Rwanda Annual Family Planning Policy and Budget Review

2014-2015 REPORT

Rwanda Annual Family Planning Policy and Budget Review

2014-2015 REPORT

Published by:

RWN (Rwanda Womens Netwok)Kinyinya Sector, Gacuriro (Next to SOS Technical School) Kg 428 StreetP.O.BOX 3157, Kigali RwandaTell +250 788 334 257Email: rwawnet@rwanda1.rw info@rwandawomennetwork.orgWebsite: www.rwandawomennetowrk.org

Author: Gitura Mwaura

Cover photo credit: RWN

Layout and design: www.magnethic.com

Copyright: RWN (Rwanda Womens Network)

All forms of reproductions, adaptation and translationsthrough mechanical, or electronic means should RWN(Rwanda Womens Network)as the source.

Disclaimer: All data is accurate as of July 2014

Rwanda Annual Family Planning Policy and Budget Review

EXECUTIVE SUMMARY

INTRODUCTION

Objectives

METHODOLOGY

Limitations

FINDINGS

Budget Analysis

National Budget

Gatsibo District Budget Analysis

Service Provision at Health Facilities

GENERAL CHALLENGES AND RECOMMENDATIONS

Recommendations

1.

2.

2.1

3.

3.1

4.

4.1

4.1.1

4.1.2

4.2

5.

5.2

4

5

5

6

6

7

7

7

9

10

11

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Table of ConTenTs

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2014-2015 REPORT

Deutsche Stiftung Weltbevoelkerung

Focus Group Discussions

Family Planning

Financial Year

Government of Rwanda

Key informant interviews

Maternal and Child Health

Maternal and Child Health Improvement

Ministry of Finance

Ministry of Health

Reproductive Health

Rwandan Francs

Rwanda Women’s Network

DSW

FGD

FP

FY

GoR

KIIs

MCH

MCHI

MoF

MoH

RH

RwF

RWN

aCRonYMs anD abbReVIaTIons

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Rwanda Annual Family Planning Policy and Budget Review

This report presents the findings of the 2014-2015 annual family planning policy and budget review carried out in October 2014. The study comprises a review of national and Gatsibo District develop-ment plans for the period, including newspaper reports, and the national and district budgets.

The review team visited Rwimitereri and Gakenke Health Centres in the District to sample family plan-ning (FP) services offered, and to monitor any likely changes to community access to these services compared to the previous year.

At the national level, the Ministry of Health (MoH) 2014/15 budget saw a significant reduction of 19.5 %. However, although family planning and reproductive health (RH) were combined as in the previous financial year, both received a 170% increment, which amounted to 7.7% in real terms after adjustment for inflation.

Gatsibo District Health 2014/15 Budget increased marginally at 0.41% in real terms. However, as in the previous year, family planning was categorized under “Disease Control” with the main activity being community mobilisation.

Rwimitereri and Gakenke Health Centres indicated a reduction on myths and misconceptions about effects of FP that had a knock-on effect of increased turnout. Gakenke realised an increase of 26.8% on service uptake, while Rwimitereri recorded a 9.4% increase. However, Focus Group Discussions with the youth indicated that more effort was required to ensure that services are friendlier for them.

Another major challenge was not being able to engage with the Ministry of Health. However, atten-dance of the DSW planning meeting by MoH officials in December 2014 provided a window to begin engaging on issues of concern.

At the district level, it remains an area of increased advocacy to “de-stigmatise” family planning from “disease control”, and ensure an increase in family planning budget allocation in the district.

1. eXeCUTIVe sUMMaRY

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2014-2015 REPORT

Reproductive health (RH) and family planning (FP) continues to receive recognition by the Govern-ment of Rwanda (GoR) as key to individual well-being and national development. This report presents the results of the annual policy and budget review for 2014-2015 carried out in October 2014. The review was a follow-up to the baseline study, The Review of National and District Policies and Budgets (2009/10 – 2013/14), under the Euroleverage Project in Rwanda.

The primary objectives of the follow-up review were to:

• Assess the extent to which family planning and other reproductive health issues were prioritized nationally and in Gatsibo District during Financial Year 2014-2015

• Establish whether key family planning (FP) issues identified by community members in Gastibo District were addressed

2. InTRoDUCTIon

2.1 Objectives

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Rwanda Annual Family Planning Policy and Budget Review

The study undertook a case study approach. This comprised a review of national development plans for the period 2014-2015, including those of Gatsibo District, newspaper reports, and the national and district budgets. Budget documents were reviewed to identify any budgetary increments, gaps and funding available for effective FP implementation in 2014-2015.

Four Focus Group Discussions (FGDs) comprising two women-only groups, one men-only group, and a youth-only group were conducted. FGDs sought to draw out community perceptions on changes of FP access and continuing hurdles to FP services. Key informant interviews (KIIs) were also conducted to provide an overview of policy implementation on the ground, including access, or lack of, to FP services from the national to the grassroots levels. A standard FGD guide developed for countries in the region under the DSW programme was adapted to suit the Rwandan local community situation. Priority issues arising were ranked as identified by each group during the discussions. The ranked issues for all the groups were synthesised to draw out similarities and crosscutting concerns to come up with representative community priorities. Similarly, a discussion guide was used to conduct KIIs and data was collected thematically analysed to bring out issues of convergence regarding the priorities identified by the FGDs.

A survey tool developed for the regional analysis was used to sample FP services in Rwimitereri and Gakenke Health Centres in Gatsibo District and monitor any likely changes to communities’ access to service from the previous year.

Rwanda conducted the study in only one district while the study could have benefited from examining an additional district to diversify, and especially provide a basis for analysis for the next annual study. Another limitation was the inability to engage with the Ministry of Health (MoH) and the Ministry of Finance (MoF) on the findings.

3. MeTHoDoloGY

3.1 Limitations

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2014-2015 REPORT

4. fInDInGs

4.1 Budget Analysis

4.1.1 National Budget

During the Financial Year 2014/2015, the national Ministry of Health budget experienced a significant reduction (19.5%) from the previous year as shown in Table 1 below. This was attributed to a delay in the remission of donor funding and reduced internal revenue towards overall Government budget.

Budget allocation for Maternal and Child Health (MCH) experienced a marginal increase in real terms at 0.56% after adjustment for inflation. The inflation rate for FY2014 had fallen to 3.4 from 3.5 in the previous year as shown in Table 2.

Although FP and RH were combined as in the previous financial year, both received a major boost in FY2014/2015 with a nominal increase of over 170%. This amounted to 7.7% in real terms after adjust-ment for inflation (Table 1).

Conversely, Maternal and Child Health Improvement suffered a significant budget decrease of 50% from FY2013/2014. Efforts to get in touch with officials at the MoH or Ministry of Finance to explain the drastic decrease were not successful.

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Rwanda Annual Family Planning Policy and Budget Review

Table 1: National Health Budget Analysis (2013/2014 – 2014/2015)

Table 1: National Health Budget Analysis (2013/2014 – 2014/2015)

2013/2014 2014/2015

Total MoH Budget (RwF) 127,642,972,458 102,710,388,630

Nominal-24,932,583,828 (-19.5%)

Real-1,123,089,361 (-0.88%)

Maternal & Child Health 6,863,453,373 7,713,567,240

Nominal850,113,778 (12.4%)

Real38,293,413 (0.56%)

Family Planning &Reproductive Health

483,643,111 1,313,757,151

Nominal830,114,040 (171%)

Real37,392,524 (7.7%)

Maternal & Child HealthImprovement

3,463,813,923 1,722,468,066

Nominal-1,741,345,857 (-50.2%)

Real-78,439,003 (-2.26%)

2013/2014 2014/2015

Inflation 3.5 3.4

Deflator 18.8 22.2

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2014-2015 REPORT

4.1.2 Gatsibo District Budget Analysis

Gatsibo District Health Budget increased marginally at 0.41% in real terms (see Table 3). However, as in the previous year, family planning was categorised under “disease control” with the main activity being community mobilisation.

There was a significant nominal decrease of 44% in the FP budget for FY2014/2015, which in real terms amounted to a decrease of only 1.7% after adjustment for inflation. We should delve further to understand why.

Table 3: Gatsibo District Health Budget Analysis (2013/2014 – 2014/2015)

2013/2014 2014/2015

Total District HealthBudget (RwF)

997,489,438 1,088,521, 184

Nominal91,031,746 (9.1%)

Real4,100,529 (0.41%)

Family Planning 7,265,000 4,030,000

Nominal-3,235,000 (-44.5%)

Real-126,367 (-2%)

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Rwanda Annual Family Planning Policy and Budget Review

4.2 Service Provision at Health Facilities

Two FP access barriers identified in Gatsibo district in 2013 included (a) myths and misconceptions about the side-effects of contraceptives; and (b) inadequate youth-friendly services.

A community awareness campaign conducted in May 2014 made significant strides in allaying myths and misconceptions regarding FP and RH, leading to rising demand for the services. The status of health facilities contraceptive/commodity stock remained adequate in meeting this rising demand.

Follow-up research in October 2014 at Rwimitereri and Gakenke Health Centres indicated a reduction in myths and misconceptions about the effects of FP that had a knock-on effect of increased turnout.

Rwimitereri Health Centre indicated that a combined total of 2,676 clients had visited the centre for FP services in 2014 compared to 2,446 by the same period in 2013. This amounted to a 9.4% increase.

At Gakenke Health Centre 5,766 clients were served in 2014 compared to 4,548 in 2013 reflecting an increase of 26.8%.

Community messages at the health facilities need to be improved. For example, casual observation by the researchers indicated there were only a few posters with relevant messages on the services provided.

Focus Group Discussions with the youth in October 2014 indicated that more effort is required to ensure that services are friendlier for them.

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2014-2015 REPORT

5. GeneRal CHallenGes anD ReCoMMenDaTIons

The major challenge was not being able to engage with the Ministry of Health on issues of concern. However, attendance of the DSW planning meeting by MoH officials in Kigali in December 2014 pro-vided a window to begin engaging on issues of concern.

The foregoing analysis and according to the priority issues by the communities, we recommend three interrelated issues for advocacy, both at the district and nationally. That the Government and interna-tional partners allocate adequate resources, both financial and human to

• Fight misperceptions, myths and rumors about FP methods and their side effects, including improvement of method mixes, through the media and at the community level through CHWs;

• Reach and involve the youth in relevant RH & FP programmes

• Separate FP from RH to track budgetary allocation and use

• At the district level, “de-stigmatising” FP from “disease control” and ensuring an increase in FP budget allocation remains an area for increased advocacy.

5.2 Recommendations

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RWN (Rwanda Womens Netwok)Kinyinya Sector, Gacuriro (Next to SOS Technical School) Kg 428 StreetP.O.BOX 3157, Kigali RwandaTell +250 788 334 257Email: rwawnet@rwanda1.rw info@rwandawomennetwork.orgWebsite: www.rwandawomennetowrk.org