Pathway 2 - Health

Pathway 2 - Health

This pathway contributes to change by:

Promoting availability, accessibility and utilization of the health services that vulnerable women need. In this, we will focus specifically on services for sexual, reproductive and maternal health, family planning services and services for women who experienced GBV.

See below for the specific sections of this pathway. For further information on each section please refer to the attached document.

Sections:

This pathway aims to have an impact on all vulnerable women of reproductive age.

Generally, all vulnerable women of reproductive age are at risk of not being able to make their own, well-informed decisions related to their sexual and reproductive health and family planning, and face the risk of GBV.

  • The Ministry of Health, being the main responsible ministry for policies related to this pathway.
  • The National Women’s Council (CNF),  whose involvement is key to reach adolescents regarding SRH.
  • UNFPA, who is an important partner when it comes to advocacy in relation to the health sector. They can also play a possible role in the scale-up of tested models by adding funds to ongoing initiatives.
  • Local authorities in charge of health (such as directors of hospitals and health centers), who are responsible for health services at the decentralized level.
  • Rwandan Parliamentarians' Network on Population and Development (RPRPD), who are very active in the domains of SRH and FP and are potentially strong advocates for these issues among high-level decision makers.

CARE Rwanda’s work on this pathway is informed by the Government of Rwanda’s policy context. Of specific importance to this pathway are:

  • The National Community Health Policy (MINISANTE, 2008) envisions the provision of holistic community health care services for all. The policy embraces the values of equity in services distribution and solidarity with the disadvantaged as they seek health care.
  • The Health Sector Strategic Plan III (MINISANTE, 2009) operationalizes the EDPRS in the health sector. Of special interest is its sub-strategy on child and maternal health.
  • The National Strategic Plan on  HIV/Aids (MINISANTE, 2009) aims to make HIV prevention, treatment, care and support accessible for all Rwandans.
  • The Adolescent Sexual Reproductive Health and Rights Policy (MINISANTE, 2012) includes four priorities, i.e. improving knowledge, skills and attitudes on ASRH&R, improve access to relevant products and services, increase community and political support for ASRH&R, and increase coordination and collaboration amongst key stakeholders who are active in the domain.
  • The National Policy Against Gender-Based Violence (MIGEPROF, 2011) shows how the GoR is engaged in prevention, response and evidence building of GBV.
  • The Health Insurance Policy (MINISANTE, 2010) allows all Rwandans in to be included in a community based health insurance scheme.
  • The National Family Planning Policy (MINSANTE, 2006) aims at households not having more children than they can support, and at increased mother and child health.

In order to achieve change in the educational situation of VW, CARE Rwanda and its partners use a combination of well-tested models and innovative approaches, including the following:

  • Awareness raising on health topics. CARE Rwanda and its partners use different channels to raise awareness amongst vulnerable women on their rights in regard to sexual and reproductive health (SRH) and family planning (FP), as well as how to access the services they need.
  • Challenge social and gender norms. Certain health challenges, mainly those related to SRH and FP, are related to social and gender norms in society. CARE Rwanda’s interventions address these through CARE’s Social Analysis and Action toolkit, engagement of men, engagement of religious leaders, couple dialogue, etc.
  • Community Scorecard. The Community Scorecard (CSC) is an approach that facilitates dialogue between citizens and service providers. It allows citizens to monitor and give feedback on the quality of a certain service provided.
  • Advocacy. CARE’s and partners’ experiences in the field provide evidence around vulnerable women’s health situation and their access to health services. This evidence is used as a basis for advocacy for appropriate, gender-sensitive laws and policies and their effective implementation.
  • Community-based GBV prevention and response. In order to strengthen communities to prevent and respond to GBV, CARE Rwanda and its partners work with different structures including case managers, GBV activists and peer educators.
  • Direct support to health centers and family planning posts. Although direct support to health centers and FP posts is not CARE Rwanda’s first choice of intervention when it comes to health, it is sometimes seen as necessary.
  • Health in emergency settings. CARE Rwanda commits to be prepared to respond to emergency situations if they appear. Women suffer disproportionally in emergencies. Our action in emergencies have a strong focus on SRH, FP and GBV prevention and response.

The following indicators are used to measure impact at the level of this pathway:

  • % of women reporting satisfaction with the availability and quality of SRH related services
  • % women attending 4 ANC visits at a health facility
  • % of births attended by skilled health personnel
  • % of women making informed decisions/choices with regard to their SRHR
  • Through the Results Initiative, CARE Rwanda and its partners have managed to contribute to an increase in the use of modern family planning methods in Gatsibo District. In the entire district, use of modern FP methods have gone up from 18% in 2008 to 47% in 2012.
  • Certain health centers are, due to their religious nature, unable to provide family planning services to the entire community. In order to find a pragmatic way around this, CARE Rwanda supports in certain instances the setting-up of a health post focusing on family planning to complement the services of the health center.
  • The Great Lakes Advocacy Initiative aims at preventing GBV and supporting women affected by GBV. Between July 2011 and July 2012, 1,732 women affected by GBV have accessed health, justice and psychosocial services through the support of 154 case managers.
  • Policy Advocacy and Learning Initiative (PALI)
  • Policy Engagement for Marginalized Inclusion (PEMI) Project
  • Great Lakes Advocacy Initiative (GLAI)
  • Results Initiative (RI)
  • Umugore Arumvwa (Kinyarwanda for ‘A woman should be listened to’)
  • Higa Ubeho (Kinyarwanda for ‘Be determent and live’)
  • Public Policy Information Monitoring (PPIMA)
  • Isaro (Kinyarwanda for ‘pearl’)
  • Kuraneza (Kinyarwanda for ‘good growth’)

CARE Rwanda is committed to learning to continuously improve the relevance and quality of its work. In relation to this pathway, it poses itself the following question:

  1. How can we move from awareness raising and challenging norms around gender and family planning to actually changing behavior?