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 evaluates the HRH Program to understand how PEPFAR's investment affected morbidity and mortality outcomes for people living with HIV. This study describes PEPFAR investments in HRH in Rwanda over time, including its support for Ministry of Health efforts to address HRH needs and the broader context in which these investments were made; describes PEPFAR-supported HRH activities in Rwanda in relation to programmatic priorities, outputs, and outcomes; examines the impact of PEPFAR funding for the HRH Program on HRH outcomes and on patient- or population-level HIV-related outcomes; and provides recommendations to inform future HRH investments that would support people living with HIV and advance PEPFAR's mission.
Table of Contents
|1 Introduction: Evaluation of Scope and Approach||15-30|
|2 Evaluation Design, Methods, and Limitations||31-44|
|3 Human Resources for Health Program Context, Vision, and Design||45-90|
|4 Faculty Twinning||91-104|
|5 Institutional Capacity for Health Professional Education||105-136|
|6 Health Worker Production||137-162|
|7 Effects on Human Resources for Health and Quality of Care||163-184|
|Appendix A: Committee Member, Consultant, and Staff Biographies||205-216|
|Appendix B: Public Session Agendas||217-220|
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