A Thousand Health Posts in the Land of a Thousand Hills, Promoting Universal Health Coverage by Catalyzing Investments in Financially and Environmentally Sustainable Primary Health Care.

Primary health care is globally perceived as the pathway to Universal Health Coverage where access to affordable healthcare services are delivered to the last mile. With almost half of the world’s population lacking access to essential primary healthcare, establishing Service Delivery Points (SDPs) within a reasonable distance is one of the avenues to achieving Universal Health Coverage (UHC). In Rwanda, health posts have proven to be viable solutions in meeting the healthcare needs at the community level, particularly in hard-to-reach areas.

First-generation health posts (FGHP) offer basic health services including rapid malaria tests, pregnancy tests, and short-acting family planning services, whereas Second Generation Health Posts (SGHP) provide more comprehensive services including outpatient consultations, provision of short and long-acting family planning (FP) services, antenatal care (ANC), maternity and postnatal care as well as dental, and ophthalmology care, among other services.

Closing the gap in healthcare access

To complement the Government of Rwanda in its efforts to achieve Universal Health Coverage, the Joint Programme was established to drive the scale-up and functionality of health posts across the country and ensure accessibility, especially those furthest behind.

Through the Joint Programme, UNFPA stands alongside the Government of Rwanda in its journey towards achieving Universal Health Coverage. By expanding and strengthening health posts, we aim to ensure accessibility and inclusivity, leaving no one behind. Together with our dedicated UN partners, we are committed to supporting Rwanda in achieving this vital milestone and enabling every citizen to enjoy the fundamental right to health and well-being.- Kwabena Asante Ntiamoah, UNFPA Representative
 

The Joint Programme is led by UNFPA, in collaboration with other UN agencies, including  UNCDF, UNDP, UNICEF, WHO, UNHabitat, and UNHCR.

These health posts have added much value to this area. We used to have many home deliveries accompanied by negative health outcomes, including maternal deaths. Now, we see increased skilled birth attendance and more women receiving Antenatal care and Family Planning services closer to their homes. We are grateful for the partnership with SFH, UNFPA and other UN agencies who are joining efforts.- Agnes Nakato, Director of Health Unit, Nyagatare District  

In collaboration with Society for Family Health (SFH) Rwanda, the Joint Programme under the framework of “Delivering as One” piloted the upgrade of eighteen (18) health posts in Nyagatare (4), Gicumbi (4), Burera (4), Nyaruguru (3) and Rusizi (3) Districts to the level of Second generation health posts. These health posts were provided with the necessary equipment, staffing and medical supplies to boost their operations towards self-sustainability in the long run.

By bringing the health posts closer to the community and engaging the community establishment and functionality of the health posts, there has been an increase in the awareness and appreciation of health services, thus promoting the sustainability of health posts in the communities. 

We used to walk for long distances to seek health care services. Now, less time and money is spent to get to a health facility. We can now seek healthcare services as well as fend for our families.- Faissa Ntayobera from Ndama Cell, Nyagatare District.

Following the Joint Programme pilot, the uptake of healthcare services delivered by second-generation health posts increased more than 10-fold within a period of only six months from 113 to 1,546 clients between July and December 2022. This shows that the Second Generation Health Posts are responding to the real healthcare needs of the community, especially in cross-border areas.

I am committed to investing in saving people’s lives! It is my passion. I am grateful for the start-up grants, materials and equipment, as well as capacity building support…this has been a great financial boost - Jean Bosco Manirakiza, Nurse Entrepreneur, Ndego Health Post 

As part of joint monitoring, a joint field visit was conducted in December 2022 bringing together different public and private partners including participating UN agencies to have first-hand experience on the functionality of health posts, services delivered and payment modalities.

Before the visit, I was curious about the functioning of Second-Generation Health Posts. During the visit, I was excited about the decentralization of quality health services; with the Community Based Health Insurance (CBHI), the services are in the vicinity. As efforts continue, I hope both urban and camp-based refugees in Rwanda will enjoy these benefits alongside their host communities. - Jean Paul Safari, UNHCR Associate CRRF Officer

To enable sustainable operations, the United Nations Regional Country Office prioritizes engagement with financial institutions to deploy innovative financing instruments that unlock affordable capital for nurse entrepreneurs. 

The Rural Health Posts have the power to revolutionize healthcare in Rwanda by catalyzing innovative health financing and contributing to achieving universal health coverage and the SDG targets set in the 2030 Agenda. If supported, the Rural Health Posts can expand their footprint to serve vulnerable Rwandans through technological innovations and business support services, resulting in significant gains to public health, gender and social equality, and climate resilience. - Alexis Ndayisaba, National Program Coordinator, UNDP

Leveraging partnerships for Health posts is indeed a timely opportunity to harness Rwanda’s progress towards universal health access by extending healthcare to the last mile while accelerating progress in the achievement of SDGs.