The quiet, clean, white painted and well-lit building of Gatenga health center in Kicukiro sub-city at the outskirt of Kigali welcomed a group of visitors from the Africa Health Agenda International Conference (AHAIC) 2019 with its health and management staff. The visiting team comprised of health program implementers, health professionals and community health workers was interested to learn how the health centers in Rwanda operate to meet the health service demands of the nation.
The visit, which began with an overview of the health center, followed by a tour of health delivery rooms, offered an enlightening experience for Ethiopian delegates. It also included visits of various maternal and child health services provided by community health workers, who are, unlike health extension workers in Ethiopia, volunteers paid based on performance. The linkages of primary health care services with the health center stirred several queries from participants, including questions around community health workers training,
remuneration linked with their commitment and accountability.
Lessons from the Rwandan health center set-up was the fact that community health workers in Rwanda send out their monthly report to health centers using mobile phone text (SMS), an innovative approach other countries could learn from. In addition, medical doctors are assigned to serve in health centers twice a week, which help decrease referral rates through enhancing service availability and accessibility, narrowing health care services disparities between facilities and addresses the shortage of medical doctors. Lastly, the payment by performance as a complementary mechanism for financing health services was a novelty to the Ethiopian delegates, an approach to examine further for Ethiopia.
Senait Fesseha, a health extension worker from Ethiopia, was excited to see what fellow community health workers in another African country, operating in a different health setting, carry-out their day-to-day activity. Weighing in light of her long years of experience working as a community health worker and now working in a health center, Senait realized similarities in the services provided by community health workers in Rwandan and in Ethiopia. During the tour what impressed Senait and most of the visitors more was how Rwanda manages to ensure its health settings become very clean and patient friendly. “Gatenga health center is unbelievably clean with green areas you can enjoy as you look out through the window, which we normally see in big hotels. I am very surprised and inspired by the cleanliness of the health center, a superb lesson I want to take home and translate in the health center I am currently working in,” Senait noted.
Belay Lemma, a project manager at Amref Health Africa in Ethiopia, was among those who joined the site visit from Amref Health Africa in Ethiopia. For him, the services provided at Gatenga are almost parallel to the services at health centers in big towns in Ethiopia. “The routine mandates of the centers are all implemented in our health centers such as disease prevention and health promotion, curative care, inpatient service and minor surgeries like circumcisions and basic wound care.”
Like many others, he was impressed by the physical environment of the health setting, which is impeccably clean and orderly. Health care settings in most localities in Ethiopia need to address the gaps they have in this regard. Their physical environment needs to be enhanced with their examination room, waiting area, latrine and other health care facilities becoming clean, patient-friendly and safe for clients, for those who provide the services and the community as a whole. As part of its support to improve quality of health services at the health post level, Amref Health Africa in Ethiopia implements a project that aims to improve the physical set up of many health posts in rural Ethiopia
For Senait and most attending such an experi- ence sharing event with thorough demonstra- tion showing what works well in a different country context and health setting has much more impact. The visiting team was very much inspired by what they saw at Gatenga health center as well as similar learning exchanges at the Gasabo district and Kabusunzu Health Centre. ‘With commitment, it is always possible to make a difference by working towards improving health settings and delivering quality health services to communities as Gatenga proved,’ was the lesson the team collectively took back home to put into action