Executive Summary
Background: A community-centered program supported by Rwanda’s national government aims to provide a “minimum package” of services for OVC, including comprehensive access to health services, assistance with school fees, child protection services, as well as nutritional, psychosocial, and economic support. While strong political will exists to protect and support this population, the mobilization of resources has become increasingly difficult given the magnitude of children’s needs throughout the country, which has endured the long-term effects of the 1994 genocide and the ongoing impact of the HIV/AIDS epidemic, resulting in nearly 3 million orphans and vulnerable children in a total population of 9 million individuals nationwide.
The overall goal of this case study is to provide in sufficient detail the process that follows from initial ideas/ vision, government policy development, the creation of national strategic plan of action, local (district-level) program and work plan development, and ultimately program implementation, including monitoring and evaluation (M&E). A detailed description of the M&E system is offered as an example of how information generated at the local level can potentially inform changes in the strategic plan to improve overall program performance.
There are innumerable examples in global health of how ‘good ideas’ stay in the board room or conference hall and never reach those in need. The Rwanda OVC case is an example of sound ideas of public service translated into action. By offering a detailed description and outlining the architecture of this process, readers can glean from the case what may be replicated in other settings, in terms of content, process, or both. Therefore, the target audience of this case includes other policy makers, government officials, decision makers for multilateral and bilateral organizations, program developers, and implementers.
Methods: Several different sources of information were used to develop this case study. These sources include primary policy documents from NACC, documents from the Rwandan NACC website, and other sources from the gray literature. A comprehensive review of government documents was performed based on these sources. In addition, documents and websites from non-governmental organizations working in Rwanda were reviewed. Primary data were collected through semi-structured interviews with key informants from governmental and non-governmental agencies in Rwanda. Key informants were from the National AIDS Control Commission (NACC), representatives from two district offices in Rwanda (one high-performing and one low-performing in terms of services provided to OVC) as well as five civil society organizations: CARE International, Haguruka, Imbuto Foundation, Rwanda Women’s Network, and World Relief. District leaders were interviewed in order to describe relevant national policies and program implementation.
Results: Findings indicate a number of key elements that have promoted advancement of the program, including: a clear vision at the outset that informed the OVC policy and framework for the strategic national plan of action with clear objectives; sustained political will and leadership at the national level; a comprehensive, multi-sector orientation; a holistic approach to services for OVC; a focus on transparency as well as decentralization of authority, planning, and responsibility at the district level; a monitoring and evaluation system that is broadly accessible and focuses on district level capacity building and analysis of the data at the local level to inform programmatic improvements; and involvement of children to inform recommendations for OVC policy and programming.
Ongoing challenges include: communication and coordination of program activities between the national and district levels as well as among district level organizations; difficulties in providing all elements of the “minimum package;” ensuring that all OVC are identified and assisted; and concerns regarding the level of resources available being outstripped by the number of orphans and other vulnerable children and the magnitude of their needs.
Policy/action implications and conclusions: Linkages to facilitate navigation of children within the system should be strengthened and documented so that they can be applied elsewhere. Future efforts should focus on employing mechanisms to coordinate, follow-up, and evaluate implementation of the OVC package. Continued engagement of OVC programmatic advancements in economic development activities will prevent marginalization of the program. Additional inputs for the M&E system will provide opportunities for increased capacity building at the district level and further authority and advance program development at the local level. Technical and financial stability of support for OVC and vulnerable families should be given high priority, and planning for future financing will be essential for sustained success of the program.
In summary, the purpose of this case study was to describe the framework or architecture of a program from the outset, starting with the initial vision and ending with program implementation. The vision of aggressively moving Rwanda’s economic situation out of poverty is an underlying force that drives the process and it is this vision that characterizes the type of leadership that is motivated by the democratic process and the promotion of human rights, particularly of those most vulnerable. The mechanics of operationalizing the vision of offering orphans and vulnerable children the services and resources they are entitled to were initiated with policy development, which provided the framework for the national strategic plan of action. The guiding principles of the strategic plan were based on content from Rwanda’s National Policy on OVC (2003) and the UN Convention on the Rights of the Child (GoR, 2006).
However, in the Rwandan case, the process did not ‘stop’ with the national strategic plan; implementation was possible because this national plan was translated into district-level plans in which district officials were responsible for program plans, implementation, and evaluation. In terms of future progress of this ambitious plan, feedback from program implementers indicated a need to strengthen efforts of communication, capacity building, transparency and coordination between national and local/district levels of operation. As more capacity building occurs at the district level, the local government will be able to develop a more coordinated response (e.g. across government entities and CSOs) to address the needs of OVC, since they may vary in different geographical areas of Rwanda.
Rwandan policy makers were able to set the agenda with development partners, such as PEPFAR, Global Fund, World Bank, etc., given the fact that they had engaged local communities as well as orphans and vulnerable children to offer feedback on how OVC could be assisted. Policy makers developed the “minimum package” program in part based on this feedback and negotiated with development partners to fund this program, rather then allowing outside funders to set the agenda. As a result, the Rwandan government was able to make its own decisions on allocation of this external funding and also was able to develop a monitoring and evaluation system that mirrored their internal goals and objectives for the OVC program. In the immediateterm, this has sustained the system and program activities. It is clear that greater external funding for the program is needed currently to meet the great need of OVC; however, as Rwanda transitions into its vision of a middle-income nation, it is anticipated that more resources will be generated internally by the very youth who benefited from the existing program.
