Rwanda Service Provision Assessment Survey 2001 [SPA3] PDF

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Rwanda Service Provision Assessment Survey 2001 [SPA3]

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Rwanda

Service Provision Assessment

Survey 2001

RwandaService Provision Assessment Survey 2001

REPUBLIC OF RWANDA

Ministry of Health

Rwanda

Service Provision Assessment Survey

2001

Ministry of Health

Kigali, Rwanda

National Population Office

Kigali, Rwanda

ORC Macro

Calverton, Maryland, USA

June 2003

This report summarizes the findings of the 2001 Rwanda Service Provision Assessment (RSPA) Survey carried out by the Ministry of Health in partnership with the National Population Office. ORC Macro provided financial and technical assistance for the survey through the USAID-funded MEASURE DHS+

program, which is designed to assist developing countries to collect data on fertility, family planning, and

maternal and child health. The opinions expressed herein are those of the authors and do not necessarily

reflect the views of the U.S. Agency for International Development. Additional information about the RSPA may be obtained from the Ministry of Health, P.O. Box 914, Kigali (telephone 250-74267; fax 250-74267). Additional information about the MEASURE DHS+ project may be obtained by contacting: MEASURE DHS+, ORC Macro, 11785 Beltsville Drive, Suite

300, Calverton, MD 20705 (telephone 301-572-0200; fax 301-572-0999; e-mail: reports@orcmacro.com;

internet: www.measuredhs.com).

Suggested citation:

Ministry of Health [Rwanda], National Popul

ation Office [Rwanda], and ORC Macro. 2003.

Rwanda

Service Provision Assessment Survey 2001. Calverton, Maryland: Ministry of Health, National Population

Office, and ORC Macro.

CONTENTS iii

Tables and Figures........................................................................ Preface ........................................................................

Key Findings and Recommendations ........................................................................

...............................xvii

Chapter 1 Survey Methodology

1.1 Overview........................................................................

1.2 Institutional Framework and Objectives of the Study...............................................1

1.3 Data Collection Instruments........................................................................

..............1

1.4 Sample........................................................................

1.4.1 Sample of Facilities ........................................................................ ..........2

1.4.2 Sample of Health Service Providers.........................................................3

1.4.3 Sample for Observations........................................................................

...5 1.5 Study Implementation........................................................................ .......................6 1.5.1 Training and Supervision of Data Collectors............................................6

1.5.2 Methods for Data Collection.....................................................................6

1.5.3 Data Analysis........................................................................

....................6 1.6 Process for Data Management and Report Writing ..................................................7 Chapter 2 Overview of the Health System in Rwanda

2.1 General Organization of the Health System..............................................................9

2.2 Overview of Operating Authorities for Health Services...........................................9

2.2.1 Public Sector........................................................................ .....................9

2.2.2 Government-assisted Health Facilities ...................................................10

2.2.3 Private Sector........................................................................

..................10

2.2.4 Traditional Medicine..................................................................

.............11 2.3 Geographic Distribution and Populations Served by Health Facilities...................11

2.4 Package of Health Services........................................................................

.............11 2.4.1 Minimum Package of Activities for the Peripheral Level......................12

2.4.2 Complementary Package of Activities for District Hospitals.................12

2.4.3 Complementary Package of Activities for National Referral Hospitals........................................................................

.........................13 2.5

Progress in Implementing the Minimum Package of Activities and the Complementary Package of Activities....................................................................13

2.6 Use of Curative Consultation Services ...................................................................14

iv CONTENTS

2.7 Issues Related to Quality of Care........................................................................

....14

2.8 Supervision.............................................................

2.9 System of Supply and Distribution of Medications................................................15

2.10 Availability of Human Resources........................................................................

...15

2.11 Basic Qualifications for Health Personnel..............................................................16

2.12 Health-sector Financing........................................................................

..................16 Chapter 3 Facility-level Infrastructure, Resources, and Systems

3.1 Basic Infrastructure and Resources Supportive of Utilization of Services.............17

3.1.1 Availability of a Range of Services and Qualified Staff.........................17

3.1.2 Availability of Services through Community Outreach .........................20

3.1.3 Facility Infrastructure Supportive of Client Utilization and

Quality Services........................................................................ ..............21

3.1.4 Infrastructure and Resources to Support Quality 24-hour

Emergency Services........................................................................ ........23 3.2 Management Systems to Support and Maintain Quality and Appropriate

Utilization of Health Services........................................................................

.........26 3.2.1 Routine Management Meetings..............................................................27

3.2.2 Supportive Supervision Activities..........................................................27

3.2.3 Management Practices Supporting Community Involvement................30

3.2.4 Funding Mechanisms That Decrease Financial Barriers to

Utilization of Health Services.................................................................32 3.3

Logistics Systems for Vaccines, Contraceptives, and Medicines (Pharmaceutical Commodities)........................................................................

.......32 3.3.1 Storage and Management Systems for Vaccines....................................33

3.3.2 Storage and Management Systems for Contraceptive methods

and Medicines........................................................................ .................35 3.4 Systems for Preventing Transmission of Infection.................................................37 3.4.1 Capacity for Processing Equipment for Reuse .......................................37

3.4.2 Infection Prevention and Hazardous Waste Control in Service

Delivery Area........................................................................ ..................41

Chapter 4 Child Health Services

4.1 Background........................................................................

.....................................43 4.1.1 SPA Approach to Collection of Child Health Information.....................43

4.1.2 Health Situation of Children in Rwanda.................................................43

4.2

Availability of Child Health Services.....................................................................44

4.3 Capacity to Provide Quality Immunization Services..............................................45

4.3.1 Capacity to Maintain the Quality of Vaccines........................................46

CONTENTS v

4.3.2 Availability of Vaccines........................................................................

.47

4.3.3 Availability of Equipment and Supplies for Vaccination Sessions........47

4.3.4 Availability of Administrative Components for Monitoring

Immunization Activities ........................................................................ .48 4.4 Capacity to Provide Quality Consultation Services for Sick Children ...................49 4.4.1

Infrastructure and Resources to Support Quality of Sick Child Services........................................................................

.................50

4.4.2 Equipment and Supplies for Assessing the Sick Child...........................52

4.4.3 Essential Medicines for Sick Child Services..........................................53

4.4.4 Management Practices Supportive of Quality Services..........................55 4.5 Adherence to IMCI Guidelines for Sick Child Service Provision..........................57 4.5.1 Full Assessment of Illness......................................................................58

4.5.2 Reducing Missed Opportunities for Promoting Child Health Care........63

4.5.3 Counseling on Child Health Issues.........................................................65

4.5.4 Supporting Continuity of Care................................................................65

4.5.5 Caretaker Opinion from Exit Interviews.................................................66

Chapter 5 Family Planning Services

5.1 Background........................................................................

.....................................67 5.1.1 SPA Approach to Collection of Family Planning Service .....................67

5.1.2 Family Planning Services in Rwanda.....................................................67

5.2

Availability of Family Planning Services...............................................................68

5.3 Components Supporting Quality Family Planning Services...................................72

5.3.1 Infrastructure and Resources for Quality Counseling.............................72

5.3.2 Equipment and Resources for Quality Family Planning Services..........74

5.3.3 Management Practices Supportive of Quality Services..........................75

5.4 Family Planning Programs for Special Groups.......................................................77

Chapter 6 Maternal Health Services

6.1 Background........................................................................

.....................................79 6.1.1 SPA Approach to Collection of Maternal Health Information...............79

6.1.2 Maternal Health and the Utilization of Services in Rwanda...................80

6.2 Availability of ANC Services........................................................................ .........81

6.3 Capacity to Provide Quality ANC........................................................................

...82 6.3.1

Infrastructure and Resources to Support Quality Counseling for ANC........................................................................

................................82 vi CONTENTS

6.3.2 Equipment and Resources for Quality ANC and PNC

Examinations ........................................................................ ..................84

6.3.3 Equipment and Resources for Quality ANC and PNC Services.............86

6.3.4 Management Practices Supportive of Quality ANC Services ................90

6.4 Adherence to Standards for Providing Quality ANC Service.................................93 6.4.1 Assessment for Early Identification of Risk Signs or Symptoms...........93

6.4.2 Counseling to Promote Healthy Outcome..............................................96

6.4.3 Supporting Continuity of Care................................................................98

6.4.4 Identification of Areas for Improvement in Service Delivery................99

6.5

Delivery Services and Emergency Obstetric Care: Capacity to Provide Quality Delivery and Newborn Care.......................................................................99

6.5.1 Availability of Components of CEOC Services .....................................99

6.5.2 Support for Safe Home Deliveries........................................................101

6.5.3 Infrastructure and Resources to Support Quality Delivery Services........................................................................

.........................102

6.5.4 Equipment and Resources to Allow Quality Delivery Services...........103

6.6 Newborn Care Practices........................................................................ ................106

6.7 Management Practices Supportive of Quality Delivery Services.........................108

Chapter 7 Services for Sexually Tr

ansmitted Infections and HIV/AIDS

7.1 Background........................................................................

...................................111 7.1.1

SPA Approach to Collection of Information on STI and HIV/AIDS Services........................................................................

......111

7.1.2 Health Situation Related to STIs and HIV/AIDS in Rwanda...............111

7.1.3 Government Policies and Programs Related to STIs and

.....................112 7.2 Availability of STI Services........................................................................ ..........113

7.3 Components Supporting Quality STI Services.....................................................114

7.3.1 System Components to Support utilization of Services........................114

7.3.2 Infrastructure and Resources for Quality Counseling...........................115

7.3.3 Availability of Equipment and Resources to Permit Quality Diagnosis and Treatment for STIs........................................................117

7.3.4 Management Practices Supportive of Quality Services for STIs..........120

7.4quotesdbs_dbs25.pdfusesText_31

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[PDF] Rwanda Service Provision Assessment Survey 2001 [SPA3]

Rwanda

Service Provision Assessment

Survey 2001

RwandaService Provision Assessment Survey 2001

REPUBLIC OF RWANDA

Ministry of Health

Rwanda

Service Provision Assessment Survey

Ministry of Health

Kigali, Rwanda

National Population Office

Kigali, Rwanda

ORC Macro

Calverton, Maryland, USA

June 2003

300, Calverton, MD 20705 (telephone 301-572-0200; fax 301-572-0999; e-mail: reports@orcmacro.com;

Suggested citation:

Ministry of Health [Rwanda], National Popul

Rwanda

Office, and ORC Macro.

CONTENTS iii

Contents

Chapter 1 Survey Methodology

1.1 Overview........................................................................

1.2 Institutional Framework and Objectives of the Study...............................................1

1.3 Data Collection Instruments........................................................................

1.4 Sample........................................................................

1.4.2 Sample of Health Service Providers.........................................................3

1.4.3 Sample for Observations........................................................................

1.5.2 Methods for Data Collection.....................................................................6

1.5.3 Data Analysis........................................................................

2.1 General Organization of the Health System..............................................................9

2.2 Overview of Operating Authorities for Health Services...........................................9

2.2.2 Government-assisted Health Facilities ...................................................10

2.2.3 Private Sector........................................................................

2.2.4 Traditional Medicine..................................................................

2.4 Package of Health Services........................................................................

2.4.2 Complementary Package of Activities for District Hospitals.................12

2.4.3 Complementary Package of Activities for National Referral Hospitals........................................................................

2.6 Use of Curative Consultation Services ...................................................................14

2.7 Issues Related to Quality of Care........................................................................

2.8 Supervision.............................................................

2.9 System of Supply and Distribution of Medications................................................15

2.10 Availability of Human Resources........................................................................

2.11 Basic Qualifications for Health Personnel..............................................................16

2.12 Health-sector Financing........................................................................

3.1 Basic Infrastructure and Resources Supportive of Utilization of Services.............17

3.1.2 Availability of Services through Community Outreach .........................20

3.1.3 Facility Infrastructure Supportive of Client Utilization and

3.1.4 Infrastructure and Resources to Support Quality 24-hour

3.2.2 Supportive Supervision Activities..........................................................27

3.2.3 Management Practices Supporting Community Involvement................30

3.2.4 Funding Mechanisms That Decrease Financial Barriers to

3.3.2 Storage and Management Systems for Contraceptive methods

3.4.2 Infection Prevention and Hazardous Waste Control in Service

Chapter 4 Child Health Services

4.1 Background........................................................................

4.1.2 Health Situation of Children in Rwanda.................................................43

4.3 Capacity to Provide Quality Immunization Services..............................................45

CONTENTS v

4.3.2 Availability of Vaccines........................................................................

4.3.3 Availability of Equipment and Supplies for Vaccination Sessions........47

4.3.4 Availability of Administrative Components for Monitoring

4.4.2 Equipment and Supplies for Assessing the Sick Child...........................52

4.4.3 Essential Medicines for Sick Child Services..........................................53

4.5.2 Reducing Missed Opportunities for Promoting Child Health Care........63

4.5.3 Counseling on Child Health Issues.........................................................65

4.5.4 Supporting Continuity of Care................................................................65

4.5.5 Caretaker Opinion from Exit Interviews.................................................66

Chapter 5 Family Planning Services

5.1 Background........................................................................

5.1.2 Family Planning Services in Rwanda.....................................................67

5.3 Components Supporting Quality Family Planning Services...................................72

5.3.2 Equipment and Resources for Quality Family Planning Services..........74

5.3.3 Management Practices Supportive of Quality Services..........................75

Chapter 6 Maternal Health Services

6.1 Background........................................................................

6.1.2 Maternal Health and the Utilization of Services in Rwanda...................80

6.3 Capacity to Provide Quality ANC........................................................................