Ministry of Health - CCHIPs Workshop

On February 25^th, the CCHIPs team participated in a workshop with Rwanda’s Ministry of Health (MoH), the purpose of which was to present the CCHIPs model to all MoH departments. During the workshop, Co-Founder Bill Wyman and Project Director Jeanne d’Arc presented the CCHIPs model and introduced CCHIPs plans for the future.

As a result of the workshop, the Permanent Secretary of the MoH, Dr. Agnes Binagwaho, agreed to support CCHIPs in working closely with the MoH in the upcoming months to further develop its model in line with MoH policies and protocols. We at CCHIPs are very excited for this opportunity to work directly with the MoH departments responsible for setting national health care policies and protocols. This is an opportunity to see our work have a much larger impact throughout Rwanda!

CCHIPs Project Director (Jeanne d’Arc Nyirajyambere), MoH Coordinator of SWAP (Michel Gatete), WWHPS-CCHIPs Co-Founder (Bill Wyman), and MoH Permanent Secretary (Dr. Agnes Binagwaho) at the MoH-CCHIPs Workshop.

The CCHIPs team following the workshop.

Logistics Coordination

Name: ELIE SEBIGOLI

Position: CCHIPS LOGISTICS COORDINATOR

With CCHIPs since: SEPTEMBER 15^TH 2006

Introduction:

 My job in this context concerns the management of the material resources that are necessary for the CCHIPS staff to accomplish their missions. This includes activities such as:

-         Arranging transportation: The CCHIPs team has one car (a LandCruiser named “Gertie”) that I use to ensure the staff has transportation to health centers and other meetings. As the CCHIPs team expands, there are more demands on the car. Sometimes, I must hire private cars or motorcycles to transport people to appointments. As the project continues to expand, we will need another car and perhaps some motorcycles in order to ensure that the staff can get where they need to be.

-        Providing equipment/materials for CCHIPs office and health centers: This includes health center equipment such as patient beds, delivery tables, examination tables, bed sheets and blankets; and training materials such as markers, flip charts, food and drinks. Not all these materials are easy to find in Rwanda, so this often requires a lot of research and negotiating.

-        Delivering materials: In addition to securing the materials needed at the health center and at the CCHIPs office, I must also arrange ways for these to be delivered. Sometimes this can happen in the CCHIPs car (such as when we transported 2 goats in September!) but sometimes requires arranging for trucks in cases of heavier deliveries.

-        Booking lodging and other arrangements: When members of the CCHIPs team travel, I ensure their safety and comfort by booking lodging and restaurants. This often requires looking around for the cheapest available rooms, that are still comfortable and safe. Also finding good, inexpensive food.

-        Sending and receiving correspondences: I ensure that the members of the CCHIPs team receive official correspondences in a timely manner by frequently checking with the post office and with Rwandan officials.

-        Managing WWHPS-CCHIPs reporting: I help make reports for WWHPS-CCHIPs, including finding somebody to do all the printing and binding of the reports, and distributing them to our many stakeholders.

In Rwanda, many of these duties are not easy: without websites or other advertising, it is not always easy to find distributors or hotels. Much of my job requires me to be very social and talk with many people, in order to find the materials or other things that will allow the CCHIPs team to successfully do their jobs, helping the project achieve its mission.

The CCHIPs team celebrated Elie's birthday on January 4!

Other Projects: I also help with the Mutuelle project by working with HC Mutuelle section authorities to think about strategies to use to sensitize local people to enroll in Mutuelle health insurance. This is the key for them to have access to the health center; to use it in order to improve their health.

Lesson Learned This Week: To be careful when  sending something to somebody; also when communicating with people.

Psychosocial Program

Name: Amber Johnston

Position: Psychosocial Program Coordinator

With CCHIPs Since: Sept. 2009

Project Update:

Since starting the Psychosocial Program at Shingiro Health Center 10 weeks ago, I’ve been amazed at the initial success of the program. During the 10 weeks we met with 38 clients, had 6 follow-up meetings where clients came back for additional appointments, and went to the sector offices 3 times to advocate for clients. The majority of people we saw were women. However, 3 times couples came in together to try and work out problems between them. The range of issues that were presented was remarkable: from young girls who had gotten pregnant out of wedlock, men who were having sexual troubles, to women who were suffering from domestic violence. Despite the variety, one of the most common issues was family conflict, with 13 out of the 38 clients coming to us because of it. The reasons behind the family conflict varied and included alcoholism, land issues, polygamy and domestic violence.

During the sessions we have had a number of clients thank us for having the program and many said that they felt much better after having someone listen to them and offer counseling.  The nurses and community health workers have also been incredibly supportive. During trainings and informal conversations it was commonly acknowledged that in Rwanda very few people have someone they can confide in and many mentioned that it is important to have someone trained to talk to.

This coming year we are looking forward to the psychosocial/mental health program become an integrated part of Shingiro health center. January, February, March and April Jean Bosco and I will be continuing the activities at the health center and after our 6 month data collection period we will begin transitioning the daily activities of the program to a trained nurse at the health center.  

Watching the psychosocial program come together has been amazing. The progress from when I first came over in September, 2009 has been incredible. There were times during those first months when it was difficult to imagine what the program would look like and if it would be functional. Seeing the program operating at the health center, and having such positive feedback about the activities has been a rewarding experience.

Best Meal of the Week: Homemade avocado juice

Favorite Place in Rwanda: Our front porch at sunset

View of the volcanoes from our front porch -- so beautiful!

Mutuelle Survey

Name: Elizabeth Mitchell

Position: Reporting & Communications Coordinator

With CCHIPs Since: August 2010

Project Update:

Recently, I’ve been working on writing a report about the Mutuelle Survey conducted by CCHIPs in 2009.

This report seems to capture the strong teamwork aspect of CCHIPs...Mike (a volunteer in 2009) designed and launched the survey with the help of Consolate, Elie, and 74 Shingiro Health Center Community Health Workers (CHWs). Each of the CHWs interviewed 10 households (5 enrolled in Mutuelle, 5 not enrolled in Mutuelle) in their village about why they were or were not enrolled in Mutuelle. Then, the 740 hand-written surveys were distributed amongst the entire CCHIPs team for inputting the data into Excel. Mike started the analysis and report-writing, including preparing a presentation for a District workshop that was unfortunately delayed. Lauren (a volunteer in 2010) continued the analysis and report writing, and handed it over to me when she left in September. I’ve been working on the report ever since, with the help of Celestin, who has been working on the Kinyrwanda presentation so that the CHWs can understand the findings from their hard work.

Ultimately, our goal is that this report will help inform the Rwanda Ministry of Health (MoH) on policy decisions that relate to Mutuelle. Mutuelle is the national public insurance program. Technically, all Rwandans are required by law to obtain Mutuelle – but this does not happen in practice. In 2009, only 52% of the Shingiro Health Center population was enrolled in Mutuelle. (The good news is that with some targeted strategies by CCHIPs and Shingiro Health Center, this number jumped to 88% in 2010!) The objective of the survey was to understand why people do not enroll in Mutuelle. Mike designed the survey such that “poverty” would not be the ultimate reason for lack of enrollment. The report, instead, focuses on concrete barriers to enrollment that can be addressed with targeted programs and specific policy changes. These barriers include timing of cash flows, financial aid policies, and lack of understanding of the financial benefits of Mutuelle. In the report, we make specific recommendations for what the community, District, and MoH can do to address these barriers.

Even though the report is being finalized a year after the survey was conducted, I believe the findings will still be very relevant, and benefit policy-makers in Rwanda. We are currently in the process of reviewing our findings with the proper entities, in hopes of the report reaching the National level in time for it to affect 2012 Mutuelle policies.

I’ve really enjoyed working on this report. The large sample size has allowed for advanced analysis – including some things I never expected to see after my Econ classes in college. It is also exciting to work on something that could ultimately have a huge impact at the National level. This report is just one example of how CCHIPs makes use of the specialized skills of volunteers to benefit Rwanda, outside of our direct interventions. In 2011, we hope to conduct similar projects on the cost-effectiveness of health centers and the potential of a patient follow-up system at health centers.

A sample finding from the Mutuelle Survey shows that households Not Enrolled in Mutuelle are more likely to grow "Season B" crops. This finding helps support the argument that cash flows are not aligned with Mutuelle enrollment cycles, and helps inform the MoH which households to specifically target for Mutuelle enrollment.

Highlight of the Week: Christmas celebrations with Jeanne d’Arc’s family and New Year’s celebrations with Elie’s family!

Best Meal of the Week: I made Baked Ziti with a few Peace Corps volunteers, using Cheddar Cheese brought from the US by Ro…mmmmm

Scheduling & Organization

Name: Marvin Arnold

Position: Management Systems Coordinator

With CCHIPs Since: August 2010

As with most activities, using basic organization and planning skills can drastically boost the efficiency of a health center. Particularly within Management Systems, CCHIPs places a heavy emphasis on this issue.  We work with the pharmacy to organize their drugs and plan ahead to prevent stock outages. We address the data manager’s needs to keep an organized archive of health center data and schedule time for regular data entry. The accountant has monthly payment deadlines and binders full of receipts for which we help develop ways to keep track of. Lastly, we support the Titulaire and managers in their planning of all health center activities. Despite our emphasis on scheduling and organization, CCHIPs doesn’t teach any groundbreaking techniques to help these stakeholders. Our solutions are focused on simple but consistent changes in behavior.

Although we are currently collecting empirical evidence to analyze the benefits of these trainings, anecdotally, they have been a huge success. For example, at Shingiro, we recently helped motivate the data manager to organize all of her data on loose paper into folders. Since then, she has frequently noted how much quicker she is able to find the right documents.

With all this success in mind, a few weeks ago I began to realize that, in my own life, I am not using the best planning or organization. While this realization is motivating me to take some steps to improve, it eludes to a bigger issue. As an organization, CCHIPs can never forget the reality of the situation we are working in. Personally I know that, in an effort to formalize my training procedures, I sometimes over-idealize the process. Moving forward, I must incorporate the human aspect into my trainings to a greater extent. How can I expect someone to adopt good habits I struggle with myself? How can I better demonstrate the long term advantages of certain behavior to the staff when so many more pressing short term issues arise in their lives every day? While I search for answers, I will continue to be inspired by the ability of the health center staff to use the trainings we give and organize themselves – usually better than I could.

Best Meal of The Week: Normally, I am not a fan of hotel food, but buffet dinner at La Palme Hotel Monday night was amazing!

News of the week: CCHIPs’ first Management Systems Coordinator, Zack Scott is headed back to the U.S. on Saturday to start work at Oliver Wyman. He has been with CCHIPs for two years and has made a huge impact on the organization. We are celebrating his time with us on Friday and look forward to making the best out of this loss.