Category: Health

{{Although Rwanda has made commendable strides in water distribution to various parts of the country, societies of most African countries still consider access to clean water and sanitation as a privilege to the rich yet those that are needy also have a right of access to safe water.}}

Aflodis Kagawa the country director of Rwanda NGOs Forum claims that in some rural areas the dwellers have difficulty in getting clean water and also lack better toilets too.

“Normally those living in the rural have less access to better toilets while slum dwellers in the city are often exposed to sewage originating from nearby factories,” he remarked.

Kagawa made the remarks during a general assembly involving members of the African Civil Society on Water and Sanitation (ANEW) of which RWASEF is part of the network.

Kagawa further noted that Rwanda’s progress towards ensuring sanitation for all wasn’t that bad compared to other countries and that RWASEF was also offering its contribution through several NGO’s that work under the umbrella.

“As we speak we’re constructing modern latrines to a good number of schools in the country as well as installing more water fountains in several villages,” he commented.

Construction of better toilets might be an impressive starting point but governments should show commitment in designing policies favouring clean environments.

ANEW has recommended to African ministers in charge of water and sanitation of water that have convened at the conference aimed at improving sanitation on the continent.

Edward Kairu the ANEW chairman based in Nairobi stressed that governments should demonstrate their political will ensuring that sanitation prevails among their citizens.

“So far we’re conducting awareness to our citizens showing them that they have a right to a hygienic environment thus should hold their leaders accountable,” he remarked.

The ANEW executive secretary Yiga Matovu noted that governments ought to ensure that marginalized people including; slum dwellers, women, disabled and the elderly especially those living in remote areas have access to both clean water and better sanitation.

Governments should have clear timetable and measurable targets for achieving expenditure of 0.5% of GDP on sanitation and safe water. This would be enhanced by separation of budget lines for sanitation spending that must be set for better targeting of funds and easy monitoring.

“Resources should be channeled towards countries with low sanitation coverage and a higher burden of sanitation diseases,” Matovu remarked.

The Unilever Global Social Mission director Myriam Sidibe highlighted that children constitute the majority of victims since on average 30% of global population wash their hands with soap before eating, meaning the rest are at a high risk of being affected.

She added that the number of children dying of diarrhoea and pneumonia is very high estimated at about 1.5million while 1.9 million children die of respiratory infections.

By:Dianah Mutimura

{{Habyarimana Anastase, a doctor with the American society and China Green World International in Rwanda says that when a person gets to know that he or she has too much weight the first step is indulging in vigorous physical exercises to minimise the weight.}}

He adds that it’s better when a person wants to reduce on weight to first consult the doctor for the advice on how to reduce weight instead of using his or her own methods that might have side effects on one’s health.

The doctor further explains that, “you can do exercises thinking that the weight is reducing yet you are adding more because there wasn’t any advice from the doctor to describe for you what type of exercise that conducive for your health”

According to him the most important thing is that when a person knows that high weight can cause some diseases like debate, high blood pressure, and heart disease, he or she adjusts accordingly. This physiotherapist emphasizes that not all people who want to reduce their weight succeed as they wish.

“The weight that is caused by the food, more especially of animals, reducing it is very simple but there are others who increase weight through family inheritance which is not easy for that person to reduce weight apart from being strong and also reduce few weights.

Adelphine, one of the patient at Green World International in Nyabugogo said that after two months, she has been following the doctor’s prescriptions, she has lost 8kg over 80kg she had, which were not making her comfortable because the weight contrasted with her height.

“The doctor recommended me to do exercise of walking every day, drinking a lot of clean water at least 3 litters per day, and even to drink tea called “thé d’amaigrissement” to reduce on my fats in the body”. Adelphine explains.

She went on to say that if she acquires the size she wants, she will try her best to avoid what was causing her fatness because it kills her figure.

If your child is five years old, pay attention to the unexpected gain, and the body weight will slowly increase normally as he or she gradually gains maturity.

It’s in five year period that kids gain weight easily and it’s most common for kids from seven years to twelve years because a children’s weight increment may relate to their widened diet and appetite. Dr. Habyariman observes.

Fattiness is seen as a disease now days, where a number of people have huge weight and in developing countries like Rwanda, hospitals or clinics which are specialized in physiotherapist are rarely found where majority of the clinics are foreign clinics which even follow their foreign currency to treat people according to Dr. Habyarimana

By: Supreetha Guballa

{{The Ministry of Disaster preparedness and Refugees has started a week long “Come and See Visit” for three Rwandan Refugees who are living in Lubumbashi, DRC.}}

The purpose of the visit is to allow the refugees to come back to Rwanda for themselves, assess the situation and choose to return voluntarily.

The refugees chosen for the visit were Methode Umimana, 17 years, Innocent Hategekimana, 43years and Jean Basco Zumushukuru 18years along with Gaitrie Ammersing, UNHCR Protection Officer .

Also in the delegation were CNR Representative Theresa Prado from DRC and the ministry official Gaspard Murekezi who will be traveling with the regugees throughout the various provinces of Rwanda to experience what it is like now.

This morning the Permanent Secretary of the ministry, Antoine Ruvebana welcomed the refugees, telling them: “The current stage of development Rwanda is on is a result of the work of all Rwandans, not an individual effort, what we need now more than ever is to work together. In order to do so, we need our fellow Rwandans in refugee camps to return”

He explained to them all the changes that have occurred while they were refugees, especially in education sector urged them to avoid the propaganda outside of Rwanda, see for themselves so that repatriation occurs out of individual desire.

Out of the three refugees that were chosen, only one had lived in Rwanda for a long time but he appreciated the changes he saw upon re-entry.

“When we entered the country no one asked for our identity, so we felt comfortable.” He said adding that the only problem is that many still believed Rwandan refugees coming from the Congo now were working for FDLR, and many refugees in DR Congo were stigmatized, although this is not the case for them.

Both Umimana and Zumushukuru, revealed they never really knew Rwanda, as they left when they were still infants. Zumushukuru said: “I was always curious about the country and its people, because I did not know what it was like here.”

UNHCR Representative Ammersing assured the refugees that the UNHCR was indeed there to assist them in understanding how Rwanda has changed and what their possibilities of life here are.

The group will now be headed to Butare to visit the Nyaruguru district, visit family there and various projects that are taking place there.

Tomorrow they are scheduled to go to Cyanguga and Rusizi, followed by a visit to the refugee transit center at Nyagatare, Gisenyi, and Rubavu.

They are expected to be shown all the socio-economic improvement programs taking place in Rwanda that seem to give them positive impression of the country.

{A mother’s education is key in determining whether her children will survive their first five years of life.}

In the 2011 Millennium Development Goals report, the highest levels of under-five mortality continue to be found in sub-SaharanAfrica, where one in eight children dies before the age of five.

In all developing regions, children of mothers with some education are at less risk of dying.

A child’s chances of surviving increase even further if their mother has a secondary or higher education.

In addition to education, child survival rates can also be improved by increasing equity in other social services.

Empowering women, removing financial and social barriers to welfare, encouraging innovations to make critical services more available to the poor and increasing the accountability of health systems at the local level are examples of policy interventions that could improve equity, with benefits for child survival.

Despite substantial progress in reducing child deaths, children from rural households are still at a disadvantage, according to household survey data from 80 countries. This holds true for all developing countries.

Disparities are most pronounced in Latin America and the Caribbean and in Eastern and South-Eastern Asia (excluding China), where overall child mortality is low.

According to data from 66 countries, children from the poorest households are also at a disadvantage when it comes to surviving their first five years of life.

In the developing countries as a whole, children from the poorest 20% of households have more than twice the risk of dying before their fifth birthday as children in the richest 20% of households.

The greatest disparities are found in Latin America and the Caribbean and in Eastern and South Eastern Asia (excluding China), where the risk is nearly three times as high.

Steady progress is being made in reducing child deaths. Globally, the mortality rate for children under five has declined by a third, from 89 deaths per 1,000 live births in 1990 to 60 in 2009. All countries, except sub-Saharan Africa, Southern Asia and Oceania, have seen reductions of at least 50 per cent.

Despite population growth, the number of deaths in children under five worldwide declined from 12.4 million in 1990 to 8.1 million in 2009, which translates into nearly 12,000 fewer children dying each day.

The greatest success is found in Northern Africa and Eastern Asia, where under-five mortality declined by 68 per cent and 58 per cent, respectively.

Among countries with high under-five mortality (above 40 deaths per 1,000 live births), 10 countries reduced their rates by at least half.

Among them, Bangladesh, Eritrea, Lao People’s Democratic Republic, Madagascar, Nepal and TimorLeste recorded a 60 per cent drop or more.

The highest levels of under-five mortality continue to be found in sub-Saharan Africa, where one in eight children die before the age of five (129 deaths per 1,000 live births), nearly twice the average in developing regions overall and around 18 times the average in developed regions.

With rapid progress in other regions, the disparities between them and sub-Saharan Africa have widened. Southern Asia has the second highest rate—69 deaths per 1,000 live births or about one child in 14.

All of the 31 countries with under-five mortality of at least 100 deaths per 1,000 live births, except Afghanistan, are in sub-Saharan Africa.

At the same time, major inroads are being made. Four of the ten countries with more than a 50 per cent reduction in child deaths between 1990 and 2009 are in Sub-Saharan Africa.

Furthermore, five of the six countries with a reduction of more than 100 deaths per 1,000 live births are in this region.

Increasing evidence suggests that the MDG target can be reached, but only with substantial and accelerated action to eliminate the leading killers of children.

In sub-Saharan Africa, diarrhea, malaria and pneumonia are responsible for more than half the deaths of children under five.

In Southern Asia, over half of all childhood deaths occur in the first 28 days after birth, pointing to the need for better post-natal care. In both regions, under nutrition is an underlying cause of a third of these deaths.

Special efforts to fight pneumonia, diarrhea and malaria, while bolstering nutrition, could save the lives of millions of children.

The Millennium Development Goals report is based on a master set of data compiled by an Inter-agency and Expert Group on MDG Indicators led by the Department of Economic and Social affairs of the United Nations Secretariat, in response to the wishes of the General assembly for periodic assessment of progress towards the MDGs.

The Group comprises representatives of the international organizations whose activities include the preparation of one or more of the series of statistical indicators that were identified as appropriate for monitoring progress towards the MDGs.

By Supreetha Gubbala

KIGALI CITY–{{Since its drafting in 2001, the community-based health insurance plan known as {mutuelles de santé}, or more commonly as mutuelles, has been an extremely effective tool for medically insuring the majority of Rwandan citizens in an affordable way. }}

Currently over 85% of Rwandans partake in the program, the highest percentage in all of sub-saharan Africa. Neighboring countries such as Burundi are looking to Rwanda’s medical insurance miracle.

However, what many have looked past in praising the universal plan is truly what lies ahead for the remaining 15% that are uninsured and the effects of this upon the public healthcare system.

In February of this year former Health Minister, Dr. Richard Sezibera, announced along with many improvements to the programme, a minimum premium price increase.

Prior to this revision, those on the lowest tier of the program were paying a minimum of Rwf. 1000, with the extreme poor often being marginalized and unable to pay even this amount.

The few micro financing NGOs available to help this population could not significantly aid this population, especially with interest rates often as high as 15% on loans given.

Unfortunately, for the extreme poor, the situation just got worse, to be exact. With the minimum now standing at Rwf 3000. By raising this bar, more poor will be unable to join the plan in the upcoming years.

Although the ministry has outlined financial support programmes for this population there, lies the question of how many will be reached by the programmes, and ultimately what will happen to those who simply cannot meet this minimum.

Well more likely than not in Kigali, they will end up at the doors of CHUK, the University Teaching Hospital of Kigali.

CHUK is currently the largest public hospital in Kigali city, and therefore often end up caring for many who are not in the {mutuelles} program, and cannot provide the premium, simply out of Hippocratic Oath.

Unfortunately, the Hippocratic Oath does not exactly stock the shelves of CHUK.

Dr. Florence Umurangwa working in Ward 6 of CHUK is a post-graduate of surgery.“We don’t wait to see whether or not the patient has {mutuelle de santé}, because we care for them first,” she explained to{ Igihe.com}”

“It is a bit difficult because some people who couldn’t afford to pay Rwf. 1000, and are now being asked to pay three times that amount. It is hard for the hospital to continue operating because so many people are being treated that do not pay for the new {mutuelle de santé}.”

“When we go to the stock and take medicine, yet the patient is not paying, it will be a big challenge to the hospital,” she concluded.

With the recent two month extension for those still not updated to the new {mutuelles} plan, this further means that the new and improved {mutuelles} services must be open to everyone.

Arthur Asiimwe Director General of Rwanda Health Communication Centre, and the communications officers for the Ministry, however was incredulous at the idea of any potential issues with the new plan.

“As far as the ministry is concerned there are no problems with the new plan, sustainability or supplies of medicine. If this exists, there must be some mismanagement in the hospital,” he told {Igihe.com} in an interview.

In regards to the population of people who will be left unable to pay, Asiimwe stated confidently that, “All those who are unable to pay for {mutuelles} will be paid for by the government through the national budget which ultimately comes from taxes.”

In fact, with the new plan Asiimwe deemed it impossible for someone not to be covered and also reassures that any doubts of financial stability of the plan as fruitless.

“In fact, the new plan improves the future sustainability and enrollment in the programme,” he told {Igihe.com}.

For those on the ground however, it seems the story still is playing out quite differently.

Although the CHUK Hospital Director Dr. Theobard Hatekamana feels the majority of the plan has been beneficial to patients, as well as for everyone in the health sector, he does assert that there are still further issues to be addressed on the health care delivery level to enable sustenance of healthcare to the entire population of Rwanda.

He told Igihe.com more specifically, “We have some issues with people who can’t pay 10% of fees, so the hospital loses this money. Since we cover Rwf. 100,000 for these kind of cases, and there is currently no mechanism for recovery of this money.”

Furthermore, patients hospitalized in Ward 2 of CHUK had mixed reactions toward the new price increase in the {mutuelles} plan.

Grace Murekatete a 22-year old with swollen limbs on her right side from the Mparanyondo sector has been sick for 16 months. She told Igihe.com, “I have been here in the hospital for only four months. But I have not yet improved. I don’t know what I will do if they increase the price to Rwf 3000 because I am alone here no one is looking after me.”

Despite Asiimwe’s confidence, it seems even those currently hospitalized are not aware that they will be covered by the government if they are unable to pay.

This viewpoint was further confirmed by other patients such as Francoise Yankurije of the Kimindu sectors who explained to {Igihe.com}, “It’s right, but the problem we are having is capacity. Which results from low income, and we don’t know whether we can manage to buy it [new medical insurance].”

As we leave, CHUK confused about the true effects of the new plan on the rural and poor populations surrounding Kigali city, the receptionist of CHUK alerts us to even larger emerging problem.

The poor that often abuse their health insurance, overusing consultations and supplies, and once again restraining the capacity of the public hospital.

At the end, where to lay the sympathy or blame in this situation remains ambiguous. However, it is clear that the ministry’s rose coloured glasses must be cleared of their fog to see the reality that is occurring on the ground.

As with all economically based plans, the {mutuelles} is heavily based upon well-calculated predictions. Due to the great praise the plan is currently receiving, it may be easy to forget that these numbers are still predictions and that many holes are still present.

The great overconfidence provided by Asiimwe, although reassuring, does not erase the fact that these issues still exist. In fact, it is probably much better for the Ministry to resolve issues faced by hospitals early on, so as not to face larger issues down the road.

Of course, they don’t have to take my word for it and they probably won’t. But at least, try taking a trip to Ward 2 of CHUK and seeing Grace and Francoise yourself. You may find out more than numbers can tell you.

{{In February of this year, Rwanda’s world renowned universal healthcare policy (Mutuelle de Sante) took a price increase in premiums. The then Minister of Health, Dr. Richard Sezibera, announced the annual premium increased from a range of Rwf 1,000-7,000 to Rwf 2,000- 7,000 Rwandan francs. }}

To explain the 100% increase for those in the lowest sectors of the plan, Sezibera pointed to an increased in the cost of health per person in Rwanda from Rwf 2,000 to Rwf 2,900-3,400.

The new Mutuelle de Santé will be based upon a similar three-tier system based upon member’s financial capacity to pay the premium.Government programme, Ubudehe, will categorize members on various gradients within the system with the extremely poor now requiring to pay the minimum of Rwf. 2,000.

Prior to this price increase, despite the 85% enrollment in the plan, the extremely poor contained within the remaining 15% remained marginalized due to their inability to pay the former annual premium of Rwf.1000. Now it seems this population will be asked to pay double this amount.

For patients residing in the University Teaching Hospital of Kigali (CHUK) this increase has brought about mixed reactions.

Yankurije Francoise from the village Buha (Kimundu Sector/Nyamasheke District) arrived at CHUK late in June to receive an operation on her stomach. She used to pay Rwf. 1000 for her mutuelle.

“According to the explanations they give us about the new medical insurance, we all understand the situation, but the problem we are having is capacity. Which results from low income, and we don’t know whether we can manage to buy it [new medical insurance].”

For some like 22-year old Grace Murekatete from Mparanyondo sector (Nyamata District), this could mean the end of care.

“I’ve been sick for 16 months. I have been here in the hospital for only four months. But I have not yet improved. I don’t know what I will do if they increase the price to 3000 because I am alone here no one is looking after me,”she told Igihe on Sunday.

More than the patients, however, it seems public hospitals are facing the greatest challenges due to the price increase.

Dr. Umurangwa Florence (Post-graduate CHUK surgery RMC 1164) told Igihe, “We don’t wait to see whether or not the patient has mutuelle de santé, because have to take care of them first.”

“It is a bit difficult because some people who couldn’t even afford to pay Rwf. 1000 before are now being asked to pay three times that amount. Moreover it would be difficult for the hospital to continue operating because so many people will be treated that have not paid for the new mutuelle de santé.”

“When we go to the stock and take medicine, and the patient is not paying, it is a big challenge to the hospital.”

CHUK Hospital Director Dr. Theobard Hatekamana told Igihe more specifically, “We have some issues with people who can’t pay the 10% of fees, so the hospital loses this money. Since we cover Rwf. 100,000 for these kinds of cases, and there is no mechanism for recovery of this money,”

A 14-day campaign aimed at fighting aganist ilicit drugs has kicked off in Kigali city.

Samuel Hakuzimana the National Youth Forum Coordinator in Gasabo district explains, “We organized this campaign because the problem is prevalent among the youth and we also find that if we as youth do not have sustainable life, our country is heading nowhere. We are the country’s future leaders”.

{{{Applying first aid to infants before taken to hospital would save their lives especially to those with less access to health centers. In this respect the Belgian Development Cooperation (BTC) in collaboration with the Ministry of Health is training pediatric nurses on how to deal with emergency cases. }}}

Despite the fact the nurses should be aware of first aid skills, the lessons builds their capacity particularly in attending to patients in rural areas. Another advantage is that while in the field they can use medical equipments for instance to conduct minor surgeries.

The 30 trainees are from Kibagabaga and Muhima hospitals which deal with the majority of pediatric cases in both the city and outskirts.

Commenting on the efficiency of the training, Samuel Van Steirteghem a pediatric expert from BTC noted that the same skills would also be applied to teenagers.

Steirteghem further pointed out that they also intend to train more in first aid skills as a way to reduce infant mortality. In this regard more capacity building will be conducted to physicians in various disciplines.

Dr Anaclat Ngabonziza who’s among the trainees from Muhima hospital highlighted that the lessons would improve his attendance to patients. “We will now do our best to ensure that babies in critical conditions are stabilized before being admitted,” he remarked.

He further advised parents to rush their kids to hospital whenever they got sick since negligence was among the reasons that complicate the infants’ health conditions.