Rwanda National Land Use Development Master Plan - Health

R W A N D A N A T I O N A L L A N D U S E D E V E L O P M E N T M A S T E R P L A N - H E A L T H
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CHAPTER 1.0: INTRODUCTION-------------------------------------------------------------- 2
CHAPTER 2.0: PRESENT HEALTH SITUATION-------------------------------------------- 3

2.1: HEALTH IMPACTS ------------------------------------------------------------------------- 3
2.1.1 Lifestyle----------------------------------------------------------------------------- 3
2.1.2: Environment----------------------------------------------------------------------- 3
2.1.3: Transportation --------------------------------------------------------------------- 4
2.2: QUALITY OF SERVICES ------------------------------------------------------------------- 5
2.3: PRIMARY AND SECONDARY HEALTH CARE ----------------------------------------------- 5
2.3.1: Situation today--------------------------------------------------------------------11
2.4: INTERNATIONAL STANDARDS ------------------------------------------------------------12
CHAPTER 3.0: CHALLENGES AND STRATEGIES ---------------------------------------13
3.1: DEMOGRAPHIC STRUCTURE -------------------------------------------------------------17
3.2: TECHNOLOGICAL PROGRESS ------------------------------------------------------------17
3.3: NEW MODELS ---------------------------------------------------------------------------17
3.4: HOSPITAL BEDS AND SERVICE PROVISION -----------------------------------------------17
CHAPTER 4.0: DISTRICT PLANNING IMPLICATIONS------------------------------------19
4.1: PLANNING STANDARDS ------------------------------------------------------------------19
4.1.1: Planning Indicators---------------------------------------------------------------19
Example ---------------------------------------------------------------------------------19
GUIDELINES-----------------------------------------------------------------------------------21
REFERENCES---------------------------------------------------------------------------------21
LIST OF TABLES------------------------------------------------------------------------------23
LIST OF FIGURES ----------------------------------------------------------------------------23
The National Land Use and Development Master Plan is referred to as the Plan in the text
Chapter 1.0: Introduction

Figure 1: L a Croix du Sud Polyclinic in Kigali1 and the Private Dispensary
It is evident that the health situation in Rwanda has improved during the last one
decade, but still major problems remain to be solved within the health care sector.
Therefore there is a need to point out the appropriate measures at national, local,
and individual levels.
However, in order to determine and understand long-term health trends, the links
between health status and individual economic, social structure and demographic
issues should be recognized and taken into account. Even population structure and
socio-economic characteristics are basic determinants of living conditions. The
development of the health sector needs to be considered by evaluating the current
situation and the demands from a rapidly growing population during 2010-2020.
The health care sector includes health care facilities, accessibility to treatment and
the supply of medical personnel. However, good human health condition is more
than absence of illness and infirmity, implying that the discussion on health issues
needs to consider other aspects than the supply of health care alone. For instance
some of other factors to be considered are; availability and access to health care
units/centers, affordability and quality of services offered are paramount issues to
be considered in planning for better health services.
It is clear that a high-quality national health status is relying on good governance of

health care and on the shaping of a healthy, safe and secure environment for all
citizens. The health care sector needs well-designed strategies to facilitate the
establishment of a professional, healthy and capable workforce.
1 The standard polyclinic in Kigali

Chapter 2.0: Present Health Situation behaviorally related risk factors such as cigarette smoking, alcohol consumption,
drug abuse, inadequate diet, consumption of sugarless food, sedentary life style
and sexual behavior also are aspects of a person’s health status.
A country’s health status is difficult to measure, but internationally recognized health
measures like the World Health Organization ranking provide acceptable In the future, one solution to life style related health problems could be the
yardsticks. Amongst the 44 African WHO members, Rwanda was ranked 29 in promotion of public transport and safe walking and cycling areas where possible in
1999. order to obtain everyday traffic systems that are favorable both to health and
environment. It is obvious that more physical activities like walking and cycling will
Two measures commonly used as health indicators are life expectancy and child have an additional positive effect on health.
mortality. According to WHO and UNICEF statistics, life expectancy at birth, both
sexes, was 44 in 1970, 33 in 1999 and about 50 years in 2008. This gives Rwanda 2.1.2: Environment
the ranking of 172 amongst 192 WHO members in 2008. Environmental issues are also interrelated aspects of human health status and so
are diseases that are determined by factors in the environment. It is important to
As for child mortality, Rwanda’s child risk of dying before reaching the age of five note herewith that the Rwandan environment is visibly being conserved and
has decreased from average 210 per 1,000 in 1970, 186 per 1,000 in 2000 to 112 protected. Organized garbage collection, a ban on the use of polythene bags and
per 1,000 in 2008. This gives Rwanda the international ranking of 181amongst the regular cleaning of the city are all strategic moves in the right direction. However,
192 WHO members in 2009.2 The rankings indicate that Rwanda is still far from wetland protection is still inadequate; the natural ecosystem is degrading as well as
achieving good health standards basing on the above indicators. contamination of soils and ground water resources. Effective measures are needed
to reduce and prevent environmental impacts which have an influence on human
2.1: Health Impacts health.
The concept of health can be defined as a concept of different determinants. They
include population structure, ageing, lifestyle, socio-economic and environmental Figure 2: Misuse of Wetland Area in Kigali
conditions, supply of health care, and handling of other health risks like prevention
plans for HIV/Aids. These determinants are interacting with one another in a
complex way and the result could be measured in terms of health status outcomes.
It is, however, not possible to find one single measure of health status. For
example, education on its own is an important determinant of health behaviour and
of health status. The criteria frequently utilized in the health literature are
aggregates of different measures such as the level of education, family patterns,
other social networks, income and employment.
2.1.1 Lifestyle
Since the definition of health is not only the absence of disease, it includes also the
individual capability to function well physically, mentally and socially. Therefore,
2 WHO: World Health Statistics 2009
In the context of environmental health it is also important to mention that the 2.1.3: Transportation
provision of safe drinking water, sanitation, garbage collection, and fight against Another important issue is the health effects of transportation and traffic. Promoting
climate change plus reduction of air pollution are essential. The encroachment on healthy and secure transport alternatives prevents negative effects on human
wetlands in Rwanda is an issue of concern, and the likely resultant contaminations health. Transportation affects the health of the whole population both directly and
of these natural ecosystems imply serious health risks to the citizens. indirectly through pollution of the air. The direct health effects include injuries from
road traffic accidents, limited physical activity, noise and stress. In combination with
The water supply system in urban areas is of low quality due to degraded poor public transport systems this leads to intense every-day car use.
ecosystems and ground contamination which already causes contaminated Consequently, the car safety is a very important issue, for the individual citizen and
household water supply. for the society as a whole. The driver has a big responsibility for the road safety by
use of safety belts and moderate rate of speed, but there are also other elements
Figure 3: Poor Quality Water System in Kigali Housing Area. influencing traffic safety like road quality and car safety issues.
Road fatalities alongside other unrecorded causes of death account for 30 % of all
hospital deaths in Rwanda. A decrease of deaths and injuries caused by traffic
requires a safer traffic system but also a health system offering crash victims
speedy transportation to health facilities and proper care. It’s worth noting that there
has been increased acquisition of ambulances in the country.
Figure 4: Bad Traffic Solutions Constitute a Sever Health Hazard
Due to low and poor water supply, some inhabitants have resorted to fetching
stream water which was rehabilitated by providing pipes. The environment around
these stream wells is usually unclean which might cause other health problems to
people and to the wetlands since almost such stream wells are located in wetlands.
See the figure above.
.
2.2: Quality of Services According to the 2008 Rwanda Health Statistical Book, the supply of hospital beds
A 2007 Survey on the health service performance in Rwanda conducted by the only reached 11,724 in 2008. When including specialized hospital beds, the ratio of
National Institute of Statistics suggested that the most severe problems are found beds per 1,000 inhabitants was estimated at 1.28. At that time this figure was far
within insufficient health planning and low standard services. The survey pointed below international standards.
out the problems resulting from lack of adequate medical tools and equipment and
the absence of an equipment maintenance plan. Furthermore, the scarcity of
physicians, especially specialists, was mentioned as a severe problem (NISR
2007). Table 1: Number of beds by health facility type and by service (2008)
The absence of an established general physician or family doctor system drives Inpatients Maternity
many Rwandans to consult secondary or tertiary care centers for treatment. As a Facility type beds beds Total
result, specialized hospitals provide basic services which should be provided more
effectively at lower levels of care. District Hospital and
Referral Hospital 5861 1704 7565
Historically, the quality of Rwandan health care is improving, but still has a great
way to move in achieving the desired health service levels. One problem is low Health Centers 5863 2343 8206
motivation among public sector health workers, depending on salary restrictions.
Limited motivation and absence of a strong incentive structure linked to patient Total 11724 4047 15771
satisfaction leads directly to poor quality service, particularly at the primary care
level. Ratio beds /Population 1.28
The funding of Rwandan doctors pursuing post-graduate specialization abroad has Source: NISR, 2009.
been inefficient, since Rwanda has not derived benefits from their skills. Faced with
low salaries at home, they have often chosen to pursue their careers abroad. 2.3: Primary and Secondary Health Care
Rwanda has 39 district hospitals, 412 health centers, and 4 referral hospitals and a
A number of well educated Rwandan doctors are now working abroad, and a grand total of 497 health facilities.
decline in quality of newly graduated doctors is to be feared. There are no data
about the specific number of doctors working abroad, but one indication that their
numbers may be substantial is that the Rwandan Diaspora Network boasts of a
considerable number of PhD holders in medical sciences. There is a lack of
specialists in a number of key areas, such as anesthesia, cardiology and radiology,
despite large numbers of medical students in local universities. The establishment
of specialized health centers, either by public or private sectors, in strategic areas of
population concentration, could lead to improved service quality and performance
in the health sector.
Table 2: Health Facilities by Districts and Provinces
Police
/Military District Health Health Prison Grand

Referral
Hospital Hospital Hospital Center Post Dispensary Total
Province District
East Bugesera 1 11 1 13
Gatsibo 2 18 20
Kayonza 2 14 2 18
Kirehe 1 11 14
Ngoma 1 12 13
Nyagatare 1 18 19
Rwamagana 1 12 1 15
West Karongi 3 18 24
Ngororero 2 12 19
Nyabihu 1 16 17
Nyamasheke 2 18 1 21
Rubavu 1 9 1 11
Rusizi 2 12 1 15
Rutsiro 1 16 18
North Burera 1 14 15
Gakenke 2 18 5 26
Gicumbi 1 21 22
Musanze 1 9 13
Rulindo 1 18 19
South Gisagara 2 12 14
Huye 1 1 14 2 18
Kamonyi 1 11 12
Muhanga 1 12 1 15
Nyamagabe 2 16 1 2 21
Nyanza 1 13 2 16
Nyaruguru 1 15 16
Ruhango 1 13 14
Kigali
City Gasabo 2 1 1 13 1 18
Kicukiro 1 8 9
Nyarugenge 1 1 8 1 12
Total 4 2 39 412 9 13 497
Source: NISR 2009
Figure 5: Health Facilities 2010 (next page)
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Table 3: Type and meaning of health care units.
Category Type Meaning
Hospitals with more qualified personnel

Secondary health and modern medical treatment- at
centers Referral Hospital national level
District Hospital Hospitals at district level
Primary health Generally a standard health care

centers Health Center center with all needed services
meant for military workers but also for

Military Hospital the public
meant for police investigations and

Police Hospital usual health services
meant for prisoners but also for the

Prison Hospital public
Polyclinic Normally privately run health care unit
Health post where people get first treatment
Dispensary Where people get first Aid
Figure 6: The Distribution of Primary Health Facilities by Population density 2010 (next page)
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N.B Table 4: Life Expectancy at Birth
Generally, all primary health care units are meant to offer primary and basic
health treatment and if need be the patients can be given transfer to Year 2000 2010 2020
secondary health care units.
Life expectancy at birth
Figure 7:Kibagabaga District Health Center.
Number of years 48 50 55
Source: Rwanda’s Vision 2020
The maternal mortality rate has risen from 500/100,000 live births in 1992 to
1071/1000 live births in 20004. The infant mortality rate rose from 85/1000 live
births in 19925 to 107/1000 live births in 20006. The principal causes of these levels
of mortality in Rwanda remain communicable diseases, which for the majority in
Rwanda can be prevented through better hygiene and behavior change. The
prevalence of HIV/AIDS amongst the adult population is estimated at 13.2% in
Kigali city, 6.3% in other urban areas and 3.1 percent in rural areas. And it is
targeted to be at 0.5 by 2012.
Malaria accounts for at least 40% of all consultations in health centers; in 2001,
malaria was found to have a fatality rate of 10.12% in district hospitals and 2.7% in
health centers.
Rwanda has 39 district hospitals, 412 health centers, and 4 referral hospitals. Data
on numbers and types of staff is showed in the table below;
2.3.1: Situation today

The annual population growth rate is 2.8%, the total fertility rate is 5.8, and 45% of
the population is under 15 years of age. Life expectancy in good health at birth for
the whole population is estimated at 50 years, while the percentage of life
expectancy lost for men and for women is respectively 13.3 and 14.1.3
4 DHS 2000
5 DHS 1992
3 Source(DHS 2000 and world health report 2003, WHO) 6 DHS 2000
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Table 5: Number of Staff Working in Health Sector by Category in 2008. Others are employed by the civil services, through contracts with health centers in
which they are paid with income from user fees, or through contracts with NGOs,
%of churches, districts, or other agencies. This system provides flexibility and may
Staff category Number total enable health centers to hire additional staff more quickly than if they had to make
all requests through the civil service.
Rwandan Doctors 384 3.4
2.4: International Standards
Foreign Doctors 187 1.7 There are also wide international variations in bed capacity in relation to size of
population. The median value of the OECD countries is a supply of hospital beds of
Nurses 6543 58.6 4.1 beds per 1,000 inhabitants in 2007. Only a few countries had a number
between 5 and 7 and only one country, Japan, had more than 8 beds per 1,000
Midwives 35 0.3 inhabitants. For almost all OECD countries the trend of a decreasing number of
beds is evident. A number of countries, including Sweden, Finland and the United
Paramedical 746 6.7 States, now have 2.5-3.0 hospital beds per 1,000 inhabitants, compared with 4-8
some 25 years ago. This is mainly explained by very high efficiency in the health
Pharmacist 39 0.3 services, with low overnight admission rates, short lengths of stay and high bed
occupancy rates.
Laboratory
The numbers of staffed acute hospital beds are falling everywhere, driven mainly
technician 804 7.2 by reductions in lengths of stay and in overnight admissions. A large group of
countries has between 3 and 4 hospital beds per 1,000 inhabitants and the trend is
Administrative staff 1293 11.6 decreasing. Considering the present planning standard need for more hospital
beds per inhabitant in Rwanda and different health service indicators for a number
Support staff 945 8.5 of OECD countries, including the health indicators of life expectancy and child
mortality, one should note that there is no positive correlation at all between a high
Other 194 1.7 number of beds and the general health situation of a country.
Grand total 11170 100 On the other hand, there is a weak but certain correlation between the health
conditions, measured by life expectancy, and the rate of physicians per 1,000
Source: NISR 2009 inhabitants. Countries like Italy, Belgium and Switzerland, for example, have both a
high supply of physicians and high life expectancy, but other countries with many
The bulk of the health workforce is made up of nurses (6543) constituting 58.6%, physicians, like the Czech Republic and Hungary, are not as such successful.
with very few midwives and pharmacists (0.3).7
7
NISR Yearbook page 43
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When looking at the number of nurses per 1,000 inhabitants, the correlation is more Ireland, Netherlands, Switzerland, Luxembourg, Norway, Denmark, Sweden and
obvious with the health conditions, measured in life expectancy. Countries like
Australia all have a high number of nurses within the health services, and also very
good health conditions. All OECD countries, with few exceptions, have low child
mortality rates. The differences between the countries are so small that it is not
possible to recognize any correlation with the number of either physicians or
nurses.
The conclusion is that Rwanda ought to increase the number of physicians and
nurses in order to improve general health care condition and services. To reach the
OECD median value of 3.1 physicians per 1,000 inhabitants, the number of
physicians has to be significantly increased if not tripled from the current 571
doctors in Rwanda. To reach the OECD median value for nurses, the number
should be doubled from 6,318 today.8
A generally reasonable assumption is that planning standards should be flexible to

the demands of modern health care and treatment methods.
Chapter 3.0: Challenges and Strategies
Figure 8: Nurses, a vital asset for our health status today and in the future
The present development of the health sector is not completely satisfactory. The
first key challenge is to guarantee sufficient accessibility to health posts,
dispensaries, health centers, district hospitals, and referral hospitals. Issues of
geographical accessibility of the population to health services and location of health
facilities are of primary concern
Accessibility is to a large extent a matter of providing a network of primary health

care with general physicians to turn to for basic medical services.
The second key challenge concerns the number of hospital beds and how to
achieve the desired level for the district and referral hospitals.
The third key challenge is the absence of health planning standards and guidelines
and current low level of health care services. This could be seen in the perspective
of poor customer care
8 Rwanda Health Statistical Booklet 2008: 32
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The fourth key challenge concerns the lack of adequate medical equipment and a The growing population and the development of treatment methods coupled with
clear plan of maintenance, as well as a shortage of physicians and specialists. increasing access to medical insurance seem to be the major drivers of bed
requirements over the planning period of the coming 10 years.
Finally, the fifth key challenge is a number of problems outside the health sector like
access to safe drinking water, environmental pollution, poor traffic safety, tobacco Population scenarios give estimates of the future size of the population in Rwanda
smoking and a need for more everyday physical activity. The above mentioned and age group distribution. The demographic structure probably still is the most
issues are related to health and play a key role in attaining a long-term sustainable predictable driver of future health services requirements. However, the
health status for Rwanda. development of medical treatment methods and the organizing of open health care
versus hospital health care is probably of greater importance than demography,
and at the same time they are factors of greater uncertainty.
Table 6: Malaria prevalence among children under five years of age. West 7.3 5.6 3.6 2.3
Number of 2008 Number of North 6.1 4.9 3.1 2.4

Province 2005 in % children in % children
South 7.7 7.7 5.2 3.5
East 22.6 482 5.3 1,121
Kigali City 15.2 13.5 9.2 7.4
West 8.0 490 0.6 1,181
HIV prevalence (VCT) 9.3 7.4 4.7 3.3
North 5.6 360 1.2 813 Source: Statistical year book 2009, page 18
South 19.6 563 3.0 1,225
Table 8: Prevalence of Tuberculosis in Rwanda.
Kigali City 15.3 151 1.9 323
Indicators 2005 2006 2007 2008
Source: IDHS 2007/2008 and RDHS 2005
Number of cases 7720 8265 8014 7841
Table 7: HIV prevalence by province among VCT9
Therapeutic success (in %) 76 84 86 86.2
Province 2005 2006 2007 2008
Failure rate (in %) 1.5 2 2.4 3
East 9.9 8.1 4.9 3.7
TB/HIV (in %) 18 32 37.5 34.1
Tested + Tuberculosis (in %) 13.7 11.3 6.6 6.6

9 VCT means; Voluntary Counseling and Testing
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Death rates associated with
tuberculosis (in %) 6 6 4.8 5
Source: NISR 2009 page 29, IDHS 2007/2008
Figure 9: Malaria Prevalence among children under five years by Province;
Figure 10: HIV/AIDS Prevalence by Province in Rwanda. (See next 2 pages)
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3.1: Demographic Structure range of evidence that, other factors being constant, patients prefer care at home,
According to experiences from Western countries, the share of people aged over or in homely settings, to in-patient care.
85 is a strong driving factor for the need for health care. This share is estimated to
be not more than 2% in Rwanda in 2007.10 This figure is extremely low and of The overall impact on hospitals of these future drivers is highly uncertain, but most
almost no importance for the need for hospital facilities. The share of people over experts believe that a wide range of services will continue to be transferred out of
65 is at present just over 4 %, a figure that might increase to 20 % in 2020. Still, the traditional hospital wards into new settings. Knowledge is likely to be centralized in
share of people aged 85 or more will be very small and well under 3 %. One can the hospital but services will be spun out to the periphery. Telemedicine is expected
assume that the increase of elderly will not have such a strong influence on the to enhance this process. Some see the major acute hospital of the future as a
need for hospital facilities as in Western countries, within the planning period. resource centre for high technology, high cost and high risk interventions. It would
Looking beyond 2020, demographic changes might become more significant as operate as a hub from which expertise and advice is available to wider health
aging accelerates. This highlights the need to keep drivers of future service networks, including a range of local facilities dealing with less severe conditions, for
requirements under regular review in years to come. example ambulatory care centers, minor injury units and rehabilitation units.
3.2: Technological Progress 3.4: Hospital Beds and service provision

A key driver of service requirements and the need for hospital beds is likely to be For the proposed planning standard of 5 hospital beds per 1,000 citizens to be
the technological progress and related changes in clinical practice, as it has been implemented, the required budget would be almost 3 times as large as the present
during the past 15 years. In a short- to medium-term perspective, medical one, and even more when meeting the demand from a growing population. Even if
technology appears unlikely to reduce the need for planned overnight hospital the health budget would be increased, it can be questioned whether the money
admissions. In the long-term perspective extensions of IT development and should be spent mainly on new hospital facilities, or to a larger extent on
telemedicine may have a more immediate impact by allowing centralized expertise maintenance of existing, purchasing of new medical tools and equipment and on
to be brought closer to patients' homes. Telemedicine is already put into practice in more physicians and nurses. The conclusion must be that, today, bed standards as
other countries and will certainly become relevant for Rwanda in the medium and an indicator of health status is not realistic as a basis for future regional and urban
long term. A number of other important new developments can be identified, but planning.
their net impact is unclear.
A reasonable assumption should also be that such a planning standard for health
3.3: New Models facilities is far too high considering the demands of modern health care and
A second major driver could be a clarification of the evidence base on the cost- treatment methods. Actually, it cannot be proved that the present level of 11,724
effectiveness of new models of care. For specific types of diseases, certain beds is below the actual need, considering the needs of beds in modern health
alternatives to hospital do appear to offer equivalent health outcomes at similar or treatment systems and a more efficient utilization. The planning process requires
lower cost, and may be preferred by patients and their carers. The future continuous revision and a plan should be seen as valid only for a limited period of
distribution of costs for health care between the government and the individuals and time. This will make it possible to update planning standards in accordance with the
the behaviour of well informed consumers and carers will also be important. One involvement of modern treatment methods.
can probably expect greater demands on services as a whole. There is also a
10 Rwanda National Population Projection 2007-2020:30

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rate (0/00)
Table 9: Ratio of health workers/hospital beds to population in 2008.
Maternal
Ratio to mortality rate (
Staff category Number population 0/00.000) 1070 600 200
Hospital beds 11724 1.28 Child

Malnutrition
Doctors 571 15780 (Insufficiency in
%) 30 20 10
Midwives 35 260590
Population
Nurses 6318 1444 Growth rate (%) 2.9 2.3 2.2
Source: statistical year book11 HIV/AIDS

prevalence rate
Table 10: Vision 2020 Health Indicators and Projections. (%) 13 11 8
Baseline Target Target International Malaria-related

Indicator 2000 2010 2020 Level mortality (%) 51 30 25
Doctors per
Rwandan
100,000
population 7,700,000 10,200,000 13,000,000
inhabitants 1.5 5 10 10
Literacy level 48 80 100 100
Nurses per
Life expectancy 100,000
(years) 49 50 55 inhabitants 16 18 20 20
Women fertility Laboratory

rate 6.5 5.5 4.5 technicians per
100,000
107 80 50 inhabitants 2 5 5
Infant mortality
Source: Vision 2020.
11 NISR 2009, statistical year book page 43
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Lack of data
Chapter 4.0: District Planning
Implications
To make situation analysis and assessment for future land use
development certain key indicators have to be defined. Due to lack of 4.1: Planning Standards
data some issues for the Baseline Studies, Needs Assessment, Risk & 4.1.1: Planning Indicators
Suitability Analysis cannot be analyzed in an optimal way.
Maximum walking distance between medical centers: maximum walking distance
Data to use for important comparative indicators showing distribution, set by Ministry of Health is five (5) kilometers, which should not take more than one
quality, performance, etc and for preparation of spatial data (the hour.
Orthophotos and the National Base Map Portfolio) have not been found.
Consequently it is not possible to compare inequalities of, for example, According to health survey conducted by Ministry of Health, it was found out that
the need for hospital bed, need for health personnel, prevalence of 65% of Rwanda’s population has access to health facilities within the limits of the
major diseases and others per Districts, which is a fundamental set standards. However, 35% still lack health facilities within their proximity as per
comparative analysis in a National Plan. the standard maximum walking distance. in reality one say that 5km between
health facilities is sufficient considering factors like; the number of qualified health
It should be noted that, besides the preparation of spatial data (the workers need for each health facility, the need for equipments, and the economy of
Orthophotos and the National Base Map Portfolio), the objective of the Rwanda in general.
National Plan is not a data producer. Its aim is to provide land use
information, analysis and proposals based on existing (sector) data. Number of beds per 1000 inhabitants: The standard number of beds in Rwanda for
any admitting health facility is 1/1000 inhabitants. This number is too small to
It is therefore recommended that the sector authority make such data accommodate the actual population demand for health facilities. Considering other
available so it can be accessible for District Development Plan revision factors like; the efforts the government of Rwanda has invested in providing health
that is due in 2012. insurances to the general public, it is evident that 1/1000 inhabitant standard bed
number is too small. This is due to the fact that, since almost 95% in Rwanda have
health insurance, people find it cheap to go for health services.
Basing on the factors above, 5 beds per 1000 inhabitant is proposed to ensure
quality service provision.
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Example Kayonga District Plan Map below with catchment radius of 5 Km for health facilities
shows the proposed and existing health facilities within the standards set by
Ministry of health as the maximum walking distance.
Figure 11: Distribution of Health Facilities in Kayonza District 2010 (next page)
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Incentives in the public health sector should be improved

Guidelines in order to achieve a better service quality through better
motivated personnel. Health care personnel should also
The aim is to achieve a sustainable health status for Rwanda’s more than 10 million be offered better training.
populations. Planning, modernization, more doctors and nurses, better training and
salaries are key issues to address. A system for licensing and controlling the private health
care sector should be introduced in order to guarantee
quality of services.
Guidelines - Health
Lifestyle and Safety Aspects
Hospitals A healthy lifestyle should be promoted by increasing
Planning standards for hospital beds need to be accessibility to facilities of physical exercise, offering
continuously revised in accordance with the development sports, recreation and physical training. Public information
of modern treatment methods and on assumptions of about the connection between individual health and
future trends for hospital overnight admissions, lengths of environmental risk factors should be improved through
stay and day case admissions. school programs and media channels.
A standard of about 5 hospital beds per 1,000 inhabitants Important issues like road safety, water quality, sanitation
should be established. This figure might even be lower in and inadequate diet habits should be issues in everyday
the future. Therefore, all future development of health work towards a healthy population.
service supply should be prepared for uncertainty and the
planning standards should be revised regularly.
Medical Professionals
The number of physicians within the health services
should be increased from the present rate of 0.06
physicians per 1,000 inhabitants to a level of 5, not
forgetting to adjust the figures to anticipated population
growth.
In order to meet the growing population the number of
nurses should be increased from the present rate of1.3
nurses per 1,000 inhabitants to about 10 atleast.
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Population Projection 2007-2020.
Ministry of Finance and Economic Planning and Ministry of Health, National Institute of Statistics of Rwanda, 2008: Rwanda
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June 2006.
National Institute of Statistics of Rwanda, 2008: Rwanda in
Ministry of Finance and Economic Planning, 2007: Economic Statistics and Figures 2008.
Development and Poverty Reduction Strategy, 2008-2012.
National Institute of Statistics of Rwanda, Ministry of Health
Ministry of Health, 2009: Norms and Standards 2009. Rwanda, and Macro International Inc. 2008: Rwanda
Service Provision Assessment Survey 2007. Calverton,
Ministry of Health, 1992: Rwanda Demographic and Health Maryland, U.S.A.: NIS, MOH, and Macro International Inc.
Survey 1992
World Health Organization: World Health Statistics, 2009. WHO
Ministry of Health, 2000: Rwanda Demographic and Health Press, Geneva.
Survey 2000
Ministry of Health, 2005: Rwanda Demographic and Health

Survey 2005
Ministry of Health, 2005: Rwanda Health Sector Strategic Plan

2005-2009.
Ministry of Health, 2009: Rwanda Health Statistical Booklet 2009.
National Health Accounts Rwanda 2006 with HIV/AIDS, Malaria,

and Reproductive Health Subaccounts. Health Systems
20/20, June 2008. Bethesda, MD: Health Systems 20/20
project, Associates Inc.
National Institute of Statistics of Rwanda, 2007: Interim

Demographic and Health Survey 2007/2008.
3/29/2010
LIST OF FIGURES
FIGURE 1: L A CROIX DU SUD POLYCLINIC IN KIGALI AND THE PRIVATE DISPENSARY .....2
FIGURE 2: MISUSE OF WETLAND AREA IN KIGALI .............................................................3
FIGURE 3: POOR QUALITY WATER SYSTEM IN KIGALI HOUSING AREA............................4
FIGURE 4: BAD TRAFFIC SOLUTIONS CONSTITUTE A SEVER HEALTH HAZARD. ..............4
FIGURE 5: HEALTH FACILITIES 2010 ................................................................................7
FIGURE 6: THE DISTRIBUTION OF PRIMARY HEALTH FACILITIES .....................................9
FIGURE 7:KIBAGABAGA DISTRICT HEALTH CENTER.......................................................11
FIGURE 8: NURSES, A VITAL ASSET FOR OUR HEALTH STATUS ......................................13
FIGURE 9: MALARIA PREVALENCE AMONG CHILDREN UNDER FIVE YEARS ....................14
FIGURE 10: HIV/AIDS PREVALENCE BY PROVINCE IN RWANDA. ..................................14
FIGURE 11: DISTRIBUTION OF HEALTH FACILITIES IN KAYONZA ....................................19
LIST OF TABLES
TABLE 1: NUMBER OF BEDS BY HEALTH FACILITY TYPE AND BY SERVICE ........................5
TABLE 2: HEALTH FACILITIES BY DISTRICTS AND PROVINCES..........................................6
TABLE 3: TYPE AND MEANING OF HEALTH CARE UNITS....................................................9
TABLE 4: LIFE EXPECTANCY AT BIRTH............................................................................11
TABLE 5: NUMBER OF STAFF WORKING IN HEALTH SECTOR ........................................12
TABLE 6: MALARIA PREVALENCE AMONG CHILDREN UNDER FIVE YEARS. ......................14
TABLE 7: HIV PREVALENCE BY PROVINCE AMONG VCT.................................................14
TABLE 8: PREVALENCE OF TUBERCULOSIS IN RWANDA.................................................14
TABLE 9: RATIO OF HEALTH WORKERS/HOSPITAL BEDS TO POPULATION ......................18
TABLE 10: VISION 2020 HEALTH INDICATORS AND PROJECTIONS.................................18
3/29/2010

Rwanda National Land Use Development Master Plan - Health

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R W A N D A N A T I O N A L L A N D U S E D E V E L O P M E N T M A S T E R P L A N - H E A L T H

CHAPTER 1.0: INTRODUCTION-------------------------------------------------------------- 2

CHAPTER 2.0: PRESENT HEALTH SITUATION-------------------------------------------- 3

LIST OF FIGURES ----------------------------------------------------------------------------23

Chapter 1.0: Introduction

It is clear that a high-quality national health status is relying on good governance of

1 The standard polyclinic in Kigali

2 WHO: World Health Statistics 2009

Figure 4: Bad Traffic Solutions Constitute a Sever Health Hazard

Table 2: Health Facilities by Districts and Provinces

/Military District Health Health Prison Grand

Total 4 2 39 412 9 13 497

Source: NISR 2009

Figure 5: Health Facilities 2010 (next page)

Table 3: Type and meaning of health care units.

Category Type Meaning

Hospitals with more qualified personnel

District Hospital Hospitals at district level

Primary health Generally a standard health care

meant for military workers but also for

meant for police investigations and

meant for prisoners but also for the

Polyclinic Normally privately run health care unit

Health post where people get first treatment

Dispensary Where people get first Aid

Source: Rwanda’s Vision 2020

2.3.1: Situation today

A generally reasonable assumption is that planning standards should be flexible to

Accessibility is to a large extent a matter of providing a network of primary health

Number of 2008 Number of North 6.1 4.9 3.1 2.4

Tested + Tuberculosis (in %) 13.7 11.3 6.6 6.6

Source: NISR 2009 page 29, IDHS 2007/2008

Figure 9: Malaria Prevalence among children under five years by Province;

Figure 10: HIV/AIDS Prevalence by Province in Rwanda. (See next 2 pages)

3.2: Technological Progress 3.4: Hospital Beds and service provision

10 Rwanda National Population Projection 2007-2020:30

Hospital beds 11724 1.28 Child

Source: statistical year book11 HIV/AIDS

Baseline Target Target International Malaria-related

Women fertility Laboratory

Incentives in the public health sector should be improved

REFERENCES National Institute of Statistics of Rwanda, 2007: Rwanda National

Ministry of Health, 2005: Rwanda Demographic and Health

Ministry of Health, 2005: Rwanda Health Sector Strategic Plan

Ministry of Health, 2009: Rwanda Health Statistical Booklet 2009.

National Health Accounts Rwanda 2006 with HIV/AIDS, Malaria,

National Institute of Statistics of Rwanda, 2007: Interim

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