2013 and the national health and development challenges
identified, the following five strategic priorities have been identified to guide the Country
Cooperation Strategy 2014-2018:
a. Support health system strengthening towards health service integration and
universal health coverage;
b. Contribute to the reduction of morbidity and mortality from major diseases
and thus contribute to the achievement of health-related Millennium
Development Goals;c. Contribute to the reduction of maternal, newborn and child morbidity and
mortality;
d. Promote health through addressing social determinants of health, health and
environment, nutrition and food safety;
e. Strengthen disaster risk management, epidemic and emergency preparedness
and response, and implementation of the International Health Regulations.
When outlining the strategic priorities, consideration was given to WHO existing
comparative advantages and core functions as highlighted in the 12th General Programme
of Work (GPW) including:
a. Providing leadership on matters critical to health and engaging in partnerships
where joint action is needed;
b. Shaping the research agenda and stimulating the generation, translation and
dissemination of valuable knowledge;
c. Setting norms and standards as well as promoting and monitoring their
implementation;
d. Articulating ethical and evidence‐based policy options;
e. Providing technical support, catalysing change, and building sustainable
institutional capacity;
f. Monitoring the health situation and assessing health trends.
The WHO Country Office in Rwanda will be strengthened to support implementation
of the agenda as defined in Section 5 of this document. Human resources will focus
on improving the number and ensuring adequate skills and capacities existing in the
Country Office to facilitate implementation of this strategic agenda.
The CCS 2014-2018 shall be used to guide workplan development over the next five
years. The operational plans shall be guided by the principles of efficiency, equity and
effectiveness and will focus on achieving results. A review and monitoring mechanisms
shall be put in place. A mid-term review of the CCS 2014-2018 shall be carried out in
partnership with stakeholders to review progress and ensure continued alignment with
national priorities.