Global Health Projects: Rwanda
Twubakane Decentralization and Health Project (2005-2010)
Client/Agency
United States Agency for International Development
Background
Like most of sub-Saharan Africa, Rwanda faces challenges in addressing the health needs of its burgeoning population of 8.3 million, which is growing annually at an estimated rate of 2.4 percent. In addition, Rwanda's maternal and child mortality rates are among the highest—and most alarming—in Africa.
The five-year Twubakane project, which means "Let's build together" in the Kinyarwanda language, is led by IntraHealth in partnership with RTI International and Tulane University.
Purpose
To improve access to quality health care by supporting decentralization efforts in Rwanda's health care and fiscal sectors.
Activities
As a partner on the Twubakane (let's build together), RTI works in 12 of 30 districts in Rwanda to improve health governance in the country's new decentralized framework. At the central level, Twubakane is building the capacity of the Ministry of Local Administration, Good Governance, Community Development and Social Affairs (MINALOC) and Ministry of Health (MINISANTE) to improve health policy analysis, increase central resource transfers to local governments, and build information communication technology capabilities. The project is also partnering with HS 20/20 to institutionalize the production of national health accounts that track health system expenditures.
At the district level, RTI is helping local officials add performance measures to their strategic planning, raise local revenues, and improve communications about district health issues and activities. Twubakane is also uniting district officials with providers and service users in JAFs to oversee the allocation of local finances and the evaluation of performance-based contracts and service delivery. In addition, the project is strengthening the Rwandan Association of Local Government Authorities as the national organization of local appointed and elected officials, which will institutionalize the work of Twubakane to build districts' capacity in planning.
With its comprehensive approach to health governance reform, Twubakane has become an entry point for other governance activities, including anticorruption, fiscal reform, and local tax reform, which emerged as problems that needed to be addressed for the advancement of Twubakane.