Fostering Effective Local Health Care Systems
RTI is working as part of a team of local and international agencies, led by IntraHealth International, to decentralize Rwanda’s health and finance sectors.
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The Health Center in Gitarama is taking part in the Twubakane project's efforts to improve district-level health care delivery. [PHOTO: Dean Swerdlin] |
“RTI is helping to bridge the planning and fiscal gaps separating the Ministry of Health, Ministry of Local Government, and district governments,” said Dean Swerdlin, RTI’s team leader for the project’s decentralization and policy components. “The goal is to create a plan for transferring both health care funds and responsibilities to the districts while mobilizing district resources.” The project team is working in four provinces—Kigali-Ville, Kibungo, Gitarama, and Gikongoro—that comprise 35 administrative districts and 11 health districts.
Enabling local health care delivery is critical in Rwanda. The legacy of the murders and other violence of the 1994 genocide includes physical injuries and psychological trauma. Also, Rwanda, like most of sub-Saharan Africa, faces challenges in addressing the basic health needs of its population of 8.3 million, which is growing at an estimated annual rate of 2.4 percent.
In the five-year Twubakane project, which means “Let’s build together” in the Kinyarwanda language, RTI is assisting Rwanda’s national and district stakeholders in integrating capacities so health facilities can monitor needs in their districts and provide sustainable, effective services. The project is suppored by the U.S. Agency for International Development (USAID).
The Twubakane project will also create a database for health care decision making. RTI will help train district health workers to use basic tools for reporting and analyzing needs for family planning, maternal health, malaria, HIV/AIDS, and other interventions identified by the Ministry of Health and district officials.
In addition, RTI and IntraHealth together will establish and monitor a $6 million grants-based District Incentive Funds program. This effort will support innovative and sustainable solutions to improve health facilities’ service delivery and encourage administrative and health districts to collaborate on planning, monitoring, and evaluating services.
“We believe the Twubakane project will build accountability across Rwanda’s health and governing sectors and significantly strengthen the effectiveness and responsiveness of the country’s health care system,” Swerdlin said.
More information: Dean Swerdlin,
e-mail dswerdlin@rti.org
Strengthening Local Government and Upgrading Slums
Over the past 10 years, Morocco has made great strides in its democratic decentralization process, switching from a governance system that aims at maintaining order to one that aims at facilitating local development, catalyzing local initiatives, and protecting citizens’ rights. In August, RTI began working on a U.S. Agency for International Development (USAID) task, the Morocco Local Governance Project (LGP), aimed at improving government
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| RTI will help local governments better respond to citizens’ needs and improve living conditions in slums, similar to this informal settlement in Tétouan. [PHOTO: Christian Arandel] |
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responsiveness by increasing transparency and fighting corruption; strengthening local governments’ ability to respond to citizens’ needs; and coordinating with the government’s Cities Without Slums (CWS) initiative.
RTI will address widespread government corruption by providing training and technical assistance to the country’s two main institutions mandated with overseeing public finance: the Audit Court and the College of the Financial Inspector. RTI will strengthen their capacity to conduct audits per international standards, oversee the use of public funds, and publicize the results of their activities. Special attention will be given to the country’s nine regional audit courts in effectively monitoring local authorities’ use of public funds.
RTI will support authorities in 3 regions, 5 provinces, and 10 cities in adopting, implementing, and monitoring economic and social development plans using a participatory strategic planning methodology. A training program for leaders will focus on strengthening outreach skills of local elected officials. It also will result in work plans outlining specific actions they will take to monitor and evaluate the effectiveness of the local administration in responding to citizens.
LGP will coordinate with the CWS initiative to engage citizens in municipal decisions about services, with an emphasis on housing. In 20 selected slum areas, LGP will strengthen ties between local organizations and municipalities, and create a viable framework for more effective citizen participation in slum-upgrading efforts. Such efforts will help ensure that upgrading projects fully calculate their social impacts and offer alternatives for slum dwellers.
“This project is unique because it explicitly links improved local governance to poverty-reduction efforts. We can demonstrate that more open and participatory governance is essential to improving the living conditions of marginalized and impoverished populations,” says Deputy Chief of Party Christian Arandel.
More information: Christian Arandel,
e-mail carandel@rti.org
Supporting the Education Sector
RTI recently began implementing two key education sector support projects in Indonesia under contract to the U.S. Agency for International Development (USAID). These projects represent two of the three main components of the U.S. Government’s Presidential Education Initiative in Indonesia.
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| RTI helps local governments better manage decentralized education and improve the quality of teaching and learning in Indonesian classrooms. [PHOTO: Stuart Weston] |
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As prime contractor for the More Effective Decentralized Education Management and Governance project, RTI will support local governments in six provinces as they assume new responsibilities within Indonesia’s education system. RTI’s team of Indonesian and expatriate advisors will help local governments improve their management systems, develop and implement more efficient and equitable systems of education finance, enhance community participation in education governance, and strengthen private sector support to education. An emerging focus is to assist the city of Banda Aceh as it rebuilds its education infrastructure, personnel, and support systems following the devastating tsunami of December 2004. “The project is timely in that the Indonesian government has just announced a new policy of free basic education,” said RTI Chief of Party Daniel Moulton. “This will result in schools and districts receiving much greater funding than in the past, so they will rely on RTI’s assistance in improving educational planning and budgeting systems.”
RTI is also helping implement the Improved Quality of Teaching and Learning project as a subcontractor to the Education Development Center, Inc. The project has several components, including improving teacher training, improving the learning environment, providing technical support on instructional leadership, and assessing school performance for school administrators at the district, subdistrict, and school cluster levels. RTI will be responsible for managing all activities in East Java and for working with the Examinations Center/Testing Unit to develop assessment instruments appropriate for measuring competencies in the new curriculum, as well as related diagnostic tools for use in the classrooms.
These projects build on the experience of the Managing Basic Education project, also led by RTI, which is introducing new school management approaches and assisting in implementing Indonesia’s active-learning curriculum.
More information:
Frank Method,
e-mail fmethod@rti.org
Stephen Dunn, e-mail smdunn@rti.org
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August/September 2005 
Starting Up
