Rwanda. Annual Family Planning Policy and Budget Review REPORT

Transcription

1 Rwanda Annual Family Planning Policy and Budget Review REPORT

2 Rwanda Annual Family Planning Policy and Budget Review REPORT

3 Published by: RWN (Rwanda Womens Netwok) Kinyinya Sector, Gacuriro (Next to SOS Technical School) Kg 428 Street P.O.BOX 3157, Kigali Rwanda Tell Website: Author: Gitura Mwaura Cover photo credit: RWN Layout and design: Copyright: RWN (Rwanda Womens Network) All forms of reproductions, adaptation and translations through mechanical, or electronic means should RWN (Rwanda Womens Network) as the source. Disclaimer: All data is accurate as of July 2014

4 Rwanda Annual Family Planning Policy and Budget Review Table of Contents 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

5 REPORT ACRONYMS AND ABBREVIATIONS DSW FGD FP FY GoR KIIs MCH MCHI MoF MoH RH RwF RWN 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 3

6 Rwanda Annual Family Planning Policy and Budget Review 1. EXECUTIVE SUMMARY This report presents the findings of the annual family planning policy and budget review carried out in October The study comprises a review of national and Gatsibo District development 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 planning (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, attendance 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. 4

7 REPORT 2. INTRODUCTION Reproductive health (RH) and family planning (FP) continues to receive recognition by the Government 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 carried out in October The review was a follow-up to the baseline study, The Review of National and District Policies and Budgets (2009/ /14), under the Euroleverage Project in Rwanda. 2.1 Objectives 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 Establish whether key family planning (FP) issues identified by community members in Gastibo District were addressed 5

8 Rwanda Annual Family Planning Policy and Budget Review 3. METHODOLOGY The study undertook a case study approach. This comprised a review of national development plans for the period , 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 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. 3.1 Limitations 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. 6

9 REPORT 4. FINDINGS 4.1 Budget Analysis 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 adjustment 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. 7

10 Rwanda Annual Family Planning Policy and Budget Review Table 1: National Health Budget Analysis (2013/ /2015) 2013/ /2015 Total MoH Budget (RwF) 127,642,972, ,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 Nominal 850,113,778 (12.4%) Real 38,293,413 (0.56%) Family Planning & Reproductive Health 483,643,111 1,313,757,151 Nominal 830,114,040 (171%) Real 37,392,524 (7.7%) Maternal & Child Health Improvement 3,463,813,923 1,722,468,066 Nominal -1,741,345,857 (-50.2%) Real -78,439,003 (-2.26%) Table 1: National Health Budget Analysis (2013/ /2015) 2013/ /2015 Inflation Deflator

11 REPORT 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/ /2015) 2013/ /2015 Total District Health Budget (RwF) 997,489,438 1,088,521, 184 Nominal 91,031,746 (9.1%) Real 4,100,529 (0.41%) Family Planning 7,265,000 4,030,000 Nominal -3,235,000 (-44.5%) Real -126,367 (-2%) 9

12 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 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. 10

13 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 provided a window to begin engaging on issues of concern. 5.2 Recommendations 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 international 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. 11

14 RWN (Rwanda Womens Netwok) Kinyinya Sector, Gacuriro (Next to SOS Technical School) Kg 428 Street P.O.BOX 3157, Kigali Rwanda Tell Website: