Category: Health

{One Family Health (OFH) is a US incorporated entity, registered in Rwanda as a private company, One Family Health (OFH) Rwanda as a low profit organization in a Public Private Partnership with the government of Rwanda through the Ministry of Health, working with ECOBANK Rwanda with loan funding from GlaxoSmithKline (GSK). The COUNTRY DIRECTOR, MAGGIE CHIRWA, explains how OFH is working to improve access to essential medicines and quality health care at the grassroots using a sustainable business model via a network of franchised Health Posts. The New Times’ THOMAS KAGERA writes: }

Owing to limited access by the rural poor to medical services, yet they carry the highest burden of diseases, OFH created a healthcare business model that supports health care providers to work and stay in remote and difficult-to-reach areas, reducing the strain on Government funds and resources in terms of salaries, accommodation and other health-based infrastructures.

OFH Rwanda therefore aims at increasing access to healthcare, essential drugs, basic healthcare and prevention services for children and families in Rwanda using a sustainable franchising business model that maintains standards, scales geometrically, and achieves economies of scale.

This objective in turn contributes to the intermediate outcome of “Increased prevention, diagnosis and treatment of the primary causes of mortality”. For the above mentioned outcome to be achieved, the community must be willing to use OFH HPs and Community Based Health Insurance (CBHI) subscription.

To date, OFH has supported establishment of health posts in; Gasabo, Kayonza, Gicumbi, Gatsibo, Nyagatare, Musanze, Rubavu, Nyabihu, Kamonyi and Burera and targeting Ngorero, Rulindo and Gisagara by the end of 2015.

Market entry and operations

OFH signed a Private Public Partnership with the Ministry of Health first PPP in 2010 and in 2012 during the post-pilot phase, having been successfully piloted in Gasabo district. Piloting in Gasabo met with such challenges as having a better off population that did not reflect targeted rural poor, with a high ratio of medical personnel –populace. Rwanda was chosen in the region to pioneer the programme because of the already established systems and apparent availability of access to internet infrastructures.

OFH, since its inception in Rwanda, has supported nurses to access bank loans to establish their own health posts and, once established, are trained in managing them professionally for the provision of quality health services but also as business entities.

The government targets to have a total of 2000 health posts with at least one in each cell. OFH has committed to supporting the establishment of at least 300 of them by the year ………

Since April 2012, OFH Rwanda, GSK, EcoBank, on one hand and the Rwandan Ministry of Health and by extension the local authorities on the other, started setting up Health Posts at cell level (Entry level health care) in Rwanda in line with the policy framework of the government.

The program was first rolled out in the Eastern Province where the incidences of malaria were high and local leaders were ready to embrace and support its implementation. MoUs were signed with district mayors for mutual support of the implementation mechanisms.

{{How it works}}

OFH working with the Ministry of Health and local leaders identify the nurse to be supported to establish a health post in the locale; where it will be located—where services are most needed, balancing with where it makes economic sense to the nurse involved. Preference is given to local nurses that are used to the operational environs and committed to their communities.

The accommodation unit once identified is accustomed to a health post design, upgraded and branded as an OFH-supported facility. The HP is then equipped with medicine and supporting facilities and infrastructures.

Sometimes, however, local communities contribute to the rehabilitation of structures and construction of such facilities as toilets during Umuganda (collective works). Local leaders also get involved in mobilizing people to subscribe for CBHI (about 95% of OFH patients are CBHI subscribers), report for and access medical services during the launch. It has been observed that during the launch of posts, the numbers of people that queue for medical services are overwhelming.

Nurses running the health posts are connected with Ecobank so they can access loans to finance their day-to-day activities including stock and operations.

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Key performance indicators}}

• The HP has to have stock all the time
• Immediately call for help as and when the need arises
• Reduce distance walked by a patient from home to medical facility to about 15 minutes
• Monitor/audit the quality of care given at all times
• An electronic health management system that ensures nurses play by the rules and monitored in real time

{{Use of IT for services delivery}}

OFH has harnessed internet technology to provide access to care and essential medicines and quality business management services. The company uses a licensed software—Life Qube—which is a mobile application developed by Life Sense. It is used in gathering information on patients, control and managing stock, quality service control, proper prescription, billing and claims.

The software captures patients’ bio-data, generates a unique identification number which is used throughout the franchise; so even when a patient is transferred to another health post, their records can still be accessed through automatic sharing.
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Capacities, Economic Performance Model
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OFH and partners have so far supported the establishment of 94 health posts of which 89 are operational. In mid 2015, three more health posts will be added. In Gasabo, some facilities had to be closed because of some challenges. Usually non-performing facilities are relocated to where services are needed.

When a nurse becomes the owner, he/she reduces the government burden of a salary, provides employment to both professional and casual staff.

The proprietors are then trained in two major areas: One; Managing a Small Franchise Business (finance, stock management and operating systems, clients’ expectations etc) with articulate proprietary manuals elaborated and provided, and two; Managing a Health Unit, which involves following the protocols developed by the government for treatment, among others.

OFH settles the monthly loan account with Ecobank Rwanda after collecting money claimed from CBHI—deducts monthly loan repayment, and drugs costs from income of those franchisees, pays the franchisees the balance due to them and franchisees are actively involved in claims follow up and answering CBHI queries.

The OFH HPs are audited by insurance companies to ensure compliance and spreading of benefits to the stakeholders involved.

{{On the path to Sustainability }}

OFH is on path to sustainability, at both the clinic and franchise levels, saving the government money in nurse salaries and benefits. Hardworking and dedicated Franchisees are now starting to yield results from their businesses.

At a clinic level, performance is monitored daily. Special attention is given to clinics not breaking even, through meetings with the Franchisee and District Officials to understand and address cause of low performance. Ultimately, clinics not breaking even are re-located to more densely populated areas.

At a franchise level, reimbursement payment collection rates have increased from 50% of verified claims in 2013/14 to 98% in the financial year to date. The key to OFH’s success is to secure reimbursement from the CBHI/ MoH and cost based prices for treatments rendered.

{{Challenges and way forward}}

A major challenge has been delays in CBHI reimbursement and non cost based pricing of drugs and consumables. OFH Rwanda remains confident that these will be overcome with the move to RSSB as the systems will be better managed.
OFH future activities shall involve improving collections and reduce costs through simplified processes possible such as e-claiming; time spent travelling shall then invested in quality control. Other actions will be improving pricing policies (market/cost based) and increased services package including aligning with market demand and increasing volumes and reduce time spent travelling.

{Rwanda Social Security Board (RSSB) has revealed that by the end of 2015, Rwandans that subscribed to medical insurance reached 79%, below the anticipated 100%. }

Officials from RSSB say that there is hope of increasing medical insurance contributions. In the last three months only 63 % of Rwandans had paid for mutuelle de santé.

The increment by 16% in Mituelle de santé contributions is attributed to mobilization RSSB started in September 2015.

The head of mobilization for mituelle de santé contributions in RSSB, Déogratias Ntigurirwa, says that mobilization on subscribing to mituelle de santé has played a vital role even though it has not attained its goals of reaching 100%.

The sensitization was conducted through community meetings, media and decentralization of paying Mituelle de santé contributions.

Ntigurirwa however said they encountered challenges where some communities did not understand that they must pay for Mituelle de santé.

In 2014/2015 Mituelle de santé contributions were at 75% and 73% in 2013 /2014 which shows some decline.

In 2012/2013 Mituelle de santé contribution was at 80.7% while in 2011/2012 stood at 90.7%. RSSB took over the management of Mituelle de santé in July 2015.

{Now that we’re about two weeks into 2016, it’s time to start getting serious about dropping old, unhealthy habits and replace them with new healthy ones. Whether it’s because you just haven’t had the time or you’re concerned about blowing your monthly budget, bad habits can be turned around in the span of a few months. The first step is recognition, and we’ve put together a list of 15 unhealthy habits to break in 2016. As the saying goes, old habits die hard, so let’s get started!}

{{Smoking }} – One the most unhealthy habits to quit immediately. You don’t want to walk around smiling like an ashtray, right? Not to mention the health risks. Lungs – you need those guys.
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Dining Out }} – Get to know your kitchen. Cooking can be a tedious task, no doubt, but it will certainly save you a little money and calories. After a while, it may become something you enjoy. Surrender to the apron.

{{Too Much Dumb Box }} – We all have our guilty indulgences in rotation on the boob tube but make sure you turn it off from time to time. Read a book instead. We get it, sometimes it has to be done – but there is nothing more unfortunate than voluntary consumption of garbage.
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Bad Snack Choices }} – You know when you’re at work and a co-workers offers to grab you something on their lunch run and you’re not even hungry but a dollar burger sounds nice? Don’t do it. You know you bought that apple with good intentions – eat it with an angry face.

{{Nail Biting }} – Sometimes our nerves get the best of us and we get to gnawing at the nails and peeling away cuticles to point we draw a little blood and it somehow sickly satisfies the impulse to indulge in an internal meltdown. Ugh! Enough of that. There’s an easy fix. Keep your nails manicured and it will make you think twice the next time you participate in hurting yourself.
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Too Many Sugary Drinks }} – Water should always be your go-to beverage. Let’s face it, we’re not kids anymore and that 20 something metabolism demanded a divorce and left us hanging. Sodas, sweet teas and flavored juices are so packed with sugar you might as well eat an apple pie … by yourself … in one sitting. Keep water on you at all times and if you need flavor that bad – put some lemon in it.
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Not Enough Sleep }} – Sleep is vital to your health – mentally, physically and spiritually. Without it, you just won’t function properly. It can leave one cranky, depressed, unhappy – all things morose and it’s just not healthy. Your body needs rest to restore and refuel itself and if you don’t hit the off switch for a reasonable amount of time, you leave yourself susceptible to illness. Rest yourself.
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Not Enough Exercise }} – Listen, ladies: that body that you picture in your head is totally attainable. All you have to do is work for it. Think about it – five days a week you get up early and drag yourself to a job that, more than likely, makes a small group of people rich. That’s the definition of the verb: to work. And, it’s not an option. So why is working on yourself optional?
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Picking at Your Face }} – Surely, it’s safe to assume you know that picking at your blemishes is bad and furthers skin damage because of the bacteria and germs under your nails but why is it so hard to stop? Those darn nerves again, right? If you could just get that last layer of skin off, you might just get that black head out. No! Stop this bathroom surgery business. Your skin will be as good to you as your are to it.

{{Wearing Sweats Everywhere }} – It’s sooo … easy. And sometimes, wearing jeans is just plain exhausting. Yes, sometimes is feels like a chore to get dressed to do anything. Especially when sweats and a t-shirt are readily available and did we mention comfy? Make a point to put some jeans and cute sweater on, a little makeup and a cute pair of boots or something. It’s sure to inspire some good ol’ self lovin’.
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Skipping Breakfast }} – Too many mornings we’re in such a rush to get where we’re going – work, getting the kids ready for school and to school and the list continues. The point is, we’re probably in such rush, we don’t take the time to make sure we get a good breakfast in. It doesn’t have to consist of several courses, but a piece of fruit or a bowl of cereal will do get you fueled up for the day and keep that midday crash away.

{{Overspending }} – There’s nothing worse than enjoying a little splurge and feeling guilty about it once you get home. Some of us have a tendency to find a good sale and go crazy for savings and wind up spending double what you anticipated. Instead of splurging budget a little bit of cash each month for wardrobe enhancement.

{{Overindulging }} – How many of us opened a bottle of wine after a hard day at work and before you know it, the bottle’s empty? Opps! Did I really just drink an entire bottle of wine in like … three hours? Fine, I’ll just sleep it off. And when the morning comes, you’re dragging major a**. It’s not worth days of recovery, headache and hangover cure, right? Take it easy and limit yourself.

{{Never Turn That Blasted Phone Off }} – Not silent. Not Vibrate. Off. It’s okay, some things can wait a few hours. Don’t we live without theses things once upon a time? There’s really nothing more to be said about this one.

{{Not Making Time for Our Little Ones}} – It’s so easy to fall into the routine of coming home and everybody goes into their respective places in the house while they do homework and you make dinner. You eat quietly, clean the kitchen and perform the bath and bed routine – and you wake up and do it again for many days. Taking an hour or two to sit with your kids and talk to them, play their favorite video game or to watch a TV show will make a world of difference for all of you and really makes a house feel like home!

Source:Madame Noire:[15 UNHEALTHY HABITS MOMS NEED TO STOP IN 2016->http://madamenoire.com/607865/15-unhealthy-habits-moms-need-to-break-in-2016/]

{The management of Gisenyi hospital in Rubavu district has observed that most of the people that have succumbed to malaria have no medical insurance (mituelle de santé) whose treatment is delayed as they only seek treatment when the disease is in advanced stages of incubation. }

Maj. Dr. William Kanyankore has said that most of malaria deaths were not a result of inadequate drugs or treatment, but related to fear of seeking medical attention due to lack of insurance access.

“Having patients without medical insurance is the most challenging matter in Rubavu district,” said Maj. Dr. Kanyankore.

Kanyankore further said that not having medical insurance forces many patients to consult traditional healers at the first symptoms of any disease where they get fake treatment and eventual deaths.

The mayor of Rubavu district, Sinamenye Jérémie told the media that they have new measures to get more people subscribe to mituelle de santé within this month.

“We have not yet attained the desired percentage, since the current subscribers to mituelle de santé are 66.3 % of the district population. We are requesting citizens from all villages of Rubavu district to subscribe for medical insurance. Everyone to have subscribed by January, 2016,” he said.

A total of 1643 malaria patients has been registered in Rubavu district within the last three months.

{The Ministry of Health had planned to eradicate Malaria before the end of 2015 but the plan has not been successful since the disease is still rampant across different parts of the country. The failure is attributed to climate change and ineffective implementation of Malaria preventive measures.}

At some health centers, the number of Malaria patients supersedes the number of patients suffering from other diseases.

At Nyiranuma clinics located in Biryogo cell, Nyarugenge sector, Nyarugenge district, 753 patients reported Malaria cases in the last four months of 2014 while 1243 patients were treated of malaria at the end of 2015.

Statistics from the Ministry of Health indicates that from 2013 to 2015 Malaria patients increased three-fold. In 2013 around 900,000 people suffered from Malaria while 2.7 million people suffered from Malaria in 2015.

In an interview with IGIHE, Nathan Mugume, the communications officer in the Ministry of Health said that the increase of Malaria emanates from people who may have believed that malaria had been wiped out and relented in fighting the disease.
“Some people have been reluctant to adopt prevention measures against Malaria like using mosquito nets, closing windows and cutting bushes around their homes, among others,” he said.

MINISANTE argues that climate change that brought excessive rain favored the increase of mosquitoes.

Sub-standard mosquito nets distributed in 2012 and mosquitoes resistant to pesticides are also said to have increased Malaria in the country.

{{Drug resistant}}

Some citizens say that malaria these days has become so resistant to drugs.

Daphrose Nyiramihanda, resident of Kiramuruzi sector of Gatsibo district, says that it is worrying for one individual to suffer from Malaria three times within one month even when the patient is subjected to regular treatment.

“I have four Malaria patients at my home. We have all got treatment but the ailment is not getting healed. After one week, Malaria attacks again,” she said.

MINISANTE reveals that it has an emergence plan of distributing mosquito nets in the most affected districts of Kirehe, Gisagara, Huye, Nyanza, Ngoma, Kamonyi, Kayonza, Bugesera, Ruhango and Rwamagana which register 80 % of Malaria patients in the country.

Recently, 1.6 million mosquito nets have been distributed to replace previous 5 million mosquito nets which were below standards.

In this year’s national budget, the government of Rwanda has allocated Rwf 2.4 billion to projects of combating Malaria and diseases falling under similar category.

The communications officer of MINISANTE said that special activities to combat Malaria and new campaigns on reminding citizens about their responsibilities to address Malaria are expected soon.

“We are about to adopt new measures to bring back the situation to normal. We plan campaigns among communities through umuganda, parents’ forum, churches and other platforms,” Mugume said.

{{Low Malaria deaths }}

Even though malaria increases, the number of Malaria deaths is said to have reduced compared to last year.

The latter is attributed to services delivered by community health workers at village level who have been trained to diagnose and treat malaria for children under five years and pregnant mothers.

The Government of Rwanda has agreed with Gilead Industry, an American pharmaceutical company, to reduce the cost of Hepatitis C drugs. The current price has reduced from 95,000 USD to 1200 USD.

On 5th February 2015, the Ministry of Health announced that it had engaged in negotiations with Gilead industry from United States to cut down cost of Hepatitis C medicaments.

As Dr Mbitumuremyi Aimable, head of the program of liver related diseases prevention and Sexually Transmissible Diseases at RBC has told IGIHE, negotiations brought fruitful result of the reduction of prices.

He says that the reduction is good news for Rwandans, particularly hepatitis patients since the price has reduced 80 times.

“The reduction of the cost of hepatitis drugs comes as a relief. More than 60% of patients who received the treatment were not cured yet new medicaments heal the disease 100%,”he said.

The number of injections has reduced to an administration period of 11 months to swallowing 29 tablets of ‘Solvardi’ at a cost of 300 USD consumed within one month while the second category ‘Harvoni’ pills at 400 USD also supposed to be consumed in one month.

Dr Mbituyumuremyi reveals that the cost has been reduced tremendously since one pill costs USD14 in Rwanda while it costs USD1000 in America.

{Want to live a long and healthy life? Who doesn’t? You can achieve it if you change your lifestyle by making these new year resolutions.}

Below are 5 new year resolutions that would help you live longer.
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1. MAKE A RESOLUTION TO AVOID PROCESSED FOOD ADDITIVES}}

A Georgia State University study found that emulsifiers found in processed foods such as ice cream, salad dressings and cream cheese seem to have damaging effects on our microbiome. Make a resolution to avoid processed food additives this year by looking on labels for carrageenan, polyglycerols, polysorbate-80, guar gum, xanthan gum, locust bean gum and carboxymethylcellulose.
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2. MAKE A RESOLUTION TO SHARE MORE CUDDLES}}

A 2014 study by researchers from the universities of Virginia and Pittsburgh found that cuddling could be key if you want to optimize your immune defences. Cuddling has the power to change our heart rate, spark the release of feel-good chemicals in the brain, stimulate the hippocampus, lower blood pressure and cortisol levels.
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3. MAKE A RESOLUTION TO AVOID FRIENDS WHO UPSET YOU}}

Make a resolution to avoid friends who upset you this year. A positive outlook is key to health.

{{4. MAKE A RESOLUTION TO WALK DAILY}}

Studies have shown that higher levels of muscle mass are associated with lower levels of chronic inflammation in the body. Having lower levels of inflammation is important because such inflammation can significantly raise the risk of heart disease and cancer. Studies have also shown that the lower the muscle mass, the longer it takes to recuperate from illness. Walking at least 450 minutes weekly is necessary if you want to live long.

{{5. MAKE A RESOLUTION TO SLEEP}}

Good sleep habits can lower the risk of heart disease and stroke, sharpen planning and memory skills, rejuvenate organs and tissues, improve concentration, and also regenerate the heart, liver, lungs and kidney. Ensure you go to bed when you are tired. Also you don’t use electronic devices just before going to bed because the light these devices transmit can suppress the body’s production of the sleep hormone melatonin.

Source:Elcrema:[5 NEW YEAR RESOLUTIONS THAT WOULD HELP YOU LIVE LONGER->http://www.elcrema.com/2016/01/04/5-new-year-resolutions-that-would-help-you-live-longer/2/]

{Do you always feel lonely? A new study has found that loneliness can weaken your immune system.}

Researchers from the University of Chicago found that the feeling of loneliness was associated with a weaker immune system and increased inflammation in the body.

The researchers suggest that the effects of being lonely are felt not just in our heads but deep inside our bodies, at the level of our cells and DNA.

The researchers found that the physiological changes gotten from feeling lonely explains the link between social isolation and poor health. This includes an increased risk of early death among the chronically lonely.

The researchers made this discovery after analysing 141 adults as well as a group of highly social monkey.

The study was published in the Proceedings of the National Academy of Sciences.

Source:Elcrema:[LONELINESS CAN WEAKEN YOUR IMMUNE SYSTEM->http://www.elcrema.com/2016/01/04/loneliness-can-weaken-your-immune-system/]