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Rwanda Holds First Conference on Quality of Healthcare
by Dr. Bruno Bouchet

The Rwandan Ministry of Health held its first conference to develop a national quality of care strategy for healthcare services in Kigali, Rwanda, in late March. The QA Project and the PRIME II Project (both funded by the U.S. Agency for International Development), the Central Medical Store of Rwanda (CAMERWA), and the Kigali Central Hospital (CHK) sponsored the event, which was attended by 100 healthcare professionals.

Opening of the Conference: (left to right) Dr. Elizabeth Drabant, Health and Nutrition Officer, USAID Population; Ida Hakizinda, Economist, Poverty Reduction Program; His Excellency Dr. Ezéchias Rwabuhihi, Minister of Health, Rwanda; Dr. Ousmane Diouf, WHO Representative.

The purpose of the conference was to make strategic and operational recommendations to design a national health sector strategy to positively influence the quality of healthcare services in Rwanda. The objectives included:

• Sharing experiences in quality improvement in the Rwandan health system
• Discussing the determinants of quality and the institutionalization of a quality assurance (QA) approach
• Making recommendations to implement and sustain a national quality improvement strategy

On the first day, the MOH departments and their partners presented their approaches, experiences, and lessons learned. They covered improving quality in six districts and the CHK (under the QA Project), and measuring the performance of healthcare providers (under PRIME II), quality control of drugs and laboratories (CAMERWA and the national reference laboratory), and the facility-based monitoring of quality (the UNICEF approach).

His Excellency Dr. Ezéchias Rwabuhihi, Minister of Health

The Minister of Health, His Excellency Dr. Ezéchias Rwabuhihi, opened the conference and contributed extensively to the first days discussions. The Ministry of Health also presented the different approaches currently being used as pilot projects. They also discussed the healthcare financing system and possible projects for future implementation, such as the accreditation of hospitals. Dr. Bruno Bouchet Associate QA Project Director for Africa, and Dr. Maina Boucar, Associate QA Project Director for West and Francophone Africa, discussed the QA Projects analysis of the determinants of quality and its framework for the institutionalization of quality assurance.

On the second day, the participants divided into five groups and debated priority topics that were selected by the Ministry of Health. These topics included the institutionalization of QA key functions, the structural support to a QA strategy and human resources needed, the impact of the healthcare financing system on quality of care, the harmonization of partners contribution to improving quality, and the role of national programs. Dr. Ousmane Diouf, of the World Health Organization, also participated and contributed actively to the conference.

Participants of the quality of healthcare conference in Kigali, Rwanda

The participants reached a consensus on 14 recommendations to develop a national quality of care strategy in several lively plenary sessions. In the future, the next step will be to turn these recommendations into a policy statement, to develop strategic directions for action, and to align stakeholders contributions to implement them operationally.

The participants recommendations included:

1. Ensuring the development of clinical and management standards for all activities and at all levels of the health system, with full participation of both users and partners
2. Defining indicators of compliance with standards and use these indicators for improvement decision making
3. Developing a quality monitoring system that relies on clinical performance indicators, including through supervision
4. Building leadership for quality at all levels
5. Formalizing a Quality Assurance (QA) approach to address issues in health system performance
6. Initiating awareness and training strategies for health providers in basic QA, targeting needs
7. Including QA approaches in the curriculum of medical and paramedical training institutions
8. Establishing a National Council for Quality Assurance
9. Motivating health providers through a specific and improved status
10. Using supervision as a mechanism to implement QA
11. Studying the impact of various financing and payment modes for healthcare on the quality of services
12. Beginning a dialogue with partners on healthcare quality and QA, and the impact of their interventions on quality of care
13. Developing a conceptual framework for the institutionalization of QA in Rwanda
14. Integrating the QA activities in the district action plan

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