Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
BMC Health Serv Res. 2013;13 Suppl 2(Suppl 2):S5. doi: 10.1186/1472-6963-13-S2-S5. Epub 2013 May 31.
Nationally, health in Rwanda has been improving since 2000, with considerable improvement since 2005. Despite improvements, rural areas continue to lag behind urban sectors with regard to key health outcomes. Partners In Health (PIH) has been supporting the Rwanda Ministry of Health (MOH) in two rural districts in Rwanda since 2005. Since 2009, the MOH and PIH have spearheaded a health systems strengthening (HSS) intervention in these districts as part of the Rwanda Population Health Implementation and Training (PHIT) Partnership. The partnership is guided by the belief that HSS interventions should be comprehensive, integrated, responsive to local conditions, and address health care access, cost, and quality. The PHIT Partnership represents a collaboration between the MOH and PIH, with support from the National University of Rwanda School of Public Health, the National Institute of Statistics, Harvard Medical School, and Brigham and Women's Hospital.
The PHIT Partnership's health systems support aligns with the World Health Organization's six health systems building blocks. HSS activities focus across all levels of the health system - community, health center, hospital, and district leadership - to improve health care access, quality, delivery, and health outcomes. Interventions are concentrated on three main areas: targeted support for health facilities, quality improvement initiatives, and a strengthened network of community health workers.
The impact of activities will be assessed using population-level outcomes data collected through oversampling of the demographic and health survey (DHS) in the intervention districts. The overall impact evaluation is complemented by an analysis of trends in facility health care utilization. A comprehensive costing project captures the total expenditures and financial inputs of the health care system to determine the cost of systems improvement. Targeted evaluations and operational research pieces focus on specific programmatic components, supported by partnership-supported work to build in-country research capacity.
Building on early successes, the work of the Rwanda PHIT Partnership approach to HSS has already seen noticeable increases in facility capacity and quality of care. The rigorous planned evaluation of the Partnership's HSS activities will contribute to global knowledge about intervention methodology, cost, and population health impact.
自 2000 年以来，卢旺达的健康状况一直在改善，自 2005 年以来取得了相当大的进展。尽管有所改善，但农村地区在关键健康结果方面仍落后于城市部门。自 2005 年以来，健康伙伴关系（PIH）一直在卢旺达两个农村地区支持卢旺达卫生部（MOH）。自 2009 年以来，MOH 和 PIH 一直在这些地区领导一项卫生系统加强（HSS）干预措施，作为卢旺达人口健康实施和培训（PHIT）伙伴关系的一部分。该伙伴关系的指导原则是，HSS 干预措施应该全面、综合、针对当地情况，并解决医疗保健的获取、成本和质量问题。PHIT 伙伴关系代表了 MOH 和 PIH 的合作，得到了卢旺达国立大学公共卫生学院、国家统计局、哈佛医学院和布莱根妇女医院的支持。
PHIT 伙伴关系的卫生系统支持符合世界卫生组织的六个卫生系统建设模块。HSS 活动侧重于卫生系统的所有各级——社区、保健中心、医院和地区领导层——以改善医疗保健的获取、质量、提供和健康结果。干预措施集中在三个主要领域：对卫生设施的有针对性支持、质量改进倡议以及加强社区卫生工作者网络。
将通过在干预地区人口抽样调查中收集的人口水平结果数据来评估活动的影响。总体影响评估由对设施卫生保健利用趋势的分析补充。一项全面的成本核算项目记录了卫生保健系统的总支出和财务投入，以确定系统改进的成本。有针对性的评估和业务研究侧重于特定的方案组成部分，并得到伙伴关系支持的建设国内研究能力的工作的支持。
在早期成功的基础上，卢旺达 PHIT 伙伴关系的 HSS 工作已经看到了设施能力和护理质量的显著提高。对伙伴关系 HSS 活动的严格计划评估将有助于全球了解干预方法、成本和人口健康影响方面的知识。
