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Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
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Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
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Page 44
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 45
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 46
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 47
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 48
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 49
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 50
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 51
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 52
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 53
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 54
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 55
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 56
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 57
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 58
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
×
Page 59
Suggested Citation:"Incamake." National Academies of Sciences, Engineering, and Medicine. 2020. Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. Washington, DC: The National Academies Press. doi: 10.17226/25818.
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Page 60

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Incamake1 Kuva mu 2004, Guverinoma ya Leta zunze Ubumwe z'Amerika yateye inkunga gahunda mpuzamahanga yo kurwanya SIDA binyuze muri Gahunda ya Perezida w'Amerika igamije gutanga ubufasha bwihuse mu kurwanya SIDA (PEPFAR). Binyuze mu bafatanyabikorwa benshi, harimo na guverinoma z'ibihugu, PEPFAR ishyigikira ibikorwa binyuranye, birimo gutanga serivisi mu buryo butaziguye, gutera inkunga za gahunda, ubufasha bwa tekiniki, konger- era ubushobozi urwego rw'ubuzima, no gufasha mu ishyirwaho rya za politiki. Leta y'u Rwanda, nk'umufatanyabikorwa wa PEPFAR kuva iyi Gahunda yatangira, yateye intambwe nziza mu guhangana na virusi itera SIDA, harimo nko kongera umubare w'abagerwaho n'imiti igabanya ubwandu bwa virusi itera SIDA no gukwirakwiza iyo miti ndetse no kugabanya ubwandu bwa virusi itera SIDA. Nyamara, kuba hakomeje kubura abakozi bahagije mu rwego rw'ubuzima, bigira ingaruka zikomeye ku bafite ubwandu bwa virusi itera SIDA ndetse no ku Banyarwanda bose. Iyi mbogamizi ikunze kujyana n'ibikorwa bikijegajega bijyanye no guhangana na virusi itera SIDA ku isi, bisaba ko habaho politiki, gutera inkunga, no gufata ingamba z'uburyo bwo kurushaho kunoza ubuvuzi kugira ngo bikemure ibibazo bijyanye na virusi itera SIDA by'umwihariko - ari na yo nshingano nyamukuru ya PEPFAR - mu rwego rw'ubuzima rudafite ubushobozi buhagije bwo gukemura ibibazo by’ubuzima bijyanye by'umwihariko na virusi itera SIDA cyangwa n'ibindi bibazo by'abaturage muri rusange. Nyuma yo kubona ko ubushobozi bw'abakozi bo mu rwego rw'ubuzima ari imbogamizi ikomeye muri gahunda z'ubuzima no mu guhangana na vi- rusi itera SIDA, Guverinoma y'u Rwanda yafatanyije na PEPFAR n'abandi bafatanyabikorwa mu gutegura gahunda yo kongerera ubushobozi inzego zishinzwe uburezi bw'abakozi bo mu rwego rw'ubuzima bityo bigatuma 1 Iyi ncamake ntabwo irimo inyandiko zifashishijwe. Amagambo ashimangira ibivugwa n’imyanzuro yatanzwe mu gihimba cya raporo. 1

2 ISUZUMWA RY'URUHARE RWA GAHUNDA YA PEPFAR MU RWANDA umubare w'abo bakozi bari ku rwego rwo hejuru wiyongera. Gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima yabanje guteg- urwa kugira ngo ikemure inzitizi enye zibangamira itangwa ry'ubuvuzi bukwiye: umubare muke w'abakozi bo mu rwego rw'ubuzima bafite ubush- obozi, imyigire mibi y'abakozi bo mu rwego rw'ubuzima, ibikorwaremezo bidahagije n'ibikoresho byo guhugura abakozi bo mu rwego rw'ubuzima, ndetse n'imicungire itanoze mu bigo by'ubuzima bitandukanye. Minisiteri y'Ubuzima, ari yo yashyize mu bikorwa iyi Gahunda, yafatanyije n'ibigo by'ubuvuzi byo muri Amerika, amashuri yigisha ubuforomo, ubuvuzi bw'amenyo, n'ubuzima rusange kugira ngo bongere ubushobozi, muri Ka- minuza y'u Rwanda, Koleji y'Ubuvuzi n'ubumenyi mu by'ubuzima (CMHS). Ibikorwa byibanze kuri gahunda ihuriweho yahuje abarimu n'abakozi bo mu rwego rw'ubuzima bo mu Rwanda n'abo muri Amerika, gahunda nshya z'amahugurwa n'integanyanyigisho byihariye, ndetse n'ishoramari mu bitaro bya Kaminuza n'ahatangirwa ubumenyi. Inkunga yaturutse ahanini muri PEPFAR ibinyujije mu Kigo cyo muri Amerika gishinzwe kurwanya no gukumira indwara (CDC). Abandi bater- ankunga barimo Ikigega cy'isi gishinzwe kurwanya SIDA, Igituntu na Ma- lariya; Minisiteri y'Ubuzima; ndetse n'izindi nzego ku rugero rwo hasi. Iyi Gahunda yose yashyizwe mu bikorwa na Guverinoma y'u Rwanda kandi yateguwe guhera mu 2011 kugeza 2019. PEPFAR yatangije gahunda yo gutera inkunga mu 2012. Mu 2015, PEPFAR yafashe ingamba nshya yibanze cyane mu duce tugaragaramo abarwayi benshi n'abanduye virusi itera SIDA, bituma habaho kuvugurura gahunda yayo ku bwandu bwa virusi itera SIDA mu Rwanda, ndetse hafatwa icyemezo cyo guhagarika inkunga muri iyo Ga- hunda, yari imaze kugaragara ko itakiri ingenzi cyane mu ngamba zayo. Mu 2017 ni bwo amafaranga ya nyuma yatanzwe muri iyi Gahunda atanzwe na PEPFAR. INSHINGANO YA KOMITE Ishami ry'Ubuzima n'Ubuvuzi rya National Academies of Sciences, Engineering and Medicine (the National Academies) byasabwe gusuzuma Gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima, binyuze mu busabe rukumbi bw'Ikigo cyo muri Amerika gishinzwe kurwanya no gukumira indwara (CDC). Intego nyamukuru y'uku gusaba yari ugusobanukirwa uburyo ishoramari rya PEPFAR ryagize ingaruka ku mibare y'abarwayi n'abapfa bafite ubwandu bwa virusi itera SIDA. The National Academies yasabwe gukora uko ashoboye kugira ngo intego enye zikurikira zigerweho: 1. Gusobanura ishoramari rya PEPFAR mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima mu Rwanda, uko imyaka yagiye itambuka, harimo n'inkunga itera ibikorwa bya Minisiteri y'Ubuzima mu gukemura ibibazo byo kongerera ubushobozi aba- kozi bo mu rwego rw'ubuzima ndetse no mu buryo bwagutse aho iryo shoramari ryagiye rikorwa. 2. Gusobanura ibikorwa byo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima mu Rwanda byatewe inkunga na PEPFAR ib- yari biteganyijwe n'ibyihutirwa muri Gahunda, ibyari biteganyijwe kugerwaho n'umusaruro bizatanga. 3. Gusuzuma umusaruro wavuye mu nkunga PEPFAR yateye Ga- hunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima

INCAMAKE 3 ndetse n'umusaruro byatanze ku rwego rw'abarwayi cyangwa abaturage bafite ubwandu bwa virusi itera SIDA. 4. Gutanga inama zizafasha mu gushora imari mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima mu gihe kizaza zikanafasha mu gushyigikira abafite ubwandu bwa virusi itera SIDA ndetse no guteza imbere inshingano za PEPFAR. UBURYO ISUZUMA RYAKOZWE Kugira ngo igere ku nshingano, komite y'impuguke yashyizweho na National Academies, yashatse uko yashyiraho uburyo bwahuza intego z'isuzuma kugira ngo Gahunda isuzumwe bijyanye n'ibikorwa byayo byihutirwa, kongerera ubushobozi inzego kugira ngo zibashe gutanga abakozi bo mu rwego rw'ubuzima bafite ubushobozi, ndetse no gusuzuma ingaruka ku bafite ubwandu bwa virusi itera SIDA. Isuzuma ryakoresheje uburyo bunyuranye bwo kongera kureba ibyakozwe, kongera gusoma ibyanditswe, ibiganiro bitanga amakuru, no kongera gusesengura amakuru mu mibare yari yarakusanyijwe mbere. Hakozwe ibiganiro mirongo inani na birindwi hamwe abayobozi ba gahunda; Abarimu bo mu bigo byo muri Amerika; amashyirahamwe y'ababigize umwuga n'ingaga; abarimu ba Kaminuza y'u Rwanda, abanyeshuri, n'abayobozi; abakozi bo mu buvuzi; n'abandi bafatanyabikorwa. Ikigo gishinzwe kurwanya no gukumira indwara (CDC) na PEPFAR byemeje ko kwitabira ibiganiro bishobora guteza amakimbirane ashingiye ku nyungu; ku bw'iyo mpamvu, ibitekerezo by'abakozi basanzwe bakorera umuterankunga ntibigaragara muri iri sesengura, bikaba ari icyuho kigaragara. Ikusanywa n'isesengura ry'amakuru mu mibare yari yarifashishijwe mbere ryifashishije amakuru aboneka muri rusange yerekeranye no kongerera ubushobozi abakozi bo mu rwego rw'ubuzima no kuri virusi itera SIDA ndetse n'amakuru yatanzwe na Kaminuza y'u Rwanda na Minisiteri y'Ubuzima. Amwe mu makuru yasabwe ntabwo yabonetse, bikaba byarabaye inzitizi ku isesengura ryakagombye kuba ryarakozwe. Komite yarebye ku cyifuzo cyo gusuzuma ingaruka z'ishoramari rya PEPFAR hashingiwe ku ruhare rushoboka rwa Gahunda mu byagaragaye bijyanye no kongerera ubushobozi abakozi bo mu rwego rw'ubuzima no kuri virusi itera SIDA. Uru ruhare rwatekerejweho binyuze mu nzira nyunguranabitekerezo yerekana uburyo ibikorwa bya gahunda hamwe n'impinduka mu byavuye mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bishobora gutekerezwa ko bizagira uruhare mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima mu gihe giciriritse ndetse no ku buzima bw'abafite ubwandu bwa virusi itera SIDA. Isano ridashidikanywaho hagati y'ibyavuye mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima n'ibyagaragaye ku rwego rw'umurwayi ryakoreshejwe mu kuziba icyuho hagati y'icyo gahunda yari igamije ku ikubitiro ndetse n'intego z'iri suzuma. Uburyo bushoboka mu kugaragaza uruhare ni uko abakozi bafite ubushobozi mu rwego rw'ubuzima kandi bashoboye, bashobora gukemura ibibazo by'ubuzima by'abaturage, kandi bikaba byitezwe ko hamwe n'ubundi buryo bunyuranye, bagomba kunoza serivisi z'ubuzima rusange no guteza imbere inzego zitanga serivisi z'ubuvuzi. Iyo urwego rw'ubuzima rukora neza kandi rukaba rufite n'abakozi bakora neza bituma habaho gutanga serivisi zinoze. Ibi bigira uruhare mu kuzamura umusaruro w'urwego rw’ubuzima muri rusange, harimo n'abafite ubwandu bwa virusi itera SIDA, ndetse no kurushaho kunoza ibijyanye na virusi itera SIDA, nko kugabanuka kw'ingano y'ubwandu, umubare w'abapfa ndetse n'abarwara.

4 ISUZUMWA RY'URUHARE RWA GAHUNDA YA PEPFAR MU RWANDA Uburyo bwo gusuzuma, uruhare rugaragara mu mpinduka ni igipimo cyemewe nk'uburyo bwiza bwo gusuzuma, binyuze mu gusubiza amaso inyuma, gahunda yo kongerera ubushobozi urwego rw'ubuzima iteye nk'iyi. Guhita twitirira ingaruka iyi Gahunda, ntibyashobotse kubera impamvu zitandukanye. Icya mbere, uburyo bwo gusuzuma bugaruka inyuma bwagarukiye gusa ku gutegura isuzuma ry'ingaruka. Icya kabiri, kuba nta buryo bunoze bwo kugereranya bwari buhari, byatumye kwitirira ingaruka iyi gahunda bitaba ari ukuri. Imiterere yihariye y'u Rwanda ugereranije n'ibindi bihugu byo muri Afurika y'iburasirazuba, uruhare rwa Kaminuza y'u Rwanda nk'ikigo cya Leta rukumbi gishinzwe uburezi bw'abakozi bo mu rwego rw'ubuzima, ndetse no gushyira mu myanya ku buryo bwagutse abahuguwe muri gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bakorera ahantu hatandukanye, bivuze ko nta hantu na hamwe iyi Gahunda itagizemo uruhare, mu Rwanda cyangwa mu kindi gihugu cyagereranywa na rwo, bishobora gutuma igereranya ryoroshya gusesengura uburyo bwo kugena ingaruka. Icya gatatu, ntibyashobotse gutandukanya ingaruka z'ibikorwa by'iyi Gahunda n'izindi mpamvu nyinshi, haba iziri mu rwego rw'ubuzima cyangwa izitarimo, byagize uruhare mu kongerera ubushobozi abakozi bakora mu rwego rw'ubuzima n'ibijyanye n'ubwandu bwa virusi itera SIDA. Icya kane, u Rwanda rwageze ku bikorwa bishimishije mu bijyanye na virusi itera SIDA mbere y’uko Gahunda itangira. Hamwe n'ibipimo ngenderwaho ku rwego rwo hejuru ku bipimo by'ingenzi bya virusi itera SIDA, ingaruka zose zabaho zaba zoroheje, kandi bikaba byagorana gukora igereranya rya mbere na nyuma ku buryo bishobora gutuma ingaruka z'iyi Gahunda zitagaragara, kuko zibanze ku gice kimwe cya Gahunda rusange y'ubuzima aho impamvu nyinshi zigira uruhare mu gufasha abantu kubona ubuvuzi bwo ku rwego rwo hejuru bwa virusi itera SIDA. Icya nyuma, igihe cyakoreshejwe muri iri suzuma ugereranyije n'igihe inkunga ya PEPFAR izarangirira, cyagabanyije ubushobozi bwo kumenya ingaruka z'ibipimo bya virusi itera SIDA ku muturage nk'ingano y'ubwandu, ubwiyongere bw'abayirwaye, umubare w'abarwaye ndetse n'umubare w'imfu. Ingaruka zose kuri ibi, byitezwe ko zizagaragara nyuma; ishoramari mu burezi bw'abakozi bo mu rwego rw'ubuzima rishobora gufata imyaka kugira ngo rigire ingaruka ku murwayi no ku muturage, ukurikije igihe ama- hugurwa atwara ndetse n'umwanya bifata abahuguwe kugira ngo binjire mu rwego rw'ubuzima mu gihe gikwiye kandi bari ku mubare ukenewe. Komite yateguye raporo y'ingirakamaro cyane kuri PEPFAR kuko igaragaza ishoramari ryayo muri Gahunda. Raporo ikubiyemo kandi amakuru y'ingenzi kuri Guverinoma y'u Rwanda mu gihe ikomeje kongerera ubushobozi abakozi bo mu rwego rw'ubuzima ndetse na gahunda z'ubuzima kugira ngo hakemurwe ibibazo by'abaturage bayo bigenda byiyongera, harimo n'ibijyanye na virusi itera SIDA. Nanone kandi, raporo itanga amakuru ku bandi bafatanyabikorwa mu Rwanda bafite uruhare muri ako kazi, nk'abandi baterankunga, ibigo byigisha abakozi bo mu rwego rw'ubuzima, ingaga z'abanyamyuga, amatsinda y'ubuvugizi bw'abarwayi, n'indi miryango itegamiye kuri Leta. Byongeye kandi, hari amasomo ku bafatanyabikorwa mu bindi bihugu agamije kongerera ubushobozi gahunda z'ubuzima n'abakozi bo mu rwego rw'ubuzima binyuze mu burezi bw'ubunyamwuga.

INCAMAKE 5 Iby'ingenzi byagaragaye: + Ibyagezweho - n'Imbogamizi Igice cya 3 • Abitabiriye ibiganiro bahurije • Kudasobanuka neza kw'uburyo n'inzira biganisha ku cyerekezo cyo mu rwego ku cyerekezo n'ikigamijwe kugira ngo haboneke rwo hejuru n'ikigamijwe urwego rw'ubuzima ruri ku rugero bihura n'intego rusange z'urwego rw'ubuzima • hagati y'ibyagaragaraga ko bikenewe n'ibyashyirwa imbere y'ibindi mu buvuzi bwihariye ugereranyije n'ubuvuzi bw'ibanze • yayobowe na Guverinoma • y'u Rwanda, bijyanye bwiza kuri Gahunda hashyirwa imbaraga mu bufasha mu ikurikiranabikorwa, isuzumabikorwa n'inzira zo kwiga agenda agaragara agenga byashyizweho kuva Gahunda igitangira ubufasha butangwa n'abaterankunga • ntangiriro ndetse no mu gihe cyose cy'ishyirwa mu + - Igice cya 4 • Byakozwe nk' uburyo • buramubyizi byahawe abarimu ba bw'ubufatanye Kaminuza y'u Rwanda bitabiriye iyi Gahunda, habayeho magirirane n'abarimu itangwa ry'amakuru ridasobanutse ku byerekeye inshingano bo mu bigo byo muri n'ibiteganijwe, n'ibyihutirwaga kurusha ibindi Amerika bafite bitumvikanyweho ku barimu ba Kaminuza y'u Rwanda ubunararibonye mu karere cyangwa • cyangwa badashoboye ntibari bujuje ibisabwa bijyanye baturutse mu karere n'ubunararibonye cyangwa ibikenewe mu rwego rwa tekiniki • • Kudatanga ubumenyi buhagije kw'abarimu b'ibigo byo muri ubumenyi mu Amerika babuha abarimu b'Abanyarwanda mitegurire • y'integanyanyigisho bagenerwabikorwa b'abanyarwanda n'abo mu bigo byo muri n'amasomo yo muri Amerika bagizweho ingaruka n'uburyo bwo gutanga kaminuza + amasezerano, gushaka abakozi, no kubashyira mu kazi - Igice cya 5 abakozi bo • Kugeza ku bahugurwa uburyo bwo kwigisha • Ihindagurika mu gufasha abahugurwa bwo ku rwego rwo hejuru, integanyanyigisho kugira ubumenyi bwihariye mu bintu nshya cyangwa zivuguruye, hamwe n'ubuvuzi bibongerera ubunararibonye bushingiye ku bushakashatsi • Kwibanda cyane ku buryo • Kongerera abahugurwa imbaraga, icyizere, buhuriweho bw'abantu ku giti cyabo ndetse n'ubunyamwuga ntibyahise byongera ubushobozi • Kwiyongera kw'ubushobozi n'ubumenyi mu muri Kaminuza y'u Rwanda kugira bushakashatsi muri Kaminuza y'u Rwanda, ngo ikomeze kongera no kwagura hamwe no gukomeza gufatanya mu gahunda z'amasomo yayo bushakashatsi nyuma yo kugenda kw'abarimu bo mu bigo byo muri Amerika • Kudashobora gutangiza gahunda y'icyiciro cya gatatu cya kaminuza • Gahunda iteguye neza y'icyiciro cya gatatu ku buzima (Master of Hospital and cya Kaminuza mu buforomo (Master of Science in Nursing) + Healthcare Administration) - IGISHUSHANYO S-1  Iby'ingenzi byagaragaye: ibyagezweho n’ibibazo. ibikurikira

6 ISUZUMWA RY'URUHARE RWA GAHUNDA YA PEPFAR MU RWANDA Iby'ingenzi byagaragaye: + Ibyagezweho - n'Imbogamizi Igice cya 6 Kongera umubare w’abakozi bo mu rwego rw’ubuzima • Yongereye umubare w'abaganga • Umusaruro unyuranye mu kugumana b'inzobere, abaforomo n'abaforomokazi abarimu muri Kaminuza y'u Rwanda bafite ubumenyi buhanitse mu kazi, n'ababyaza bafite ubumenyi bwisumbuye • Ntabwo byahise bikemura ikibazo cyo kugumana no gukwirakwiza mu buryo • Hagaragaye intambwe nziza yatewe mu guha bukwiye impuguke z’abaganga zari akazi abarimu bahuguwe muri Gahunda yo zikimara guhugurwa, abaforomo kongerera ubushobozi abakozi bo mu rwego n'abaforomokazi bafite ubumenyi rw'ubuzima buhanitse mu kazi n'abafite ubumenyi • Miliyoni 17,9 z'amadorari zavuye mu mutungo wa bwisumbuye PEPFAR zakoreshejwe mu kugura ibikoresho •Mu Rwanda hari ibitaragezweho byinshi byifashishijwe mu burezi bw'abakozi bo mu kongerera ubushobozi w'abakozi bo mu rwego rw'ubuzima no kubikwirakwiza mu mu rwego rw'ubuzima, hashingiwe ku bitaro byigisha biherereye cyane cyane muri mubare w'abakozi bo mu rwego Kigali rw'ubuzima ndetse no mu duce + bakoreramo. - Ingaruka ku kongerera ubushobozi abakozi bo mu Igice cya 7 rwego rw'ubuzima no ku ireme rya serivisi z’ubuvuzi • Gahunda yasobanuwe nk'ifite • Ubushobozi bwo mu burezi bw'abakozi bo mu rwego ingaruka nziza ku mutekano, rw'ubuzima no kongera umusaruro w'abatanga serivisi ku gukora neza, ku gukorera nziza z'ubuvuzi kugira ngo ubuvuzi bwiza butere ku gihe, no ku kugeza serivisi imbere biracyabangamirwa n'impamvu zitandukanye ku bafite ubwandu bwa virusi z'imikorere, nk'ibikorwaremezo, ibikoresho, uburyo itera SIDA n'abandi. bwo kwisuzumisha indwara, hamwe no gukwirakwiza • Haba abafite inshingano mu serivisi z'ingenzi mu duce dutandukanye. burezi bw'abakozi bo mu rwego • Urebye inyungu u Rwanda rwabonye mu kurwanya rw'ubuzima cyangwa abatanga virusi itera SIDA, urundi ruhare urwo ari rwo rwose serivisi z’ubuzima, bose rwa Gahunda yo kongerera ubushobozi abakozi bo basanze iyi Gahunda igira mu rwego rw'ubuzima rwaba ruto kandi byagorana uruhare mu kuzamura ireme kurubona. Na none kandi, hamwe no kuba serivisi ry’ubuvuzi ku Banyarwanda zijyanye na virusi itera SIDA zarinjijwe mu rwego bose, harimo n'abafite rw’ubuzima, biragoye gutandukanya ingaruka iyi ubwandu bwa virusi itera Gahunda yagize kuri virusi itera SIDA. SIDA, binyuze mu nzira • Uburambe n’ishimangirwa bya Gahunda yo kongerera zitaziguye n'iziziguye, nko kuba ubushobozi abakozi bo mu rwego rw'ubuzima hari abatanga serivisi benshi, byabangamiwe n'uburyo yari iteguye n'uko yashyizwe ubumenyi buhagije mu buvuzi mu bikorwa, ndetse n'impinduka mu byihutirwaga bw’ibanze no kwita guterwa inkunga na PEPFAR by'umwihariko ku bafite virusi • Gahunda yo kongerera ubushobozi abakozi bo mu itera SIDA ndetse n'ubumenyi rwego rw'ubuzima ntiyagize igihe gihagije cyo gukora buhagije mu gukemura ibibazo ku byasabwe n'isuzuma ry'igihe giciriritse rijyanye bijyanye na virusi itera SIDA. + n'igenamigambi rirambye - IGISHUSHANYO S-1 Ibikurikira IBYAGARAGAYE N'IMYANZURO Iby'ingenzi byavuye mu isuzuma biragaragara ku gishushanyo S-1, byateguwe hakurikijwe ibice bya raporo aho byatanzwe mu buryo burambuye. Komite ishingiye ku byagaragajwe haba mu byagezweho ndetse n'imbogamizi zagaragaye muri Gahunda, yashoboye gufata imyanzuro ku ishyirwa mu bikorwa ryayo n'ingaruka zayo. Ku bw'impamvu zasobanuwe haruguru, ntibyaba byumvikana kwitega

INCAMAKE 7 ko ishoramari mu kubaka ubushobozi bw'ibanze bwagutse, bugaragazwa na gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima ryagera ku mpinduka nini mu byagaragaye ku bijyanye by'umwihariko na virusi itera SIDA n'urwego rw'abaturage mu gihe cyagenwe cy'iri suzuma. Ishoramari nk'iryo ntirigamije kugera ku mpinduka z'igihe gito, zo ku rwego rugari mu mibare y'indwara z'abaturage bityo ntibyaba rero ari amahitamo akwiriye niba ari yo ntego y'ishoramari. Bijyanye na gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima, umubare w'abafite ubwandu mu Rwanda waragabanutse, aba- habwa imiti yo kugabanya ubwandu bwa virusi itera SIDA bariyongera ndetse n'aho ikwirakwizwa hariyongereye, ijanisha ry'abantu bakuru bazi uko bahagaze n'abafata imiti igabanya ubwandu ryariyongereye ndetse bageze no ku rwego rwo kugabanya ingano y'ubwandu bwa virusi mu mubiri. Birumvikana ko hamwe n'izindi mpamvu birashoboka gutegereza ko hari impinduka nziza zishobora no kuva mu kuboneka kw’ubuvuzi bu- noze biturutse muri iyi Gahunda bikaba bishobora kugira uruhare no ku baturage muri rusange. Ntabwo byashoboka gutandukanya, kugereranya, no kwitirira izo ngaruka kuri iyi Gahunda hatabayeho kubanza gutegura isuzuma hamwe n'amakuru aboneka ahuye n'iyi ntego. Nyamara, iri suzuma ryashoboye gufata imyanzuro ijyanye n'ingaruka za Gahunda ku bafite ubwandu bwa virusi itera SIDA. Isesengura ry'amakuru aboneka ryerekana ko kunoza ireme ry'ubuvuzi rihuza ibikorwa bya Ga- hunda n'ingaruka zayo - ari byo kuzamuka k'urwego rw'ubuzima muri rusange ndetse n'ibijyanye na virusi itera SIDA. Mu batanze amakuru bafite inshingano haba mu burezi bujyanye n'umwuga w'ubuvuzi ndetse no mu gutanga serivisi z'ubuzima, basanze iyi Gahunda ifite uruhare mu kuza- mura ireme ry'ubuvuzi ku Banyarwanda bose, harimo n'abafite ubwandu bwa virusi itera SIDA, binyuze mu nzira zitaziguye n'iziziguye, nko kuba hari abatanga serivisi benshi, ubumenyi buhagije mu buvuzi bw'ibanze no kwita by'umwihariko ku bafite virusi itera SIDA ndetse n'ubumenyi buhagije mu gukemura ibibazo bijyanye na virusi itera SIDA. Gahunda yasobanuwe nk'ifite ingaruka nziza ku mutekano, gukora neza, gukorera ku gihe, no ku kugeza serivisi ku bafite ubwandu bwa virusi itera SIDA. Ubushobozi bwo mu burezi bw'abakozi bo mu rwego rw'ubuzima no kongera umusaruro w'abatanga serivisi nziza z'ubuvuzi kugira ngo ubu- vuzi bwiza butere imbere biracyabangamirwa n'impamvu zitandukanye z'imikorere, nk'ibikorwaremezo, ibikoresho, uburyo bwo kwisuzumisha indwara, hamwe no gukwirakwiza serivisi mu duce dutandukanye. Ku bijyanye n'intego yo kongera mu bwinshi no mu ireme abakozi bo mu rwego rw'ubuzima mu Rwanda, hari byinshi iyi Gahunda yagezeho. Gutanga inyigisho zo ku rwego rwo hejuru zitanzwe n’abarimu bashakishijwe binyuze mu bufatanye n'ibigo by'Amerika byatumye abahuguwe batangira gutanga ubuvuzi bufite ireme, gufata inshingano z'ubuyobozi, no guhugura bagenzi babo bazakora mu rwego rw'ubuzima mu gihe kizaza. Iyi Gahunda yazamuye ireme rusange ry'imitegurire y'abinjira mu mwuga biturutse ku musaruro wavuye mu kongerera inzego ubushobozi, nka gahunda nshya n'integanyanyigisho zivuguruye, ndetse no kongera ubwinshi bw'abakozi bo mu rwego rw'ubuzima n'imikorere myiza yabo, cyane cyane mu baforomo n'abaforomokazi, ababyaza, no mu bindi byiciro by'ubuvuzi bisaba inzobere. Yongereye kandi ubushobozi bw'abahuguwe mu bushakashatsi, no kumva bashishikariye kwinjira mu bakozi bashinzwe ubuzima, ndetse n'amahirwe yo gutera imbere

8 ISUZUMWA RY'URUHARE RWA GAHUNDA YA PEPFAR MU RWANDA mu mwuga. Imikoranire inoze hagati ya Minisiteri y'Ubuzima na Minisiteri y'Uburezi no kongerera ubushobozi amashyirahamwe y'abanyamwuga n'ingaga z'abanyamwuga, ni ibisubizo bishobora kongera imbaraga zo guko- meza ibikorwa no gukomeza kubaka ubushobozi bw'inzego. Iri suzuma ntiryashoboye kugaragaza ku buryo burambye ibyagezweho binyuze muri izo nyungu kubera igihe gito gishize kuva ishoramari rya PEPFAR rirangiye. Uburyo gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima ikomeye ndetse na gahunda yari igamije gushyigikira bigaragaza ko ibyagezweho byaherekejwe n'imbogamizi, kandi byose hamwe bitanga amasomo na gahunda zo mu gihe kizaza. Inzitizi zijyanye n'intego zikomeye zo kongera ubushobozi bw'inzego z'uburezi bw'abakozi bo mu rwego rw'ubuzima zirimo ibibazo by'imikorere, ibijyanye n'ishyirwa mu bikorwa ry'uburyo buhuriweho hagati y'abarimu ba Kaminuza y'u Rwanda n'abarimu bo hanze, imitegurire idahagije y’uburyo bugamije kugera ku cyerekezo cyuzuye cya Gahunda, n'igenamigambi ritanoze mu mpinduka y'imikorere ikenewe kugira ngo iterambere ry'uburezi bw'abakozi bo mu rwego rw'ubuzima rigerweho kandi rikomeze gusigasirwa. Habayeho kandi ikibazo hagati y'ibyagaragaraga ko bikenewe mu buvuzi bwihariye ndetse n'ibyagaragaraga ko bikenewe mu buvuzi bw'ibanze. Haracyari ibitaragezweho mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima, hashingiwe ku mubare munini w'abaganga ndetse n'uduce bakoreramo Mu gutera inkunga iyi Gahunda, yagaragaraga nk'uburyo budasanzwe, ariko butari umwihariko, bwakoreshwaga n'umuterankunga mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima binyuze mu ishoramari ryagutse mu kubaka ubushobozi bw'inzego z'uburezi bw'abakozi bo mu rwego rw'ubuzima. Ubu ni bwo buryo PEPFAR yatangiye ikoramo ibikorwa byayo hagati y'umuterankunga na Leta. N'ubwo bitari mu bisabwa mu cyiciro cya mbere cy’inkunga ya PEPFAR, kuba hatarabayeho gahunda isobanutse neza y'igenzura n'isuzumabikorwa mu gihe iyi Gahunda yatangizwaga, byatumye hataboneka amahirwe yo kwiga uburyo buhamye bwo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima ndetse n’uburyo guverinoma, abandi bafatanyabikorwa, n'abaterankunga bo hanze bashobora gufatanya mu kwita ku byihutirwa cyane cyane ibijyanye n'indwara ndetse n'ibindi bikenewe mu rwego rw'ubuzima muri rusange. INGARUKA KURI VIRUSI ITERA SIDA NO KU BAKOZI BO MURI GAHUNDA Z'UBUZIMA Mu gihe u Rwanda n'ibindi bihugu bigenda bitera intambwe ishimishije mu kurwanya iki cyorezo no kunoza uburyo bw'abagerwaho n'ubuvuzi, abafite ubwandu bwa virusi itera SIDA benshi, bari kurushaho kuramba, bafite ibibazo by'ubuzima bihuriweho mu kurwanya virusi itera SIDA n'ingaruka zayo uko imyaka igenda itambuka, guhangana n'indwara z'ibyuririzi ndetse no guharanira kugira ubuzima bwiza. Ubufasha bwuzuye ku bikenewe n'abafite ubwandu bwa virusi itera SIDA burarushaho gushingira ku bushobozi bw'urwego rwose rw'ubuzima. Ku bw'iyo mpamvu, kugira ngo igere ku nshingano yayo, PEPFAR ifite inyungu mu gushyigikira gahunda yo kongerera ubushobozi urwego rw'ubuzima binyuze mu ngamba z'igihe kirekire zihujwe neza hamwe n'abandi baterankunga n'ishoramari rya Leta. Kugira ngo izi ngamba zibashe gutanga umusaruro, ntizategurwa hashingiwe ku ndwara runaka, ariko kandi birakwiriye ko abaterankunga mu by'indwara zihariye bashora imari mu bikorwa bigari byagira ingaruka zigaragara, nubwo

INCAMAKE 9 zitagera hose ku ngaruka zishingiye ku ndwara. Ishoramari rishobora gutanga umusanzu muri gahunda zagenewe kunoza no gukurikirana ingaruka zihariye ku ndwara zitabangamiye ingaruka zigaragara muri gahunda ku rwego runini. Ishoramari nk'iryo rifite amahirwe menshi yo gutanga umusaruro urambye. IBYIFUZO Komite yarebye kuri iri gereranya hagati y'umwihariko w'indwara no kongerera ubushobozi uburyo bw'imikorere mu rwego rwo kuzuza inshingano yahawe zo gutanga ibyifuzo byazafasha mu ishoramari ryo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima mu gihe kizaza rishyigikira abafite ubwandu bwa virusi itera SIDA ndetse no kugera ku nshingano za PEPFAR.” Ibyifuzo byatanzwe byerekana ko hifuzwa ko mu gihe PEPFAR n'abandi baterankunga bafite intego yo kwita ku ndwara by'umwihariko bashora imari mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima, bakoresha uburyo bwita cyane ku byihutirwa, bashaka guhuza ibikenewe n'umusaruro uva mu buryo bwibanda ku ndwara hamwe n'imbaraga zishyirwa mu mikorere ntambike bishobora gufasha mu kugera ku bikenewe. Ibyifuzo byatanzwe bigaragaza ko aho ubwo buryo bwombi buhurira, hakwiye kuringanizwa, kandi hakaba hashobora kugerwaho no gupimwa hagamijwe ishoramari mu gihe kizaza mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima. Ibyifuzo byatanzwe bitanga uburyo bwo gutegura no gushyira mu bikorwa izindi mbaraga zizakoreshwa mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima ndetse no gutanga serivisi ku bafite ubwandu bwa virusi itera SIDA. Hashingiwe ku byagezweho muri iyi Gahunda, no ku masomo yavuyemo, kandi harebwe no ku buremere bwo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima, ibi byifuzo bikubiye mu bice bitanu by'ingenzi: 1. Hakenewe gufatanya mu gushyiraho gahunda hagati y'abafatanyabikorwa batandukanye bireba; 2. Akamaro ko gushyiraho uburyo buhuriweho; 3. Akamaro k'igenamigambi imicungire ijyana n'ibihe; 4. Akamaro ko guhitamo uburyo bukwiriye (cyangwa ibice byabwo) mu rwego rwo kunoza imyigire y'abakozi bo mu rwego rw'ubuzima; na 5. Ipfundo ry'uburyo bukora neza kandi buhuriweho n'inzego myinshi mu gukuririkana, gusuzuma no kwiga. Gutegurira hamwe Gahunda Mu batanze amakuru bose ndetse no mu nyandiko za gahunda, haga- ragaramo guhuriza ku cyerekezo cyo ku rwego rwo hejuru cya Gahunda, cyahujwe n’intego nini z’urwego rw’ubuzima, ariko habaho kutumvikana hagati y’abafatanyabikorwa ku buryo n'inzira zo kugera kuri iki cyerekezo. Ibi byagize ingaruka ku mitegurire, ishyirwa mu bikorwa, igenamigambi rirambye kandi byiyongereyeho uburyo butandukanye bw'imiyoborere y’ibigo byabigizemo uruhare. Icyifuzo cya 1: Abaterankunga bashora imari mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bagomba gushyigikira uburyo buteguriwe

10 ISUZUMWA RY'URUHARE RWA GAHUNDA YA PEPFAR MU RWANDA hamwe binyuze mu nzira ihuza abahagarariye abafatanyabikorwa batandukanye nk'abagize uruhare mu gutegura,2 harimo abaterankunga, abayobozi ba gahunda, ababishyira mu bikorwa, inzego zishinzwe kugenzura, n'abazakoresha cyangwa bakungukira mu bikorwa byatewe inkunga. Kugira ngo iyi gahunda ishoboke kandi igaragaze ukuri inakemura ibibazo, gahunda y'ubufatanye ihereye ku nzego zo hasi kugeza hejuru kandi igizwe n'abaterankunga, abahagarariye Leta mu nzego zose bireba, abashyira gahunda mu bikorwa, hamwe n'abagenerwabikorwa (aha ni ukuvuga, abarimu, abanyeshuri, n'abarwayi) ishobora kuba uburyo bwiza. Amasezerano y'i Accra mu 2008 ndetse n'Amasezerano ku butwererane y'i Busan mu 2011 agaragaza akamaro k'ubufatanye hagati y'ibihugu biri mu nzira y'amajyambere3 n'uburyo bw'iterambere buhuriweho n'abafatanyabikorwa benshi. Ubu buryo bushishikariza guverinoma n'inzego ziyishamikiyeho kugira uruhare runini mu kugenzura no kubazwa ibyo bakora, Imiryango itegamiye kuri Leta na yo ikagira uruhare mu kugenzura politiki n'ishyirwa mu bikorwa ryazo, ndetse n'abikorera bagasabwa gushaka uburyo bwo guteza imbere no gushimangira iterambere rihuriweho na bose. Inzira ibigo bitera inkunga bisigaye bikoresha yo gufatanya mu gushyiraho uburyo butandukanye, itanga amahirwe yo kurushaho gushyiramo abafatanyabikorwa banyuranye (nk'abafatanyabikorwa bashyira mu bikorwa, guverinoma z'ibihugu bihabwa inkunga, abahagarariye abikorera, n'imiryango ikorera imbere mu Gihugu n'inzobere) kugira ngo bayobore igikorwa cyo gushyiraho no no gutanga umurongo, kongerera ubushobozi abenegihugu kugira ngo bumve ko ibintu ari ibyabo, ndetse no kongera amahirwe yo kugera ku musaruro wifuzwa. Gutegura uburyo bw'imitekerereze bwaguye ku mikorere y'inzego Urwego rw'ubuzima rukubiyemo ibintu byinshi kandi binyuranye, bi- saba ubufatanye bw'ibigo n'inzego zose. Gahunda yo Kongerera ubushobozi abakozi bo mu rwego rw'ubuzima yirengagije iki kibazo. Ibi byagaragajwe no kuba hatarabayeho gukorana na Minisiteri y'Uburezi na Kaminuza y'u Rwanda mu itegurwa n'ishyirwa mu bikorwa ry'ibyiciro byabanje. Uku gukorana n'izi nzego nyuma yaho byaje gutuma Gahunda irushaho ku- genda neza. Ikindi kibazo cyari cyirengagijwe kijyanye n'igihe cyagenwe. Kongerera ubushobozi abakozi bo mu rwego rw'ubuzima no kubasha ku- genzura uruhare rwabo mu bijyanye n'uburwayi ndetse n'imfu zikomoka kuri virusi itera SIDA bifata imyaka igera ku icumi, ibi nubwo ari ukuri ntibyagaragajwe mu gihe gito ishoramari rya PEPFAR ryamaze. Icyifuzo cya 2: Abategura gahunda zo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bagomba gukoresha uburyo bw'imitekerereze bwaguye ku mikorere y'inzego, burimo n'uburyo buhuriweho n'inzego nyinshi buhuza inzego zo hasi n'izo hejuru ndetse n'izo hejuru zikegera 2  Izindi nama z'uko ibyemezo byafashwe n'abashinzwe gutegura gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bishingira kuri iri tsinda ry'abafatanyabikorwa batandukanye. 3 Iri jambo risobanura ubufatanye hagati y’ibihugu bibiri cyangwa byinshi bifite ubukungu buciriritse, aho bihanahana ubumenyi n’ubufasha bituma bishobora kugera ku ntego zabyo z’iterambere.

INCAMAKE 11 izo hasi hamwe n'uburyo bwo gutera inkunga bw'igihe kirekire bushobora gufasha mu gukemura ibibazo byihutirwa n'ibimaze igihe, nko kugumana mu kazi abakozi bo mu rwego rw'ubuzima. Gukoresha uburyo bw'imitekerereze bwaguye ku mikorere y'inzego bishobora guhindura uburyo abategura gahunda batekereza ku mbogamizi ziri mu rwego rw'ubuzima, ibibazo babaza bijyanye no kurushaho kunoza uru rwego, ndetse no gusobanukirwa impamvu zihutisha cyangwa zibangamira iterambere ry'urwego rw'ubuzima. Ubu buryo bw'imikorere bwerekana kandi ko urwego rw'ubuzima rukorera mu buryo bw'imiyoborere yaguye kandi abakozi bo mu rwego rw'ubuzima bakaba bari ku isoko ry'umurimo ry'akarere, bikaba bisaba rero imikoranire myiza n'ubufatanye bw'inzego ndetse no hagati y'ibigo bya Leta n'imiryango itegamiye kuri Leta. Ku bakozi bo mu rwego rw'ubuzima, hagomba gukurikizwa uburyo bunoze mu rwego rw'isoko ry'umurimo, hakurikijwe umubare w'abasaba akazi n'ahakeneye abakozi ndetse n’uburyo ibyo bikorana n'ibikenewe muri serivisi z'ubuzima, ibikenewe mu buzima bw'abaturage bose, ndetse n'intego z'Igihugu zo kugeza ubuvuzi kuri bose no kubukwirakwiza. Uko Gahunda iteguye ntibigomba gutanga abakozi bashya bo mu rwego rw'ubuzima gusa ahubwo bigomba no gukemura ibindi bibazo bikibangamira ubushobozi bw'abasanzwe bakora. Isoko ry'umurimo ryita ku bashaka akazi n'ahakenewe abakozi rishobora gukoresha ishoramari ririho mu burezi bw'abakozi bo mu rwego rw'ubuzima maze hagakosorwa ubusumbane mu mibare y'abakozi bashyirwa ku isoko, akenshi biterwa no kwiganza k'uruhande rw'abakenewe. Politiki za Leta zigamije kongera umubare w'abakozi bo mu rwego rw'ubuzima zigomba guhuzwa na politiki zo mu rwego rw'uburezi n'umurimo, ndetse na politiki zo kwinjiza mu rwego rw'ubuzima abakozi bashya bakirangiza amasomo yabo. Leta kandi igomba gushyiraho amategeko agenga urwego rw'abikorera kugira ngo babashe gutanga ubuvuzi bukwiye kandi bufite ireme, ndetse no kugira ngo abakozi bo mu rwego rw'ubuzima basaranganywe hose. Urwego rw'abikorera rugomba gufata iyambere mu guhanga ibishya, nko gushyiraho uburyo buhuza Leta n'abikorera hagamijwe kongerera ubushobozi abakozi kugira ngo babashe kubyaza umusaruro amahirwe ari ku isoko ry'umurimo ndetse n'ahandi hose Leta idashobora kubonera ibisubizo. Mu rwego rwo guhuza n'igihe cyagenwe mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima, ingamba zo gutera inkunga zigomba kuba ari iz'igihe kirekire kandi zihuye n'ingamba ngari z'igihugu giterwa inkunga. Inkunga ntigomba gushingira gusa ku murongo n'amahame ya politiki y'igihugu inkunga iturutsemo no kuri gahunda zisanzwe z'abaterankunga, kandi hakabamo n'uburyo bwo gushyigikira uko igihugu kigira uruhare mu kwishakamo ubushobozi. Ibi abaterankunga bagomba kubiteganya, ku buryo bushoboka, hamwe no koroshya uburyo bwo gushyiraho no guhuza ingengo y'imari igenewe imishinga n'uko izakorwa. Abaterankunga bagomba gushyiraho uburyo buhujwe bwo gutera inkunga mu gihe kirekire no guteganyamo ibikirwa nk'igihe cyo gutangira, gutanga amasoko; kurushaho koroshya uburyo bwo gusubiramo intego, ibigomba kugerwaho, n'umusaruro witezwe; no kwemerera ko igice cy'ingengo y'imari igenewe umushinga kijya mu guhuza ingamba na gahunda z'iterambere zishingiye ku bigenda bihinduka. Muri urwo rwego kandi, ibyo abaterankunga bategereje mu kuvugurura gahunda

12 ISUZUMWA RY'URUHARE RWA GAHUNDA YA PEPFAR MU RWANDA bigomba gusobanurirwa neza abagenerwabikorwa, binyuze mu mucyo ugomba kuranga inzira zoze bizanyuramo. Nk'abafatanyabikorwa, Leta igomba kwibanda ku guhuza uburyo butandukanye bukomokamo inkunga ndetse igahuriza hamwe abagira uruhare kandi bashishikajwe no kongerera ubushobozi abakozi bo mu rwego rw'ubuzima haba mu nzego za Leta n'iz'abikorera kugira ngo bahurize hamwe ibikorwa byo gutera inkunga kandi bagabanye gutega amaboko abaterankunga, bidahoraho. Igenamigambi n'imicungire ijyana n'ibihe Imicungire rusange ya gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima yahuye n'imbogamizi yo kudasobanuka neza ku bijyanye n'uburyo n'inzira zo kugera ku cyerekezo cyayo ndetse no kubura umwanya n'ubushobozi byagenwe mu micungire y'ibikorwa, haba mu ntangiriro ndetse no mu gihe cyose cy'ishyirwa mu bikorwa. Icyifuzo cya 3: Kugira ngo ishoramari mu bakozi bo mu rwego rw'ubuzima rirusheho kugenda neza, bisaba impinduka mu mikorere rusange, abategura gahunda zo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bagomba kumara igihe mbere yo gutangira kuyishyira mu bikorwa kugira ngo bashyireho icyerekezo kimwe, bateganye uburyo bwo kugera kuri icyo cyerekezo, na gahunda y'ibikorwa igomba gushingira ku buryo bw'imicungire ijyana n'ibihe Abaterankunga bagenda bamenya ko ari ngombwa guhuza n'imikorere isanzweho kugira ngo ishoramari rigende neza. Abatera inkunga gahunda zo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bagomba gu- koresha ubu buryo, harimo kumvikanisha mbere ikigamijwe n'umwihariko wo gutegura iyo gahunda, hamwe no gukora impinduka zishingiye ku masomo yizwe uko gahunda igenda ishyirwa mu bikorwa. Isuzuma rya gahunda hamwe no kubazwa ibijyanye nayo bigomba kuba bisubiza iba- bazo byagaragaye mu ishyirwa mu bikorwa ryayo, aho gushingira gusa ku kubahiriza uko yari yateguwe mbere. Imicungire ijyana n'ibihe ni uburyo bugambiriwe bwo gufata ibyemezo no guhindura ibikorwa bya gahunda hashingiwe ku makuru agenda agarag- ara, ingaruka zitateganijwe, n'imbogamizi zitunguranye. Amahame y'ingenzi arimo kuvugurura imiterere ya gahunda no kuyishyira mu bikorwa ku buryo ishobora gutanga umusaruro, kubaka inzego z'imicungire mu buryo bunoze, kugaragaza ibihe byo gusuzuma no kongera kureba ibyemezo byo gushyira mu bikorwa, no gushyiraho uburyo bwo gutanga ibitekerezo hagati yo gufata ibyemezo n'amakuru atangiwe igihe ku bijyanye n'iterambere rya gahunda n'imbogamizi zayo. Imicungire ijyana n'ibihe ishingiye ku makuru yuzuye, ahoraho, kandi asesengurwa byihuse kandi akaganirwaho kugira ngo afashe mu gufata ibyemezo hagamijwe kurushaho gukora neza. Ikintu gikomeye ni uguhuza inama hagati y'amashami n'imirimo, bigakorwa hashingiwe ku nshingano zisobanutse zo gufata ibyemezo no gukora ibikwiye. Nk'uko bya- vuzwe mu cyifuzo cya 6, gahunda zo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima zigomba kuba zikubiyemo uburyo bunoze bwo gukuriki- rana, gusuzuma, no kwiga nk'inshingano ihuriweho, itareba abakozi runaka gusa ahubwo inareba abakozi bo ibya tekiniki n'ibindi bikorwa.

INCAMAKE 13 Uburyo bwo guteza imbere uburezi bw'abakozi bo mu rwego rw'ubuzima Kubaka ubushobozi muri Gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima byakozwe ahanini binyuze mu ihuriro rya za Kaminuza ririmo ibigo byo muri Amerika byagiranye amasezerano n'abarimu kugira ngo bihuze mu bufatanye buhuriweho hamwe n'abarimu ba Kaminuza y'u Rwanda. Aba barimu kandi batanze amasomo ndetse na serivisi z'ubuvuzi. Gahunda yatanze umusaruro uringaniye muri gahunda y'ubufatanye buhuriweho, ahanini bitewe n'ubunararibonye butandukanye mu mitegurire, mu micungire ndetse n'ishyirwa mu bikorwa mu nzego z'ubuvuzi bw'inzobere n'ubuforomo. Ahagaragaye imbaraga ni mu kuzana impuguke zo hanze muri Kaminuza y'u Rwanda, ibi bikaba byarazamuye ubushobozi bw'abarimu bo mu Rwanda mu kuyobora gahunda, byongera umubare w'abahugurwa, kandi byubaka ubufatanye burambye hagati y'Amerika n'u Rwanda mu bushakashatsi no kubaka ubushobozi bw'abarimu. Iyi gahunda ihuriweho ntiyageze neza ku ntego zayo zo gukwirakwira hose, imyigishirize inogejwe no gutanga ubumenyi bwo kuvura bitewe no kudasobanuka neza kw'iyi gahunda ubwo yatangiraga ndetse n'imbogamizi zabayeho mu mikorere n'ishyirwa mu bikorwa ryayo. Icyifuzo cya 4: Abategura gahunda zigamije kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bagomba, hashingiwe ku cyerekezo n'intego za gahunda, gusuzuma uburyo butandukanye bwo guteza imbere uburezi bw'abakozi bo mu rwego rw'ubuzima bujyanye neza n'abakozi bakenewe hamwe n'imiterere y'akarere n'ibitekerezo biriho mu rwego rwo kongerera abakozi ubushobozi. Gahunda yo kongerera ubushobozi abakozi bo rwego rw'ubuzima ya- koresheje uburyo uburyo bw'ubufatanye bushingiye ku muntu ku giti cye hagamijwe kubaka ubushobozi bw'abarimu n'inzego z'uburezi bw'abakozi bo mu rwego rw'ubuzima. Hari kandi n'ubundi buryo buriho bwagom- baga gusuzumwa mbere yo guhitamo, hashingiwe ku ntego za gahunda, icyerekezo n'ibikenewe n'abakozi bo mu rwego rw'ubuzima. Uburyo bwo kunoza imikorere y'inzego busaba ibi bikurikira: • Inzego zo gufasha abarimu mu gihe kirekire; • Kuboneka kw'abarimu bafasha mu iterambere ry'uburezi bw'abakozi bo mu rwego rw'ubuzima; • Igihe gikwiye n'inkunga zo gufasha mu nzira zo kwemererwa gukora, kubaka ubushobozi bwo gukora ubushakashatsi, ndetse n'ibindi bigize uburezi bw'abakozi bo mu rwego rw'ubuzima bitari ubumenyi mu kwigisha; • Ubufatanye bw'inzego bw'igihe kirekire; na • Uburyo bwo kwigisha bukoresha igihe gito. Abategura Gahunda bagomba no kureba ku ikoresha ry'ikoranabuhanga mu kwigisha no kongera ubumenyi ndetse n'uburyo bwo kwigisha bukomatanyije (buhuza ikoranabuhanga n'uburyo busanzwe bwo kwigisha abantu barebana amaso ku yandi). Kuri gahunda zahisemo uburyo bw'ubufatanye hagamijwe guteza im- bere uburezi bw'abakozi bo mu rwego rw'ubuzima, iri suzuma ritanga

14 ISUZUMWA RY'URUHARE RWA GAHUNDA YA PEPFAR MU RWANDA amasomo menshi ku byo bashobora kurushaho kuvugurura, hashingiwe ku gihe cyashyizweho, intego, ndetse n'ubumenyi bukenewe bugomba gutangwa. Icyifuzo cya 5: Abategura gahunda zo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bashaka gukoresha uburyo bw'ubufatanye buhuriweho bagomba gushyiraho intego zisobanutse ndetse bakanareba uko bategura gahunda ijyanye n'ubufatanye buhuriweho haba ku rwego rw'ibigo cyangwa ku muntu ku giti cye, kandi byose bishingiye ku mirongo ngenderwaho myiza ihari. Uburyo bw'ubufatanye ku rwego rw'ibigo bugizwe n'ubufatanye hagati yinzego, bushobora kuba burimo imikorere inyuze ku bufatanye bw'abantu ku giti cyabo hagati y'abarimu bitabiriye ubufanye cyangwa abanyam- wuga. Ishami ry'Umuryango w'Abibumbye ryita ku buzima, gahunda yiswe ESTHER y'Umuryango w 'Ubumwe bw 'Uburayi 4, Umuryango w'ubufatanye mpuzamahanga mu kurengera ubuzima ndetse na Tropi- cal Health Education Trust yo mu Bwongereza bose bakoresheje ubufa- tanye buhuriweho n'inzego kandi bafite ibisobanuro, imikorere, uburyo bw'imikorere biteguye neza, n'ibikoresho byo gutegura, gushyira mu bikorwa, no gusuzuma imikorere myiza y'uburyo buhuriweho n'inzego. Uburyo bw'ubufatanye bw'abantu ku giti cyabo bukubiyemo ubu- fanye bushingiye ku guhuza abantu babiri babiri, kugirana inama cyangwa guhuza uhugura n'uhugurwa. Imikorere myiza y'ubu bufatanye ishobora kunozwa mu gihe ubu bufatanye bukorewe mu mikoranire myiza y'inzego. Gukoresha uburyo bwo guhuza abantu babiri bigomba kujyana no ku- vanga Uburyo bw'ubufatanye bw'abantu amaso ku yandi cyangwa kwiga hakoreshejwe iyakure cyangwa gukoresha uburyo bwo kujyana abakozi gu- korera mu bindi bihugu mu gihe gito. Gukoresha umubare urenze umuntu umwe ku wundi mu guhuza abantu bari mu mahanga n'abari mu gihugu imbere na bwo bwaba ubundi buryo bwiza. Hari ingingo ebyiri z'ingenzi zigomba gusuzumwa mu kongerera ubushobozi inzego zishinzwe uburezi bw'abakozi bo mu rwego rw'ubuzima binyuze mu buryo buhuriweho. Icya mbere, ubu buryo bugomba guhuzwa n'uko inkunga itangwa ndetse n'ibyo igihugu gikeneye. Ni ngombwa kwita ku bijyanye n'umuco, ururimi n'amateka kuko bigira uruhare mu bufatanye buhuriweho, mu gutegura no gutoza abazafatanya ndetse no gushyira imbere uburyo bw'ubufatanye ku rwego rw'akarere igihe bishoboka. Iya kabiri, ubu buryo buhuriweho bugomba gufatwa nk'ubufatanye. Abafatanyabikorwa bagomba kwemeranya neza ku nshingano zateganyijwe mbere zisangirwa binyuze mu mucyo n'abantu babifitemo uruhare mbere yo gutangira ubufatanye. Inshingano zishobora kubamo ibijyanye no kungurana ubumenyi mu gihe abantu basangira uburyo bwo kwigisha cyangwa inshingano z'ubuvuzi, guhana inama, amahugurwa, cyangwa urukomatane rw'ibyo byose. Gahunda zitegura uburyo bwagutse bwo kwiga, nk'uko byavuzweho 4 Izina ry'umwimerere ry'umuryango ryari Ensemble pour une solidarité thérapeutique hos- pitalière en réseau (ESTHER) cyangwa Network for Therapeutic Solidarity mu bitaro, nk'uko byari bizwi mu Cyongereza.

INCAMAKE 15 mu cyifuzo cya 6, zizatanga umusanzu ukenewe cyane mu bumenyi ku buryo bushobora gukoreshwa buhuriweho n'imikorere myiza yabwo. Ikurikirabikorwa, igenzurabikorwa n'imyigire N'ubwo Gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima ishimwa nk'amahirwe y'umwihariko mu guhuriza hamwe kongerera ubushobozi urwego rw'ubuzima na virusi itera SIDA, habayeho igenamigambi n'ishoramari bidahagije mu kwigira ku buryo bwiza ku mbaraga zakoreshejwe binyuze mu ikurikiranabikorwa n'isuzumabikorwa byashyizweho ku ikubitiro. Icyifuzo cya 6: Abategura gahunda zo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima bagomba gutegura kandi bakanashyiraho uburyo bunoze kandi bukomeye bwo kugenzura, gusuzuma, no kwiga buhuye neza n'urwego rw'ubuzima akenshi rugizwe n'inzego zinyuranye zikorera hamwe ndetse n'imihindagurikire ya hato na hato, kandi ibyo bikagereranywa n'ikiguzi n'uburyo gahunda ishobora gukorwamo, mu mucyo, abantu babazwa ibyo bakora, ndetse baniga. Ikurikiranabikorwa, isuzumabikorwa no kwiga binoze bigomba gutan- girira mu cyiciro cyo gutegura hashingiwe ku bimenyetso byinshi kugira ngo byongere akamaro n’imikorere myiza ukurikije uko igihugu gihagaze ubu. Harimo ubushakashatsi bw'ibanze ku ngero z'ingenzi mu karere, is- esengura ry'imibereho cyangwa ry'imikorere y'inzego z'abasanzwe bakora mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima, cyangwa gukoresha ibikoresho n'amabwiriza bihari, nk'ibyakusanyijwe n'Ishami ry'Umuryango w'Abibumbye ryita ku Buzima, kugira ngo hamenyekane icyuho gihari kandi hagereranywe n'ibikenewe byihariye mu bakozi bo mu rwego rw'ubuzima, harimo n'ibikenewe by'umwihariko n'abakozi bo mu bijyanye na virusi itera SIDA. Isuzuma ry'ibikenewe bigomba gushingirwaho rigomba kugaragaza uburyo bwo kugereranya ibyihutirwa, nko gushyira imbaraga nyinshi ku buvuzi bwihariye cyangwa mu buvuzi bw'ibanze. Ku bijyanye na virusi itera SIDA, uburyo bw'igihe kirekire bwo gushora imari mu kongerera ubush- obozi abakozi bo mu rwego rw'ubuzima bugomba kugaragaza n'ahazaza hateganijwe h'iki cyorezo - kongerera ubushobozi urwego rw'ubuzima ku- gira ngo rubashe kwita ku bafite ubwandu bwa virusi itera SIDA bashaje. Itegurwa rya Gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima rigomba kwita ku biteganyijwe mu iterambere ry'ibikenewe n’abakozi ugereranyije n'ubukana bw'indwara bugenda buhinduka uko imyaka igenda ishira. Urugero, mu Rwanda, ibyinshi mu byagaragajwe ko bikenewe mu buvuzi ntibijyanye na virusi itera SIDA. Isuzuma risesuye kandi rihujwe neza rizafasha ishoramari mu kongerera ubushobozi abakozi bo mu rwego rw'ubuzima ryo mu gihe kizaza kumenya inzitizi n'amahirwe ahuriweho, ndetse n'ibyihariwe n'izo ndwara zonyine n'inzego z'inzobere. Itegurwa rya Gahunda rigomba kandi kubamo uburyo bunyuranye bw'ikurikiranabikorwa burimo igihe cyo kongera kwiga kugira ngo ibikorwa birusheho kugenda neza. Ibice by'ingenzi birimo kubanza guhitamo cyangwa gushyiraho ibipimo bizakoreshwa mu gusuzuma imikorere myiza ya gahunda, akamaro kayo, umusaruro wayo na gahunda

16 ISUZUMWA RY'URUHARE RWA GAHUNDA YA PEPFAR MU RWANDA yatewe inkunga yo gukwirakwiza no gukoresha ibyavuye mu isuzuma rya gahunda. Ikurikiranabikorwa ridahagarara rigomba gushingira cyangwa kunoza uburyo bwa Leta busanzwe bukoreshwa mu kubika amakuru kugira ngo hagabanuke imbogamizi kandi ubwo buryo bunungukire ku ishoramari rizakorwa. Isuzuma rihoraho cyangwa inyigo zihariye ku nzego zimwe na zimwe zigize gahunda bishobora gutanga amakuru y'ingirakamaro yokoreshwa mu kuzuza amakuru asanzweho n'arimo gukusanywa no gukoreshwa. Gahunda z'igenamigambi riteguwe neza ry'ikurikiranabikorwa, isuzumabikorwa, n'imyigire zifite inkunga ndetse n'abakozi bahagije byafasha kurushaho gusobanukirwa ibikenewe mu kubaka, gushyira mu bikorwa, no gukomeza gusigasira gahunda iboneye yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima, hamwe n'umusaruro ushobora kuzanwa n'iyo gahunda. Ibipimo by'uburyo buzakoreshwa byafashwe mbere bishobora gufasha mu gukosora inzira izifashishwa. Ibipimo byatoranyijwe kandi byateganyijwe mu buryo bukwiye bishobora kugaragaza ingaruka z'igihe kirekire ku mpinduka z'uburyo bukoreshwa. Igihe Gahunda yo kongerera ubushobozi abakozi bo rwego rw'ubuzima yifashishije uburyo bw'ubufatanye, kugenzura ubu buryo buhuriweho n'imikoranire ndetse no guhuza uburyo bwo gushaka abakozi no kubashyira mu kazi uko bikwiye bishobora kunoza ishyirwa mu bikorwa no kugera ku musaruro. Kumenya neza no gukurikirana aho abahuguwe bakorera ndetse n'inshingano bafite nyuma y'iyi Gahunda, byoroshya isesengura ry'akamaro Gahunda yagize ku rwego rw'umurwayi. Niba hari ibiteganijwe ko Gahunda igomba kugaragaza uruhare haba ku ngaruka z'imikorere muri rusange no ku ndwara by'umwihariko, buri gice mu bijyanye n'igenzura, isuzuma, n'ibikenewe mu kwiga kigomba gutegurwa kuva mu ntangiriro kugira ngo handikwe neza kandi hasesengurwe iyo ntego mu buryo bwombi. UMWANZURO Gahunda yo kongerera ubushobozi abakozi bo mu rwego rw'ubuzima, yatewe inkunga na PEPFAR kuva mu 2012 kugeza 2017, yagaragaje amahirwe ku baterankunga bo hanze bibanda cyane kuri virusi itera SIDA, bashora imari mu mpinduka z'imikorere ntambike binyuze mu kongerera ubushobozi ibigo byigisha abakozi bo mu rwego rw'ubuzima mu Rwanda kugira ngo haboneke abakozi benshi kandi bashoboye hagamijwe gukemura ibibazo by'abaturage b'u Rwanda, harimo n'abafite ubwandu bwa virusi itera SIDA. Mu gihe PEPFAR yashoraga imari muri iyi Gahunda, hari intambwe ishimishije yatewe kugira ngo haboneke abakozi bo mu rwego rw'ubuzima bari ku rwego rwo hejuru, kandi abagize uruhare muri iri suzuma bashyigikiye byimazeyo iyi Gahunda. Kutabyaza aya mahirwe umusaruro mu buryo bwuzuye ku bijyanye no kongera ubushobozi ku rwego rw'ibigo kugira ngo bikomeze kubona abakozi bo mu rwego rw'ubuzima, byadindijwe n'igenamigambi ridahagije, itumanaho ritanoze, ikurikiranabikorwa, isuzumabikorwa n'imicungire myiza ya Gahunda bitagenze neza. N'ubwo hari amasomo y'ingenzi n'imbogamizi dushobora kwigira mu byagezweho na Gahunda hari amahirwe atarabyajwe umusaruro yo kwiga neza binyuze mu buryo bwafashwe, bitewe n'uko hatabeyeho uburyo bwo gutegura no gusuzuma ingaruka za gahunda yose muri rusange ndetse n'ingaruka zihariye ku kuvura virusi itera SIDA.

INCAMAKE 17 Kugira ngo ubushobozi bw'abakozi bo mu rwego rw'ubuzima buziyongere mu gihe kizaza, ahantu hatari ubushobozi buhagije kandi mu buryo butanga umusaruro ushimishije mu bikorwa byo kwita ku bafite ubwandu bwa virusi itera SIDA, birasaba kongera gutekereza uko ubufatanye bushyirwaho, uko ishoramari rikorwa, ndetse n'uko ingaruka z'ishoramari zandikwa. Umusaruro w'iryo shoramari ushobora kuba munini kandi ukaramba mu gihe ishoramari rya gahunda rifashe igihe kirekire, rihuriweho n'inzego zinyuranye, kandi ryarateguwe hitawe cyane cyane ku gusobanukirwa no gutanga ibyo abakozi bo mu rwego rw'ubuzima bakeneye, hitawe ku bikenewe bigenda bigaragazwa n'abafite ubwandu bwa virusi itera SIDA.

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Multilingual Summary for Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program Get This Book
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This multilingual publication summarizes the recent Evaluation of PEPFAR's Contribution (2012-2017) to Rwanda's Human Resources for Health Program. 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. The summary distills the main messages of the consensus report.

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