Rwanda – FY 2010 Approved Funding by Program Area, Agency and Funding Source*
*Only appropriations from the GHCS (State) fund account are notified by the Global AIDS Coordinator.
PEPFAR programming in Rwanda exemplifies strong government-to-government collaboration, which has resulted in many programmatic successes in the fight against HIV. PEPFAR has finalized a Partnership Framework with the Government of Rwanda, focusing on the areas of health sector HIV service delivery; sectoral mainstreaming of HIV/AIDS in prevention, care and treatment, and health systems strengthening; community-based HIV programs; and governance and strategic information. The PF was officially signed in June 2010 and is available online (http://www.pepfar.gov/frameworks/rwanda/index.htm).
Key strengths of this program include: prevention programming such as the retesting of sero-discordant couples, male involvement with ANC, and VMMC programs within the military. Other strengths include the use of data to address a changing Rwandan HIV epidemic, integration of HIV activities into other services, and 79% of national coverage for ART to date. The Rwanda program also exemplifies several emerging best practices, including performance-based financing to improve quality of care, local ownership and cost efficiencies leading to greater access, use and sustainability of services. A key focus of this year’s program will be to transition activities to Government of Rwanda (GOR) local ownership. Rwanda has demonstrated the political will to achieve that goal.
PEPFAR places strong emphasis on linkages between prevention, HCT, care, and treatment. PEPFAR prevention funding will support GOR efforts to achieve the national benchmark of halving HIV incidence in Rwanda by 2012. Prevention activities to achieve this goal include: PMTCT; prevention of sexual transmission; biomedical prevention, including improving blood and injection safety practices in health facilities and VMMC within the military; and integrated HCT services with a special emphasis on MARPs. The FY 2010 PEPFAR prevention activities will continue to be based on best practices and emerging evidence and will the incorporate results from the 2009 data triangulation exercise designed to gain information on MARPs and drivers of the epidemic. These programs will focus on transitioning to GOR ownership in a way that enables the GOR to sustain prevention activities in the long term.
In Rwanda, PEPFAR and the GOR provide care and support activities such as provision of basic health care and support for adults and children, support for integrated TB/HIV services, and programs for OVC. PEPFAR will strive to ensure that all PLWHA receive support through a comprehensive network of district hospitals, health centers and community services. In FY 2010, PEPFAR will also continue to emphasize the use of a family-centered approach for care; improvement of pain management; improved prevention and interventions counseling for PLWHA, and stronger linkages. There will also be a significant emphasis on pediatric care and support activities. PEPFAR will continue to support integration of TB/HIV services in collaboration with the Global Fund. The main priority will be to expand the implementation of regular TB screening to all ART sites, and the diagnosis and complete treatment with directly observed treatment, short-course (DOTS). PEPFAR will target support for child-headed households and the most vulnerable orphans. PEPFAR implementing partners will increase national capacity to respond to OVC priorities such as policy and legal reform, government and civil society coordination, and monitoring of services.
Treatment activities consist of ART programs, focused on both adults and children, and laboratory support. PEPFAR will work to support the GOR goal of reducing morbidity and mortality due to HIV/AIDS. In FY 2010, PEPFAR will strengthen the MOH’s capacity to improve program quality and sustainability through national and district-level support. PEPFAR will facilitate the transition of several partner-supported clinical service delivery sites to GOR management to ensure long-term sustainability. Finally, PEPFAR will support a more strategic approach to ART, to include task shifting, decentralization of services, and targeted use of viral load testing. FY 2010 resources for laboratory infrastructure will support key reference laboratory functions, including training, QA, and developing in-country expertise for HIV-related care and treatment.
In FY 2010, the overarching SI priorities are: the improvement of data quality; enhancement of data utilization; and the coordination of reporting systems. PEPFAR will support implementation of the national HMIS and strategy and the national HIV/AIDS M&E system. PEPFAR will continue providing assistance to enhance data analysis skills at the district and facility levels. PEPFAR will also help the GOR develop a more robust and sustainable health system by strengthening national health sector financing, increasing the availability of skilled human resources, providing institutional capacity-building for local organizations, and improving management systems for critical health support systems such as logistics and information management.
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