Rwanda / Inshuti Mu Buzima

Inshuti Mu Buzima (“Partners In Health” in the Rwandan national language, Kinyarwanda) is the first PIH project in Africa. Launched in the spring of 2005 at the invitation of the Rwandan government, the project marked our determination to respond to the escalating crisis in global health by bringing the PIH model of care to the continent that is the epicenter of twin pandemics of poverty and disease. Inshuti Mu Buzima (IMB) confronts this challenge as part of an innovative partnership among strongly committed public and private organizations, including the Rwandan Ministry of Health, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the Clinton HIV/AIDS Initiative. Together, IMB and its partners have undertaken a commitment to scale up HIV treatment and care in rural Rwanda; to strengthen the country’s national training and evaluation programs; and to develop, document and disseminate a rural care model for HIV that can be adapted and replicated throughout Rwanda and other African countries.

PIH's intervention in Rwanda consciously replicates the model that has proven successful in central Haiti. Our success in building comprehensive HIV prevention and treatment programs in rural Haiti encouraged the Rwandan Ministry of Health to call upon PIH to bring this model to rural Rwanda, where treatment was lagging as most other HIV programs were centered in the capital city, Kigali. In April 2005, PIH began working at the first of six sites that had been selected in two rural health districts in southeastern Rwanda — Rwinkwavu and Kirehe – home to almost half a million people and not a single doctor. (After administrative boundaries were redrawn several months later, the PIH sites are now located in the three districts of Kayonza, Kirehe and Ngoma.)

The first site, Rwinkwavu Hospital, was a derelict facility that had been sitting in disrepair for years with few patients, no doctors and only a handful of nurses with no tools to serve their patients. Within weeks of arriving in Rwinkwavu, PIH and IMB constructed consultation rooms, hired nurses, restored electricity and running water, and brought basic medical equipment to the site. Just eight months later, in districts where few people had been tested for HIV and almost none were on treatment, IMB had tested more than 30,000 people and enrolled nearly 700 on antiretroviral therapy.

From the outset, AIDS prevention, testing and treatment have been embedded in the comprehensive array of medical and social services prescribed by the PIH model of care. The hospital reconstruction progressed over the first year to include five dedicated inpatient wards with more than 80 beds. The pediatric building houses the general pediatric ward as well as a separate inpatient center for children suffering from severe malnutrition. Rwinkwavu Hospital and the adjoining health center now offer a full range of services including comprehensive HIV prevention and treatment programs, tuberculosis treatment, ambulatory primary care services prenatal care, family planning, malnutrition programs, and maternity and emergency obstetrical care.

In keeping with our commitment to ensure that poor people are not denied health care or education because of inability to pay, PIH is working with the Rwandan Ministry of Health to support the cost of insurance and consultation fees for the indigent population and is assisting with the costs of school uniforms and supplies. Strong community partnerships have been forged by recruiting, training, and hiring hundreds of local villagers, many of them HIV patients themselves, to work as community health workers. Social support programs were also launched almost immediately. As part of a Program on Social and Economic Rights (POSER) modeled on the program in Haiti, IMB distributes food packages to the families of all patients being treated for HIV or tuberculosis, builds solid houses for patient families living in tumble-down shacks, pays school fees, and employs local people at a carpentry and metalworking shop that produces supplies for the hospital, health centers and POSER houses.

With Rwinkwavu Hospital as its main referral site, IMB has expanded and now offers HIV prevention, testing, and treatment at all six sites in southeastern Rwanda. Working in four health centers in Kirehe health district, we soon recognized the desparate need for a district hospital to serve a population of more than 350,000 people. PIH has made a commitment to work with the Ministry of Health to build a district hospital in Kirehe in 2007. As the new hospital is being built, clinical and laboratory facilities have been expanded and clinical staffing has been increased at the existing health center. With support from the Bill & Melinda Gates Foundation, ground has also been broken at Rwinkwavu for a training center where sessions will be conducted not only for IMB personnel but for Ministry of Health staff from throughout Rwanda and for delegations from other African countries. As of the end of September 2006, a total of 1,761 patients were receiving antiretroviral treatment across all six sites, with almost four thousand being tested and more than 100 new patients being enrolled on therapy every month.