Rwanda

Rwanda
 
The FAM Project: Expanding family planning options and services in Rwanda
Rwanda is a ‘scale-up’ country for the Institute for Reproductive Health’s (IRH) Fertility Awareness-Based Methods (FAM) Project, a U.S. Agency for International Development (USAID) funded initiative that ends in 2012.  IRH has operated in Rwanda since 2002, initially studying the introduction of the Standard Days Method® (SDM) into public and private sector family planning (FP) programs and the feasibility and acceptability of adding FAM.  The FAM Project aims to scale up to national level with key Ministry and NGO partners involved in family planning programs and services.  IRH-Rwanda is also working with partners to revitalize the Lactation Amenorrhea Method (LAM) and to pilot the TwoDay Method® (TDM).
 
Key FAM Project accomplishments in Rwanda
The FAM Project is focusing on completing this SDM integration into norms and systems and countrywide expansion of service delivery sites offering the SDM, in collaboration with the Ministry of Health (MOH), USAID-funded projects, and Caritas, which supports over one-third of health service sites in country.
Examples of success:
  • SDM is now widely available in USAID zones, representing 2/3 of the country, and has just begun to be integrated into the remaining third of the country supported by the United Nations Population Fund (UNFPA).
  • SDM is now offered in approximately 85% of health facilities in the country which offer FP services.  
  • SDM and LAM are now integrated into key national norms, policies and guidelines: National FP in-service training manual, national pre-service nursing curriculum, national Information Education and Communication (IEC) materials, national FP tools (FP register, FP client cards, and health center report templates).
  • SDM has been integrated into the national Management Information System (MIS) and the 2005 Demographic Health Survey (DHS).
  • IRH recently published a brief on the SDM as a long-term method in the local World Health Organization (WHO) bulletin to reach policymakers and reposition the SDM.
  • USAID in consultation with the MOH recently allocated substantial resources to purchase a new stock of CycleBeads®.  In addition, the MOH has now integrated the SDM into its performance-based financing reporting form for family planning and CycleBeads are now part of the national logistics and distribution system.
The FAM Project addresses unmet need for family planning in Rwanda
The family planning story in Rwanda is one of gain and loss and now significant rebuilding of family planning programs and use.  A viable family planning program existed prior to the 1994 genocide with a 13% CPR.  By 2000, CPR had dropped to only 4%.  President Kagame declared family planning a national priority for the country’s development (Rwanda is one of the most densely populated countries on the continent) and by 2005, CPR had more than doubled to 10% of married women and 2008 estimates of CPR exceed 20%.
 
Following the research-to-practice-to-scale model in Rwanda
The AWARENESS Project began introduction studies of the SDM in October 2002, integrating the SDM into family planning services offered by 13 public FBOs (Catholic and Protestant) and NGO health centers and clinics on a pilot basis.  With the positive results after one year, the SDM services were extended to 74 sites throughout Rwanda.  The corresponding impact study confirmed that there was demand for the SDM, providers could effectively offer it, and clients could correctly use the method.  At the end of 2006, the MOH and USAID requested full integration and scale-up of the SDM throughout the country.
In 2008, IRH/Rwanda undertook a facility assessment to assess the effectiveness of scaling-up.  The results showed that 75% of visited Service Delivery Points (SDPs) that offer FP methods had included the SDM as part of the method mix.
IRH is supporting the government initiatives to increase further access to family planning through Community Based Distribution (CBD) networks and by working with Population Services International (PSI) to support pharmacy sales of the SDM (as part of social marketing efforts led by PSI).
IRH -Rwanda's role has changed from the initial years, from a hands-on technical assistance organization focused on service delivery and program implementation to a technical assistanceresource organization supporting other organization efforts to scale-up SDM services within their family planning programs. 
 
Building partnerships to expand choice
The SDM’s success in Rwanda is the result of collaboration of IRH with its RH/FP Partners.  Sincethe beginning, the project has been positioned to support the MOH in building capacity to offer the SDM through its public sector programs.  Some NGO and FBO partners are directly involved in increasing service availability, such as the Association Rwandaise pour le Bien-être Familial(ARBEF), Association Familiale-Rwanda (AFR), Population Services International (PSI) and Caritas; others collaborate in capacity building efforts such as the USAID’s Twubakane and Capacity Projects.  Finally, IRH is an active member of the main coordinating body for family planning activities in Rwanda, the Family Planning Technical Working Group (FPTWG).
 
Contact the FAM Project in Rwanda
For more information on IRH’s programs in Rwanda, contact IRH/Rwanda Country Representative Marie Mukabatsinda at awarenessrda@rwanda1.com