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Click here to receive our detailed Ortinola Prospectus PDF.
Rwanda is being challenged with an increased prevalence of malaria that is associated with low income areas, non-compliance with bed-net usage and living below 1700 meters of altitude. New interventions are being used in lower income areas, but with questionable results. While available evidence suggests that in the event of equal exposure, adult men and women are equally vulnerable to malaria infection, women tend to be a much higher risk.
The Rwandan Ministry of Health (MoH) is determined to eradicate malaria and is working with the Roll Back Malaria program, and the U.S. President’s Malaria Initiative (PMI) that is being led by USAID and implemented together with the US Center for Disease Control and Prevention.
The Rwandan MoH has a strategy that is focused on 1) vector control; 2) human health including diagnosis and drug-based treatments and prevention; and 3) critical support systems that include supply chains. Within this strategy, there are concerns with data collection and implementation, by NGO partners, at the community-level.
Rwanda is among the few countries to have achieved universal health coverage due to its vision of inclusiveness, equity, and comprehensive and integrated quality service delivery, with a strong focus on primary health care. Within the health sector, Rwanda has been open to financial innovations, such as health insurance and performance-based financing models.
At the district level, government officers sign performance-based contracts with health facilities. Performance against indicators is monitored with quarterly evaluations and through analysis of results in annual reports. While these performance-based models have worked well they do not apply to NGO health partners implementing malaria programs.
While the MoH has a strong culture of enforcing data-driven decision-making and policy formulation there are challenges in getting timely and accurate community-based information. The main source of data is the Health Management Information System (HMIS) where data is inputted in health centres and hospitals, and then compiled monthly and transmitted to the centralized HMIS server. At the moment, paper reports are prepared at community health posts, health centers and local hospitals. Community Health Workers prepare a monthly report of activities using 13 different forms, all paper-based. Once the reports are prepared, they will be sent to be digitized and then submitted to the main HMIS.
Another related challenge is making sure that health partner NGOs are effectively addressing the needs of the community and especially those most vulnerable, such as women and girls. Poor data and weak data-systems, especially at the local level, impair an adequate understanding of issues impacting the poor, as well as the ability to deliver evidence-based policy and programming. To have NGO partners maximize the net social benefits of their programs will require the sharing of timely and relevant data. It will also be important to positively incentivize program partners so that target interventions are prioritized and intended results achieved.
The pilot project is premised on alignment with existing systems where there are niches for improvement. The pilot project has two innovation solutions – 1) data collection and management, and 2) service delivery incentives that include targeting gender equality issues.
The Fionet software and mobile devices enables community health workers to deliver expert-level testing and clinical case management and having all the data captured, geo-tagged, and uploaded in real time. The Fionet portal allows for remote supervisors in Kigali to generate real-time managerial insights for program managers to make dynamic adjustments to improve outcomes. It connects with multiple 3rd party point-of-care devices, such as diagnostic and physiological measurement devices, and uploads all their data. It also integrates seamlessly with the Rwandan health care HMIS systems.
The technology being deployed is innovative, but to achieve the intended outcomes it is depended on the service delivery system to be working efficiently. This is especially the case for NGOs that are a partner of the Ministry of Health. IBG has worked on a performance-based contract methodology that is expected to improve outcome level results. The IBG methodology focuses on three key areas:
Targeting what Matters - the Fionet mobile devices are a critical part of a performance management system (PMS). A PMS needs to collect the right data, that is, data that will drive the team’s understanding of whether and how the program is achieving critical results. Impact Bridges Group works with NGO teams to shift the measurement focus towards generating real-time managerial insights for program managers to make dynamic adjustments to improve gender equality and other program outcomes. This is unique, as many NGOs are focused on measuring outputs.
Use of Incentives to Improve Gender Equality - in a similar manner to the performance contract implemented by the Ministry of Health, Impact Bridges Group will tie funding to implementing organizations to agreed-upon results. In other words, the implementing NGOs will be financially rewarded for achieving the intended results and not for having good intentions to do so. Financial and other incentives are used to have NGO implementers to be explicitly focused on finding the best means of providing services to marginalized groups of women and girls. It is expected that implementing organizations will have a mindset shift in that these women will be seen as clients and given the utmost attention in providing services.
Creating Space for Innovation and Maximizing Results - Impact Bridges Group will design the payment instrument so that it offers the space, needed by the implementing organization(s), for adapting and iterating the program design and delivery practices. The focus is on achieving improved outcomes for marginalized women and girls and implementers are encouraged to change activities, based on the evidence from the data collected, in an effort to further improve services. Unlike traditional programs that hold implementing organizations to the proposal plans, the pilot project will provide flexibility and freedom to pursue a range of strategies, based on evidence, that are expected to achieve greater impact.
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