1 THE HEALTH SECTOR POLICY AND STRATEGIC PLAN FRAMEWORK Claude SEKABARAGA, MD, MPH

2 HSSPMTEF Budget Long term country vision Short term operational framework Medium term operational framework Medium term country strategy Medium term sector strategy VISION MDGs PRSP HSP

3 Le scénario pessimiste de notre Futur La population sera de en 2020, si le taux de croissance démographique reste proche de 3%, La population sera de en 2020, si le taux de croissance démographique reste proche de 3%, Les besoins en services sociaux (écoles primaires et secondaires, soins médicaux, eau potable …) seront triplées. Les besoins en services sociaux (écoles primaires et secondaires, soins médicaux, eau potable …) seront triplées. La misère sera alors plus forte encore, si le Rwanda ne réussit pas un véritable bond économique. La misère sera alors plus forte encore, si le Rwanda ne réussit pas un véritable bond économique.

4 Les piliers de la Vision La bonne gouvernance politique et économique; 1. La bonne gouvernance politique et économique; 2. La transformation économique rurale; 2. La transformation économique rurale; 3. Le développement des services et de lindustrie; 3. Le développement des services et de lindustrie; 4. Le développement des ressources humaines; 4. Le développement des ressources humaines; 5. Le développement et la promotion du secteur privé; 5. Le développement et la promotion du secteur privé; 6. Lintégration économique régionale et internationale; 6. Lintégration économique régionale et internationale; 7. La réduction de la pauvreté. 7. La réduction de la pauvreté.

5 Quelques objectifs de la VISION 2020 Quelques indicateurs Population (millions) 7,710,213,0 Taux de croissance démographique (%) 2,92,32,2 Mortalité infantile (0/00) Taux net denrôllement aux primaires (%) Femmes aux postes de décision (%) Mortalité due à la Malaria (%) Population pauvre (%) Taux de croissance du PIB (%) 6,28,19,3 PIB par habitant ($/hab) Population accédant à leau potable (%) Accès à lElectricité (%) 22535

6 The Health Sector Policy has identified the major health challenges facing the country The Health Sector in Rwanda is characterised by high mortality and morbidity rates: Maternal mortality stands at 750/100,000 live births Maternal mortality stands at 750/100,000 live births Under five mortality stands at 152/1000 Under five mortality stands at 152/1000

7 The Health Sector Policy identified seven focus areas, which are detailed in the Strategic Plan I)Human Resource Development II)Availability of Drugs, Vaccines and Consumables III)Geographical Access to Health Services IV)Financial Access to Health Services V) Quality of and Demand for Health Services in the Control of Disease VI)National Referral Hospitals and Treatment and Research Centres VII) Sector Institutional Capacity The seven focus areas have been formulated to ensure progress towards the Millennium Development Goals; they are implemented through the strategic plan

8 The HSSP was created in a consultative, sector wide bottom-up approach under the lead of Ministry of Health Government Ministries Development Partners Private Health Sector Development Partners Government Ministries Government Institutions SWAp MOH HSSP

9 The HSSP follows a Logical Framework Methodology Horizontal Dimension: What to measure By what means Vertical Dimension: What are the goals For what purpose What programmes are used What assumptions are made LogFrame Matrix The Logframe Matrix creates a coherent framework for the HSSP: It establishes a logical hierarchy of goals, purposes and programmes It establishes the associated risk It provides dimensions for the monitoring of results

10 Each Focus Area of the HSSP plays an integral part in achieving the goal of the health system The Health System Public Health Functions Infrastructure, human- and material resources, and health care financing Public Health Services and High Impact Health Interventions Goal of the Health System To Guarantee the Wellbeing of the Population To Guarantee the Wellbeing of the Population To Ensure and Promote the Health Status of the Population IMCI Reproductive Health EPI Nutrition Malaria HIV / AIDS / STI Tuberculosis Epidemics and Disasters Mental Health Blindness & Phys. Hand. Environmen- tal Health IEC / BCC Health Care Financing Quality of and Demand for Health Services and Efforts to Control Disease Human Resource Development Drugs, Vaccines and Consumables Infrastructure, Equipment & Laboratory Network National Referral Hospitals & Treatment and Research Centres Institutional Capacity

11 A Sector Wide Approach will guide the implementation of the Health Sector Strategic Plan The Sector Wide Approach is based on partnership and collaboration of actors in the health sector and will be lead by the Ministry of Health The Sector Wide Approach is based on partnership and collaboration of actors in the health sector and will be lead by the Ministry of Health All significant funding should support the HSP, HSSP and associated expenditure programmes All significant funding should support the HSP, HSSP and associated expenditure programmes The structure will be formalised in a Code of Conduct and a Memorandum of Understanding The structure will be formalised in a Code of Conduct and a Memorandum of Understanding Implementation will take place through yearly operational plans linking logically all activities to outputs Implementation will take place through yearly operational plans linking logically all activities to outputs SWAp Ministry of Health Government Entities Other Stakeholders Development Partners Health Sector Strategic Plan (HSSP) Health Sector Policy (HSP)

12 SWAp Coordination Structure SWAp Coordination Structure Ministry of Health Cabinet Meets Weekly Ministry of Health Cabinet Meets Weekly Health Sector Cluster Group Meets at least Bi-Monthly Health Sector Cluster Group Meets at least Bi-Monthly Technical Working Groups Temporary Basis Technical Working Groups Temporary Basis Members Cabinet Minister of Health Minister of State for HIV/AIDS Secretary General MoH Directors and Coordinators MoH Chaired by Honourable Minister of Health MoH, MoF, Donors and other Representatives SG MoH and Directors; MINECOFIN; Donors; Lead NGO; CCM; HIV/AIDS cluster group rep; other institutions by invitation Chaired by the General Secretary of the Ministry of Health Technical Representatives MoH; Other stakeholders relevant to particular working group Summary of Functions Policy Assurance Makes top management decisions Endorse HSCG proposals Guide policy and strategy development Sector Consultation Policy development Aid coordination Sector / project monitoring and review Make recommendations to MoH cabinet Decided by HSCG Functions are specific to working group

13 Decentralization and health Decentralization and health Opportunities: More involvement of local authorities, especially in behaviour change; better management of local institutions; more resources in addition of central government effort. Opportunities: More involvement of local authorities, especially in behaviour change; better management of local institutions; more resources in addition of central government effort. Constraints: health planners in health, insufficient in quality and quantity of human resources, integration of health in prioritization process of local government. Constraints: health planners in health, insufficient in quality and quantity of human resources, integration of health in prioritization process of local government.