Strengthening Rwanda's health system and access to clean water: A district-managed grants mechanism

Purpose: USAID's Twubakane Decentralization and Health Program, led by IntraHealth International in partnership with RTI and others, has implemented a $6 million district-managed grants mechanism to strengthen district capacity and positively impact health and hygiene in Rwanda, including through water projects.

Data: Twubakane collected data over three years on district capacity to manage grants and on the grants' impact on the population's health.

Methods: Key to Rwanda's decentralization effort, the District Incentive Fund (DIF) grants support capacity building of local authorities in 12 districts while providing additional resources to meet districts' locally determined priority community health needs. Part of their success is reflected in their ensuring improved access to clean water.

Results: Since 2006, eight of the program-supported districts committed a portion of their DIF grants to addressing community health needs stemming from poor potable water quality or waste management and successfully planned, financed, implemented, and evaluated initiatives including building water tanks, installing septic tanks on latrines near markets, repairing rainwater recuperation systems, and rehabilitating water purification systems. In Rwamagana district, the percentage of households more than 500 meters from a clean water source decreased from 48% to 35% in three years and is targeted to decrease to 0% in the next three years.

Recommendations: The DIF mechanism's potential to strengthen Rwanda's health system and improve the population's health lies in districts aligning their district development plans and performance contracts—two components of Rwanda's decentralization process measurable against specific indicators—with specific activities they implement through DIFs.