MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Rwanda: The Impact of Global Health Initiatives on
the Health System: A mixed methods
analysis
Abstract
Mukherjee JS, Jerome JG, Sullivan E, May MA, Mayfield A, Lambert W,
Dhavan N, Carney N, Rhatigan J, Ivers LC
With acknowledgment to Ruzindana K, Wroe E, Kersten E.
Increasing attention is being paid to the impact that GHIs such as the Global Fund and PEPFAR
have on health systems as a whole. We aimed to evaluate the impact of these two GHIs on the
health system in Rwanda.
We used mixed qualitative and quantitative methods: semi-structured interviews, observation,
examination of documentary material, and collection of quantitative data. Fifteen key informants
from NGOs, international organizations and the Ministry of Health (MOH) participated in semistructured
interviews.
The Global Fund and PEPFAR were largely associated with strengthening of the health system in
Rwanda, with clear credit for the success of the programmes attributed to the strong national
framework and to coordination by the government of Rwanda.
GHIs such as the Global Fund and PEPFAR can successfully strengthen health systems if this
objective is included in planning and design, and if leadership and coordination are ensured.
Background
The Rwandese Republic is a small, landlocked country in East Africa. Bordered by the Republics of
Burundi, Uganda and Kenya, and the Democratic Republic of Congo, it has a population of 9.7
million and is expected to average a 2.7% annual population growth rate between 2005 and 2010
[1]. After decades of colonial rule by Germany and Belgium, Rwanda gained independence and
held its first parliamentary elections in 1962. Violent outbreaks between the majority ethnic group,
the Hutus, and the minority Tutsis, characterized the following decades. In April 1994, ethnic
tensions between the extremist Hutu-led government and the Tutsis culminated in a 100-day
genocide in which approximately 800,000 Tutsis and moderate Hutus were killed. In July 1994,
Rwanda Patriotic Front (RPF) troops, led by Commander Paul Kagame, defeated the extremist
regime.
In the years following the genocide, a single-party coalition government was established, and a
new constitution was adopted in 1995 [2]. Rwanda held its first post-genocide local elections in
March 1999, and its first presidential and legislative elections in August and September of 2003,
respectively. In the parliamentary elections of 2003, the RPF won 33 of 53 seats and became the
ruling party of Rwanda. Later that year, Kagame was elected President by a direct popular vote.
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