The decentralization of health services in Rwanda: Challenges and Strategies.

Abstract

xiii ABSTRACT Iragaba Felix, (2016), The decentralization of health services in Rwanda: Challenges and Strategies, Case of Kirehe District. Masters‘ Thesis of the University of Rwanda,College of Arts and social sciences. The Rwandan government has made a significant improvement in decentralizing local institutions. Health sector is among has been also decentralized, from 2000, steps have been taken toward restructuring and decentralizing management. The district health offices have operated as autonomous entities, providing services to well-defined populations in either urban or rural zones. The district health offices are responsible for the health needs of the population in that zone and for the health facilities and services. However, there is still some gaps or persistent problems to enable local government be more effective in fulfilling their duties in: involving community in the management and running of the health services, providing technical assistance, Planning, The gap of autonomy in financial air management,…. The aim of this Thesis is to analyze some of the challenges of decentralization and specifically in relation to the provision of health services. Apart from these challenges, this thesis identifies the strategies that are necessary in order to overcome these challenges. Studying the challenges and strategies that have come with the decentralization of health services, one needs to understand them from the following research questions: What challenges are being faced by Kirehe District in relation to the decentralization of health services? And what strategies have been put in place in relation to overcoming these challenges? While studying decentralization it necessitates that we understand decentralization as the legal transfer of administrative, political and economic responsibilities from the central government to the local authorities. This is based on the logic that the local authorities have the authority to make decisions and also manage public functions. This is meant to ultimately empower the local people, assist them to run their daily affairs with the support of their local governments. Hence with proper implementation of the decentralization policy, there will be a reciprocal relationship between the citizens and the state, leading to positive state society relations. xiv In terms of methodology, this Thesis is an exploratory study that tries to understand the implementation process, in terms of challenges and strategies that are in place for successful delivery of services. The study‘s findings showed that districts were no longer passive recipients in the planning process, and financing of local government projects, while being actively involved in assessing the needs, allocation of resources and the implementation of activities. The study noted that Community participation is taking place through the elected health committees. However, other members of the communities had a passive responsibility in planning, and budgeting for health related activities. Other findings indicate that local-level participation in health service provision is extremely weak, as local people are not totally involved in the process. In terms of scientific contribution to knowledge, this Thesis contributes to the pool of knowledge on decentralization, and specifically in relation to the decentralization of health services.