Since 2004, the U.S. government has supported the global response
to HIV/AIDS through the President's Emergency Plan for AIDS Relief
(PEPFAR). The Republic of Rwanda, a PEPFAR partner country since
the initiative began, has made gains in its HIV response, including
increased access to and coverage of antiretroviral therapy and
decreased HIV prevalence. However, a persistent shortage in human
resources for health (HRH) affects the health of people living with
HIV and the entire Rwandan population. Recognizing HRH capabilities
as a foundational challenge for the health system and the response
to HIV, the Government of Rwanda worked with PEPFAR and other
partners to develop a program to strengthen institutional capacity
in health professional education and thereby increase the
production of high-quality health workers. The Program was fully
managed by the Government of Rwanda and was designed to run from
2011 through 2019. PEPFAR initiated funding in 2012. In 2015,
PEPFAR adopted a new strategy focused on high-burden geographic
areas and key populations, resulting in a reconfiguration of its
HIV portfolio in Rwanda and a decision to cease funding the
Program, which was determined no longer core to its programming
strategy. The last disbursement for the Program from PEPFAR was in
2017. Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's
Human Resources for Health Program describes PEPFAR-supported HRH
activities in Rwanda in relation to programmatic priorities,
outputs, and outcomes and examines, to the extent feasible, the
impact on HRH and HIV-related outcomes. The HRH Program more than
tripled the country's physician specialist workforce and produced
major increases in the numbers and qualifications of nurses and
midwives. Partnerships between U.S. institutions and the University
of Rwanda introduced new programs, upgraded curricula, and improved
the quality of teaching and training for health professionals.
Growing the number, skills, and competencies of health workers
contributed to direct and indirect improvements in the quality of
HIV care. Based on the successes and challenges of the HRH program,
the report recommends that future investments in health
professional education be designed within a more comprehensive
approach to human resources for health and institutional capacity
building, which would strengthen the health system to meet both
HIV-specific and more general health needs. The recommendations
offer an aspirational framework to reimagine how partnerships are
formed, how investments are made, and how the effects of those
investments are documented. Table of Contents Front Matter Summary
1 Introduction: Evaluation Scope and Approach 2 Evaluation Design,
Methods, and Limitations 3 Human Resources for Health Program
Context, Vision, and Design 4 Faculty Twinning 5 Institutional
Capacity for Health Professional Education 6 Health Worker
Production 7 Effects on Human Resources for Health and Quality of
Care 8 Recommendations Appendix A: Committee Member, Consultant,
and Staff Biographies Appendix B: Public Session Agendas
General
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