rwanda citizen report and community score cards - World Bank Group

Organization for Social Science Research in Eastern and Southern Africa Rwanda Chapter

RWANDA CITIZEN REPORT AND COMMUNITY SCORE CARDS empower ment account abilit y

ef f iciency monit or ing

Ser vice deliver y cost access

qualit y par t icipat ion

evaluat ion

OSSREA Rwanda Cha pter

$FNQRZOHGJHPHQWV

In conducting the Second Pilot Survey of CRC and CSC in Rwanda OSSREA Rwanda Chapter received a lot of support, encouragement and inspiration. We are grateful to the Minister for Local, Government, Good Governance, Community Development and Social Affairs, Honorable Protais MUSONI for his advice and guidance on the importance of the study and his opinion on methodology. We are thankful to the State Minister for Planning in the Ministry of Finance and Economic Planning Honorable Monique NSANZABAGANWA, for overseeing our engagement as local consultants and signing our contract. Equally helpful in coordinating the stakeholders to the project is the Secretary General, Honorable Eugene BARIKANA. We thank him for his support in getting us permission to visit the survey areas and writing to introduce our teams of researchers. We express sincere and profound thanks to all those who provided us with technical and logistical support in preparing and executing the project. Uniquely we are thankful to Ms Francis NSONZI, a World Bank consultant based in Uganda, for the guidance in formulating the survey instruments, the training of research teams and testing the instruments. Her experience with the Kampala Score Card that she shared with us was immensely helpful to us. There was also somewhere in the background some people in the World Bank Country Office who made things work for us. We thank them very much. MINALOC was the Coordinator of the project. But as provided by procedure all financial and technical activities were handled by the Ministry of Finance and Economic Planning. We thank very much the continuous support and sharing of knowledge of what was to be done rendered by Ernest RWAMUCYO the Director of Planning in the Ministry of Finance. We are grateful to his staff who handled all matters related to payment and preparation of a final workshop. We hope OSSREA will continue to enjoy the good working relations that it has enjoyed with Ministry of Finance for years now. Of course the work would have not been completed without the tireless efforts in the field and later behind the computer of about 30 senior and junior researchers. Of special significance are the 8 Team Leaders who conducted the field surveys in the 8 areas appearing in the sample. We are grateful to the following Team Leader who led teams of enumerators in surveys in areas indicated in brackets behind their names; Mme Sharon HABA(Cyangugu),Mme Marie Therese KAMPIRE(Gisenyi), Mr Gerard NYABUTSISTSI(Nyagisagara), Mme Therese MUSABE(Butamwa).Miss Susan MUTONI(Nyarugenge), Mr Pierre Claver MUTAMBUKA(Kibungo),Mr Bernard RUTIKANGA(Gatare) and Mr Joseph HAHIRWA(Mirenge).

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Last but not least we are grateful to the leaders, the heads of households, service providers in education and health, pupils and other opinion leaders in each of the area visited who spared their time to give data and information to our teams. It is on their views that this report is based. We thank them very much. Of course the errors of commission and omission belong to the authors. The final report was compiled by Mme Sharon HABA, Prof RAMA RAO, Dr. Herman MUSAHARA with technical support of Mr. JAWAHAR.M Dr Herman MUSAHARA Liaison Officer - Rwanda Chapter


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February 2006

Executive Summary The CRC and CSC study was commissioned by the Ministry of Local Government, Good Governance, Community Development and Social Affairs. The aim was to gather data and information on a pilot scale regarding how citizens rate the quantity and quality of services delivered in the health and education sectors. For Kigali City an additional questionnaire elicited responses on how citizen’s views plot distribution services. Secondly through CSC the aim was to assemble community perceptions on accountability and efficiency of service delivery. The data collected and results in this report were gathered from 4 provinces of Rwanda; namely Cyangugu(West), Gisenyi(West), Kibungo(East) and Kigali Ville. The names in bracket represent new administrative provinces. In each of the provinces, ‘secteurs1’ from both rural and urban districts were visited. There are considerable overlaps and slight divergences between findings from CRC and CSC. Since the two are supposed to complement each other, especially CRC to CSC, more detailed analysis of what ratings and recommendations imply for more accurate policy making will have to be undertaken. However the general highlights are as summarized in the following paragraphs. More detailed data is provided in the rest of the report. A data set on the outcomes of the field work is viable separately. It is clear even at this stage that there is ample opportunity of interpreting these simple responses from the citizens and communities. A sample frame of 800 units had been planned. However only 707 were actually surveyed. Respondents were mainly heads of households. However there are also individual respondents who are not heads of households particularly pupils and some teachers. The data reports from the latter category clearly show that it does not represent households. In general citizens rate highly access to government primary education services. Up to 92.7 per cent have access to primary schools that are between 0-1 km. Citizens rate well the quality of teachers. More than 66.8 per cent think the quality of teachers is good. However pupil performance is not rated highly. Only 39 per cent state that it is ‘good’. Teachers’ availability is also given a second best rating with ‘sometimes available’ having a rating of 40%. Notable ratings that may be interesting to policy making are various. Schools having no lunch collected a rating of 92.9 per cent. A substantial number of respondents show that they are still required to pay some fees and other monetary contributions. Up to 47.3 per cent, majority rating is related to expenses for constructions and renovation of buildings. Participation of 1

Secteur is the lowest administrative unit in Rwanda


parents is high with the rating for existence of PTAs as high as 91.6 per cent. In one term the interaction between teachers and parents was between 1 and 3 times. However the participation in terms of holding ‘open’ and ‘sports’ days is still low. More than 54.1 per cent indicated that they have no such days. About 66.1 per cent are satisfied with how problems related to schooling of their children are solved. Providers of education services offer ratings that are informative on some problems in the sector. Girls abandon school because of being orphaned or for seeking jobs (17.8 per cent rating each), the highest frequency among different reasons. Boys abandon school mainly due to looking for jobs (a rating of 44.4 per cent). A majority of schools show lack of laboratories and workshops. Latrines are available in many schools but are said not to be in adequate quantities and many schools do not have separate facilities for boys and girls (75.6 per cent of all responses). School teachers get materials like chalk and books (rating 65.9 per cent) but many indicate no programmes for ICT and technical skills. Most of monetary funds disbursed are from government (90.7 per cent) but parents have still to pay for uniforms, the most frequent rating being Rwf 5000.For school lunches, the most frequent rating is Rwf 500.Providers seem to be dissatisfied with accommodation of teachers (78.4 per cent) and partly satisfied with pupils behavior. Pupils seem to think distance is not a problem. About 51.5 per cent believe the school is close to their home. However they think the provision of desks is poor (70.5 per cent),lack of library(89.5 per cent) and lack of computers(69.5 per cent).The rate of provision of piped water is about 39.3 per cent among the respondents and a common problem leading to absenteeism is poor health(42.1 per cent). The health sector involved the same number of respondents but involving men and women users as well as providers. Government health services are moderately available with a rating of 53.3 per cent compared to availability of private services which are rated at 45.9 per cent. The most frequent time taken to the nearest government health service is 30 minutes (28.1 per cent).A rating of 70.1 per cent thinks the distance to the service is convenient. But a substantial number of households visit other services other than government facility (57 per cent). Major reasons are high costs that they cannot afford (10.1 per cent), distance (9.4 per cent) and to get special treatment (3.7 per cent). A large number of women do not deliver at a government facility. The rating is 40.6 per cent and the rating for delivering at home is 37 per cent. A most frequent answer is because of being unable to afford the cost (28.4 per cent). More than 82.5 per cent responded that access to medical services in government hospitals is equitable and 92.9 per cent believe the medical personnel are available. There is a fair availability of equipment (70 per cent) except for dental services (negative response is 51.8 per cent). There is a good number of households that are partly satisfied with government health services generally (22.5 per cent) and responses on insufficiency of funds for


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running the health facility are up to 75.8 per cent. About 75.7 per cent of the responses are partly satisfied with the attitudes to patients by the health facility workers. Responses show that uniforms are worn(97.4 per cent) and facilities are relatively clean (93.7).However a lot of payment for services still come from their own pocket(42.3 per cent) and about 11.0 per cent agree that there are some unofficial payments especially for laboratory tests(95.1 per cent) and for delivery(73.1 per cent). The respondents are completely satisfied with health services by 72,5 per cent but 25.1 per cent indicate partial satisfaction. Members of staff are ‘helpful completely’ to 65.8 per cent but to 26.2 their helpfulness is only partial. Up to 96.4 per cent indicate that toilets are available but 34 per cent say no to availability of separate toilets for women and for men. There are apparently active health committees in many places (91.2 per cent) and 53.5 per cent show that there are at least monthly meetings. Health facilities are generally rated favorably except in relation to child delivery facilities (mother care) which were rated negatively by 56.4 per cent, availability of x-ray was rated negatively by 84.6 per cent and lack of family planning services scored 73.7 per cent. Other significant negative ratings are separate toilet facilities for both sexes (71.8 per cent), availability of staff accommodation 84.2 per cent, dental services 83.8 per cent, school health services 75 per cent, availability a fully qualified medical doctor 91.7 per cent and availability of qualified midwives 69 per cent. Other ratings are presented in the report. The study included a short questionnaire for plot distribution services in Kigali City. It involved a total of 179 heads of households in Nyarugenge and Butamwa districts. Among these 71.9 per cent were male and 28.1 per cent were female. Most of the respondents had settled in Kigali before 1994 or 65.3 per cent. Only 21 per cent responded that they had received services related to plots from the government. Major services offered by government include surveying 46.9 per cent, registration 18.4 per cent and arbitration 14.1 per cent. Most other services are offered by MVK 77.4 per cent. About 58.9 per cent own plots and 52.3 would wish to get low density ones. The factors for access to plots were identified as being wealthy 37.6 per cent, having authority 9.9 per cent and corruption 6.4 per cent. Combining wealth and corruption the rating became 6.4 per cent while wealth and authority rated 3.5 per cent while wealth plus authority and corruption rated 12.1 per cent. Some respondents (47.2 per cent) indicated that they paid some money to get land services and the average was about RWF 40,000 which they considered to be on the high side (39.7 per cent). On whether payments are accompanied by receipts some 47.8 per cent responded affirmatively while 31.5 responded in the ‘negative’. In relation to whether it takes years or months to get a plot in Kigali Ville, 32.6 per cent responded that it is in terms of years while 31.5 per cent responded


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that it was in months (less than a year). About 52.4 per cent thought it took long. Cases of problems related to plot distribution services in Kigali were regarded as many by 36 per cent average 28.1 per cent and few by36 per cent. Asked on whether they see any change in land/plot distribution services in Kigali within the last 5 years 53.9 per cent felt that there has been none and 30.4 per cent believe the services had deteriorated. More that 55.1 per cent are aware of multiple plot owners. About 7.1 per cent of these cases may be through ‘know who’ while ‘know who’ plus kin relation and corruption may account for 25.9 per cent of the multiple plot access. Community Score Cards are almost self explanatory. The reports are presented as templates with scores and comments for each category of participation. They constitute the second part of the findings. They include four health CSCs at Nyange in Mirenge in Kibungo, Muhima in Kigali City, Ntagazwa in Nyagisagara District, Gisenyi and Rusizi I in Cyangugu Town. Four CSCs for education are Cyato Primary School in Gatare Cyangugu, Umubani I in Gisenyi Town, Butamwa in Kigali for urban areas and Rubona in Kibungo Town. Before each CSC there is an overview of the process. Each CSC consists of an Input Tracking Matrix, Community Score Cards prepared by different focus discussion groups and a Joint Action Plan prepared by all of members of each community. While detailed information is in the tables we can only give highlights in this summary. Many schools reflect similar problems such as lack of ICT, laboratories, dilapidated or lack of buildings and low salaries. There is no lunch for children, school accounts run by parents and schools are working but transfers take a long time. In Cyato Primary School pupils score (positively) teaching quality by 75 per cent and the rest of school services score between 0 and 35 per cent particularly building equipment, materials and teachers welfare. In Umubano I Primary School a new issue that arises is lack of play grounds where they have to borrow space from some other institution as well problems of teaching English. At Rusizi I Health Centre ambulatory services are given a score of 0. Space for consultation is given a score of 30 per cent. But at the same time it is noted that it has high quality services that attract patients from neighbouring DRC. The contractual approach to health service delivery at the centre is noted as an important innovation. However problems still persit in relation to cost of services to poor people and the restricted subscription to health insurance services. Some participants in Butamwa Primary School score utilities 0 per cent.This is in relation to non availability of water and electricity.However there is also lack of school materials generally. But one group scores 95 per cent the the availability of qualified teachers. The only problem is that when they fall ill or


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go for maternity leave a problem of replacement is recurrent because a majority of teachers are women. Nyange Health Centre has a unique problem of lacking a maternity ward (scored 12 per cent). It is recommended that the centre be upgraded to a hospital. There are no HIV testing facilities (scored 0 per cent) and essential drugs for pregrant women are not available (e.g. drugs for inducing labour). Health insurance ‘mutuelles’ has not been widely adopted by most of the people (scored 15 per cent). Muhima Health Centre has very good scores above 50 per cent. The lowest score is 30 per cent for equipment availability. Response/subscription to ‘mutuelles’ is given a score of 40 per cent and availability of drugs given 40 per cent. It is possible to believe that common problems encountered in rural health centres are not necessarily common to a center in an urban area particularly Kigali City.


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Table of Contents Acknowledgements………………………………………………………………….2 Executive Summary .........................................................................................4 Table of Contents.............................................................................................9 Acronymys .......................................................................................................9 1. INTRODUCTION........................................................................................11 2. BACKGROUND .........................................................................................13 3. OBJECTIVES.............................................................................................15 4. METHODOLOGY.......................................................................................16 4.1. Phases.................................................................................................16 4.2 Sampling Criteria ..................................................................................18 4.3. Sample Size ........................................................................................20 4.4 Community Score Card ........................................................................23 4.5 Field Work Procedures .........................................................................24 4.6.Rwanda CRC / CSC Project .................................................................25 5.SERVICE DELIVERY CONDITIONS IN RWANDA.....................................26 5.1.Evolution of Service Delievry Discourses in Rwanda............................27 5.2. Current Situation..................................................................................28 5.3 Governance and Service Delivery ........................................................32 6. CITIZENS REPORT CARDS .....................................................................35 6.1. Education.............................................................................................35 6.2 Health ...................................................................................................54 6.3.Plot Distribution/Allocation Services in Kigali City.................................68 7.COMMUNITY SCORE CARDS...................................................................78 7.1.Cyato Primary School, Gatare, Cyangugu ..........................................78 7.2. Umubano I Primary School-Gisenyi ...................................................83 7.3.Rusizi I Health Centre - Cyangugu ......................................................89 7.4.Butamwa Primary School.Kigali City ...................................................95 7.5 Nyange Health Center.......................................................................101 7.6.Muhima Health Centre ......................................................................104 7.7.Ntaganzwa Health Center .................................................................108 7.8 Rubona Primary School- Kibungo .....................................................114 7.9 Pictorial Presentation Of The Summary Of Csc………………………118 8.POLICY IMPLICATIONS.............................................................................78 8.1 General Referenced ..........................................................................124 8.2 Recommendations………………………………………………………125 BIBLIOGRAPHY ..........................................................................................125 ANNEXES ....................................................................................................126


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Acronyms

ADB AIDS BWI CDC CRC CSC CS CWIQ HC ICT MINALOC MINECOFIN MINEDUC MINISANTE NGO OSSREA PETS PTA QUIBB

African Development Bank Acquired Immune Deficiency Syndrome Brettonwood Institutions Community Development Committee Citizen Report Card Community Score Card Centre de Sante (Health Centre) Core Welfare Indicators Questionnaire Health Centre Information and Communication Technology Ministry of Local Government, Good Governance, Community Development and Social Affairs Ministry of Economic Planning and Finance Ministry of Education Ministry of Health Non Governmental Organization Organization for Social Science Research In Eastern and Southern Africa Public Expenditure Tracking Survey Parent and Teachers Association Questionnaire des Indicateurs de Base des Bien-etre


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1. INTRODUCTION In one decade after genocide Rwanda has undertaken many steps in stabilizing the economy and improving the living conditions of the people. In this regard a number of reforms have been undertaken. Two important policy interventions have defined the path and approach to social and economic development in Rwanda. These are the Decentralization policy of 2000 and Poverty Reduction Strategy of 2002. In both strategies the focus is decentralization of decision and resources to local government units to deliver services more efficiently and effectively and to empower the people especially –poor groups to take part in decisions that affect their lives. It is in this framework that tools for planning, monitoring and evaluation of policy interventions have been put in place.

The Citizen Report Cards (CRCs) and Community Score Cards (CSCs) are recent approaches that MINALOC and MINECOFIN, with support from development

partners

are

adopting

for

improving

efficiency,

policy

effectiveness, accountability and participation in decentralized levels of administration. These will be approaches that trigger on processes of getting feedback on service delivery in Rwanda at both macro and unit levels respectively.

CRCs are participatory surveys that provide feedback on user perceptions on the quality, adequacy and efficiency of public services. The CSCs are on the other hand qualitative monitoring tools that are used for local level monitoring and performance evaluation of services (World Bank 2004).

A study combining the two approaches is geared not only to producing documents or data alone but also to initiate processes that influence policy on how to improve service delivery especially among poorer groups.

The

processes (especially CSC) are expected to improve dialogue between frontline service providers and the users or the right holders. The processes initiated by the approach will empower the people and thus enhance the


11


decentralization process and influence policy making on matters that affect service delivery. The CRCs and CSCs project is a second pilot study carried out by the OSSREA-Rwanda Chapter in the initiative of replicating these approaches in the country. The first pilot study was carried out in the second half of 2004. Its objective was to develop a CRC for public services with a focus on Civil Status. The current pilot study on health and education was also carried out by the same network of researchers. As stated above this pilot study involved also Community Score Card processes with reference to education and health issues.


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2. BACKGROUND Both the Citizen Report Cards and Community Score Cards are innovations of an ongoing dialogue between government, civil society and communities with regard to improved service delivery and poverty reduction. Although they are a new approach in Rwanda, they have been in operation for well over a decade elsewhere.

The Citizen Report Card was developed by a civil society in Bangalore, India, in 1993. The initiative was undertaken by a small group of people who were concerned with the deteriorating public services in the city (Paul, S. 2000). They enlisted the support of a market research agency to gather systematic feedback through sample surveys from citizens. The survey findings were then used to create a report card that gave performance ratings to all the major public agencies.

Thus, the CRC is an innovative approach designed to monitor public accountability and transparency. It provides an opportunity to the users of various public services to tell the service-provider about the quality of their services and their satisfaction levels on the service delivered. The service providers on the receipt of the evaluations by the citizens may respond positively by modifying the services in tune with the suggestions offered by the respondents. As a consequence it would be possible to establish a permanent interface.

They are now in use in various parts of the world. CRCs are in use in Philippines, Ukraine and Vietnam. In Africa they have been used in improving service delivery in Tanzania, Kenya, Uganda, Ghana, Malawi, Ethiopia and Nigeria.

They have also been used in developed countries such as Canada, Denmark, Sweden, United Kingdom and United States in evaluating public service delivery in urban areas.


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On the other hand CSCs are broader than CRCs.

They are community-

monitoring tools, which have evolved from a combination of social audit techniques, community monitoring and citizen report cards themselves (World Bank 2004). As such they are means of monitoring public accountability and the responsiveness of the service providers. Uniquely they involve an interface meeting between service providers and the community. CSCs have been applied successfully in a few countries like Gambia and Philippines.


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3. OBJECTIVES As provided by the Terms of Reference the objectives of the study will be the following i.

To obtain responses from a selected sample of areas to be piloted for pre-designed questionnaires on adequacy and quality of real and practical aspects of service delivery at grass roots

ii.

To assess, based on community perceptions, the efficiency and effectiveness with which services are being delivered at grass roots

iii.

To ascertain the presence and extent of public accountability by authorities to communities which they are elected to serve

iv.

To use the feedback obtained from citizens as a tool for recommending remedial actions to the concerned government institutions and public authorities

v.

To acquaint the local citizenry with the responsibility to be proactive in decision making on issues that concern their daily livelihood and community development

vi.

To generate a useful and relevant set of recommendations from responses and discussions with selected members of sampled communities via questionnaires and community meetings

vii.

To test and improve the CRC/CSC methodology to prepare for scaling out nationally in Rwanda.


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4. METHODOLOGY 4.1. PHASES The project was executed in 4 interrelated phases Phase 1. Preparations. August 30th –9th September 2005 This phase had a number of interlinked activities that will be implemented as follows

Ground Breaking. The activity involved a number of activities that are necessary for putting the project in place. These were a) Meeting of the local team of consultants, the International consultant and MINALOC. 7th September 2005 b) Meeting with MINALOC and other stakeholders in the project 7th September 2005 c) Meeting between the Minister, International consultant, Local consultants and Director of Good Governance in MINALOC. 8th September 2005 d) Signing contract with MINECOFIN. 15th September 2005 e) Attending the Service Delivery and Accountability Conference organized by MINALOC by th

the Team Leader of local

th

consultants 15 –17 September 2005

Preparation of Instruments and training. a) Intensive drafting sessions by international consultant and local team leaders. 7th and 8th September 2005 b) Local team develops the instruments and methodology 9th to 14th September 2005 c) Training Session I. International Consultant carries out a two days session on the concepts of CRC and CSC with examples from Uganda. 15th and 16th September 2005 d) Testing of the instruments. 17th and 18th September 2005 e) Training Session II. The International Consultant carried out sessions on using the instruments and simulating fieldwork. 23rd, 24th and 25th September 2005 f) International

consultant

and

local

team

revisited

the

methodology and instruments. 24th to 26th September 2005 5ZDQGD&LWL]HQ¶5HSRUWDQG&RPPXQLW\6FRUH&DUGV)HEUXDU\

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g) Further

rehearsals

and

preparations.

Finalizing

financial

arrangement. 26th September to 30th September 2005

Phase 2. Field Visits

There was a lapse of time in continuing the execution of the project; a) Field Visit I. Team leaders visit respective districts and communities to fix appointments, collection of some secondary and primary data and finalize sampling for information that was missing. 31st to 4th November 2005 b) Field Visit II. Team Leaders and enumerators visit communities to administer CRC and conduct CSC sessions. 7th to 11th November 2005 c) Field Visit III. Coordinators of the local team visit the communities to verify data, fill data gaps and finalize secondary data collection. 14th to 18th November 2005

Phase 3. Analysis of data and drafting of the report

14th November to

30th November 2005

The collected data was analyzed

by the research team in Butare at the

National University of Rwanda. Along with the analysis the core of the Research Team was drafting of the report. Phase 4. Quality control and dissemination 1st December to 15th December 2005

The draft report will be discussed in Validation Workshop. An international consultant will review the report. The final version will be presented to the World Bank by MINALOC.


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4.2 SAMPLING CRITERIA Four sample provinces have been already determined in the Terms of Reference and ground breaking discussions. These are; 1. Kibungo 2. Cyangugu 3. Gisenyi 4. Kigali Ville

4.3. WORK PLAN The work plan delineated for carrying out this study is presented in Table 4.1.. It has four main components namely Preparation, Field Visits, Analysis of Data and Quality Control and Dissemination. Table 4.1. Summary of Work Plan of CRC and CSC project Activity 1. Preparations Ground Breaking First meeting with consultants Meeting with stakeholders in the project Meeting the Minister Signing contract with MINECOFIN Conference organized by MINALOC Preparation of Instruments and training Intensive drafting sessions Local team develops the instruments and methodology Training Session I. Teams do tests of instruments. Training Session II Revisit the methodology and instruments 2. Field Visits Field Visit I Field Visit II Field Visit III 3. Analysis of data and drafting of the report 4. Quality control and dissemination


Dates

7th September 2005 7th September 2005 8th September 2005 15th September 2005 15th –17th September 2005

7th and 8th September 2005 9th to 14th September 2005 15th and 16th September 2005 17th and 18th September 2005 23rd , 24th and 25th September 26th to 30th September 2005

31stOct to 4th Nov 2005 8t h to 11th November 2005 1 3 t h to 1 6th November 2005 13th to 30th November 2005 1st to 15th December 2005

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Like in the first pilot study, areas were selected from rural and urban areas. Rural districts were selected as those, which are regarded as farthest from the Provincial headquarters or in the case of Kigali City from the Central District. Like wise the ‘secteurs’ were selected according to the ‘secteur’ containing the District headquarters and one, which is geographically farthest from the headquarters or township. The communities used for CSC however were purposively determined to include groups of service providers and users and local leaders respectively.

The overall list of districts and sectors that were included in the CRC study are as presented in Table 4.2.

Table 4.2. Provinces, Districts and sectors in the sample for CRC No

Province

District Umujyi wa Gisenyi

1

GISENYI Nyagisagara

Nyarugenege 2

KIGALI CITY Butamwa

Umujyi wa Cyangugu 3

CYANGAGU Gatare

Umujyi wa Kibungo 4

KIBUNGO Mirenge


Secteur Byahi Gisenyi Rubona Sovu Biryongo Nyarugenege Butamwa Nyarubande Kamembe Shagasha Cyato Cyiya Kibungo Rubona Nyange Zaza

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4.4. SAMPLE SIZE The sample frame is set at 800.This was arrived at by estimating the number that could be worked by the team after testing the questionnaires and within the time frame provided in the Terms of Reference. The respondents included mainly household’s heads. One eighth of the sample size for each province however represented pupils who are not heading households as will be reflected by data extracted from them. The sampling details were worked out as follows;

Total population in the selected communities= 32255 Formula

n

=(1.96) ² * N/(1.96) ² + l² * (N-1) =(1.96) ² * 32255/(1.96) ² + l² * 32255)

Numerator

= 123910.8

Denominator

= 3,8416 + l² * 32254

Thus 800

= 123910.8 / 38416 + l² * 32254

3,8416 + l ² * 32254 = 123910,8 /800 3,8416 + l ² * 32254 = 154,8885 l² * 32254

= 154,8885 – 3,8416

l² * 32254

= 151,0469

l²

= 151,0469 / 32254 = 0.004

Sampling error is then 0,4%

The sample size of the respondents planned to contact in each sector is presented in Table 4.3.


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Table 4.3. Sample size by head of household from each of the province, district and sector Male Female

Total

%

%

Umujyi wa Gisenyi Byahi Gisenyi

1000 5985

727 2638

1727 8623

Sample size Total Male Female 58 42 25 18 43 69 31 214 148 65

Nyagisagara Rubona Sovu

514 1412

333 909

847 2321

61 39 61 39

21 58

13 35

8 23

Nyarugenge Biryogo Nyarugenge

3054 943

1103 190

4157 1133

73 27 83 17

103 28

76 23

27 5

Butamwa Butamwa Nyarubande

639 740

627 477

1266 1217

50 50 61 39

31 30

16 18

16 12

Umujyi Wa Cyangugu Kamembe 1907 Shagasha 497

818 370

2725 867

70 30 57 43

68 22

47 12

20 9

Gatare Cyato Cyiya

961 506

359 257

1320 763

73 27 66 34

33 19

24 13

9 6

Umujyi Wa Kibungo Kibungo Rubona

1183 833

609 587

1792 1420

66 34 59 41

44 35

29 21

15 15

Mirenge Nyange Zaza

646 598

297 536

943 69 31 1134 53 47 32255

23 28 800

16 15 531

7 13 269

A random sample of pupils, as aleady mentioned, was at least 1/8th of total sample units. This is roughly the ratio of pupils to total number of households in each district. For each ‘secteur’ the number of households to be surveyed was determined. The ratio of female-headed households was calculated from Census ratios. However to get a varied mixture of types of households other forms of households whose ratios were not available for computing exact proportions were ensured by Team Leaders from the actual conditions in the communities. These have to be included in the households selected


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depending on information at community level-i.e. ‘secteur’ and ‘cellule’. These are -Child Headed Households -Poor households -Households headed by illiterate -Non-users e.g. households without school going children

The number of households is not the sample unit for the Community Score Card. Instead the field team together with local leadership will determine the right mix of users, providers and local leaders. In relation to getting substantial participation each focus group would need 8 members i.e. a group of about 30 members of the community. In each district the CSC will focus on 1 health facility and 1 public primary school. The selection of these is consistent with facilities, which the majority of the people and poor groups use. From Districts these were identified in the sampled areas as follows;

Table 4.4. Selected Health and Education facilities for CSC PROVINCE 1 GISENYI

DISTRICT Town Nyagisagara

SECTOR Education Health

CENTRE Umubano IB Primary School Ntaganzwa Health Centre

2 CYANGUGU

Town Gatare

Health Education

Rusizi I Health Centre Cyato Primary School

3 KIBUNGO

Umujyi Mirenge

Education Health

Rubona Primary School Nyange Health Centre

Health Education

Muhima Health Centre Butamwa Primary School

4 KIGALI CITY Nyarugenge Butamwa


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4.5 COMMUNITY SCORE CARD PROCESS The different steps in CSC process are listed out as follows: Step 1. Collect secondary data of health facilities schools existing in provinces of KIBUNGO, CYANGUGU, KIGALI and GISENYI • • • • •

Type, number, location, date of establishment, persons responsible Inventory of actual situation of inputs, materials, infrastructure, staff, process and cost Standards/Targets based on national health maps/school maps MINISANTE, MINEDUC, MINECOFIN publications Financial records or audit reports Budgets

Step 2. Stratify community by usage • Who uses what services • How much they use • What demographic features • Income based • Household heading Step 3. Identify facilitators and train them Step 4. Involve other partners • • • • •

Traditional leaders Members of local government Workers at the service facilities Community volunteers Staff room from NGOs

Step 5. Mobilise community – communicate in advance to the people through District Mayors Step 6. Decide venue of CSC Step 7. Procure materials –paper, pencils, flip charts, markers, tape recorders Step 8. Work out a model of an input-tracking matrix Step 9. Community performance scoring by user groups for different stakeholders Step 10. Service providers self evaluation process


23


Step 11. The interface meeting Step 12.Joint action plan for the improvement of the service delivery. 4.6 Field Work Procedures The Field Visits were carried out as explained above. The main and important visit during which data was collected is Field Visit II. General Procedure

OSSREA teams are deployed in the field as follows; •

2 teams were deployed to each of the Provinces sampled.

•

In each province 1 team was be deployed to each of the sampled district

Fieldwork Schedule Each team undertook the field work in their respective geographic domains as specified below:

Day 1. CRC Education and CRC Health main questionnaires in first secteur •

Morning at 8.00 a.m. The Team Leader and associates met with the ‘responsable’ of the ‘secteur’ and the heads of households

•

Morning at 9.00a.m.Two associate researchers and the Team Leaders filled in the CRC questionnaires.

•

More CRC questionnaires filled in from 2.00 p.m. onwards till the first ‘secteur’ units have been enumerated

•

Afternoon 2.00 p.m. More CRC filled in to complete all the households

Day 2. CRC Education and health main questionnaire in second ‘secteur’’ Day 3. Fill in questionnaire for pupils and service providers (health and education) randomly selected from the two sectors


24


Day 4. CSC at a specific facility as sampled in Table 4.4. 1. Input Tracking 8.00-8.30. Arrival of consultants service providers, users and moderators 8.30-8.40. Sensitization 8.40-9.00. Give information on standards and targets 9.00-9.30. Develop input indicators 9.30-10.30. Fill in the Input Tracking Matrices 2. Community Scoring 10.45-11.00 Establish focus groups 11.00-11.30 Generation of group indicators 11.30- 12.30 Scoring indicators by focus groups

3. Interface Meeting 2.00 p.m. a) Interface meeting to include for health 1. Users –men and women 2. Providers –doctors, nurses and technicians 3. Local leaders (cell/sector/district leaders) 4. Health Committee 5. Local/International NGO operating in the area b) Interface meeting to include for education 1. Users- pupils and parents 2. Provider-teachers and school administrators 3. Local leader( cell/sector/district leader) 4. Education committee 5. Local /International NGO operating in the area Day 5. Spare Day for contingencies or for interface meeting if it was not held the previous day.


25


4.6. RWANDA CRC / CSC PROJECT PROJECT

CRC -Health Sector -Education sector -Land – Kigali City

PROVINCES -Kibungo -Cyangugu -Gisenyi -Kigali City

DISTRICTS 1. Kamembe 2. Shagasha 3. Kibungo 4. Mirenge 5. Gisenyi City 6. Nyagisagara 7. Nyarugenge 8. Butamwa

CSC - 4 Health facilities - 4 Primary Schools

Health Centres 1. Ntagazwa(Gisenyi) 2. Nyange(Kibungo) 3. Muhima(Kigali) 4. Rusizi I(Gisenyi) Primary Schools 1. Umubano 1B(Gisenyi) 2. Rubona I(Kibungo) 3. Cyato (Cyangugu) 4. Butamwa(Kigali)

CSC PROCESS 1. Input Tracking Matrix 2. Community Generated Performance Score Card 3. Provider Self Evaluation Score Card 4. Interface Meeting 5. Joint Action Plan

Fig.4.1 A bird’s eye view of CRC / CSC Project Fig.4.1 provides a schematic presentation of the CRC /CSC project depicting the major components in each of the branches.


26


5. SERVICE DELIVERY CONDITIONS IN RWANDA 5.1. EVOLUTION OF SERVICE DELIVERY DISCOURSES IN RWANDA Service delivery issues have been grounded in the search for efficient and effective functioning of the public institutions. The current strategies meant for strengthening public sector provision of service constitute a third generation of Public Sector Reform (PSR) in the series. The first generation of reforms was in the 1980s and 1990s which involved restructuring the public sector. At that time, it was thought that the economic and technical inefficiency of the public sector was caused by its size. The second wave was the reform that started taking place in late 1990s. It focused mainly on capacity building. Some skepticism had started to develop with adjustment. It was thought one constraint was lack of capacity. Reform focused on enhancing skills, improving management systems and structures and restoring incentives. The present generation is identified with the period after 2000, focuses on improved services. This phase is identified with the need for developing countries to demonstrate early results, promoting transparency and accountability, shift to market economies and private sector led growth as well using PRSPs to drive efficiency in sectoral performance (OECD 2002). CRC and CSC evidently belong to this phase.

The first attempt to reform in Rwanda took place in 1988. It was an advice that followed the economic crisis that followed the external shocks to the Rwandan economy. It generally envisaged trade liberalization, devaluation, privatization, and cutting down the number of civil servants. The overall aim was to downsize the public sector for efficient operation, reducing and reorienting policy towards private sector led growth. Rwanda embarked on the structural adjustment course in November 1990. In any case the reforms affected service delivery as well. The government was advised during 1992-93 to reduce its financial burden by endorsing privatization, introduction of cost sharing in education and health, and reducing the number of civil servants. In Rwanda adjustment is thought to have been a cause of general impoverishment (Marysse, Herdt and Ndayambaje 1993) and political crisis (Chossudovsky 1997). In reality however the real impact of the reform on social services can hardly be traced, given that the country entered into war a few weeks after signing with the BWIs, to adjust in 1990. The war gave priority to military expenditure at the expense of delivering social services. Between November 1990 and the time of the genocide in 1994, military expenditure rose drastically and was costing the government up to $100 million a year. Military personnel rose from 5,000 to 40,000. After genocide


27


the major preoccupation was rehabilitation and reconstruction of the economy. Up to a million people had died. Almost every 1 in 3 person had been displaced and infrastructure had been destroyed. The government was bent on bringing the economy and services to levels reached before the war. By 1996 Rwanda was again negotiating with the BWIs. In 1998 Rwanda signed with the IMF an agreement that committed her to liberalization and setting in motion reforms towards a more open economy. In 1999 when Poverty Reduction Strategy Papers (PRSPs) replaced the Policy Framework Papers (PFP) Rwanda followed suit. Rwanda produced the I –PRSP in 2000 and the final PRSP was officially in use by mid 2002. Now in its final year the PRSP like in other countries, is the key guide to service delivery. The service delivery problem in Rwanda like in several other developing countries consistently show a number of issues. Firstly the relationship between resources spent on delivering services ( such as education ) and outcomes are weak. Public spending tends to be a poor proxy for actual service delivery. At a general level the following cycle (See Box 5.1) seems to provide a good framework for evaluating the current status of service delivery.

Box 5.1 The service delivery problem •

Government may spend on wrong goods or wrong people. In education or health the share of public spending going to the lowest 20% of the population is less than 20% (Leal ,C et al 1999) • Government spends on right goods and right people but money does not reach the frontline providers • Even when services reach the primary school or clinic the incentives to provide the services may be weak. e.g. poor pay, lack of an efficient monitoring mechanism • Even when services are provided, households may not take advantage of them. e.g. there may be school dropouts still Source: Den, Reinikka, and Svensson 2002

A review of the current provision of services in Rwanda reflects some, if not all, of the features in the box.

5.2. CURRENT SITUATION The status of essential service delivery can be viewed from three vantage points. First, are indicators from the sector reports at national level. Secondly are World Bank initiated Public Expenditure Tracking Surveys. These use analyses of flow of funds to frontline service providers in the two sectors. The first one was published in 2002 but uses data for 1998 and 1999. It focuses


28


on education and health. The second was completed in 2003. The findings of these are extensively used to assess the situation of provision of services in Rwanda. A third source is the Core Welfare Indicator Questionnaire published by the government in 2002. A second conducted in 2003 has been completed. At national level a lot of data show that the essential services outcomes are still very low. Table 5.1 shows the current situation in the health sector while 5.2 shows that of education sector. Table 5.1. Health outcomes in Rwanda during 2000-2003 2000 2001 Infant Mortality rate per 1000 107 107 Maternal mortality rate per 100000 1071 1071 Incidence of Malaria 49 50 Rate of utilization of health services % 25 Fully immunized children 32.1 70 .Source: MINECOFIN 2004

2002 107 1071 57.7 28 69

2003 107 950 60.7 30 90

Table 5.2 Education outputs and outcomes in Rwanda during 2000-2003 2000 2001 2002 2003 Pupil:Teacher ratio 51.0 58.7 65.8 66.9 % primary teachers certified to teach according 62.7 81.2 85.2 88.2 to national standards GER % 99.9 103.7 128.4 134.1 NER 73.3 74.5 91.2 95.4 Completion rate 24.2 29.6 38.1 44.9 Average drop out rate 14.2 16.6 15.2 . Table 5.3 and Fig. 5.1 presents the efforts put in by the Government of Rwanda for improving the access levels to health and education during 19972003 Table 5.3. Efforts for improved access in health and education the period of 1997-2003 1997 1998 1999 2000 2001 2002 Health as % public 6.41 6.20 6.13 7.29 7.94 9.60 spending Health as % of 2.62 3.03 4.71 7.50 8.54 10.26 recurrent budget Education as % of 18.91 16.20 16.74 21.11 23.46 26.21 public spending Education as % of 21.75 22.94 23.59 25.55 25.85 28.94 recurrent budget Source: MINECOFIN 2004


during 2003 10.98 11.54 28.86 28.21

29


Fig.5.1 Trends in Public Spending for improved access in health and education during 1997-2003 35

% of public spending

30 25

Health as % public spending

20

Health as % of recurrent budget

15

Education as % of public spending

10

Education as % of recurrent budget

5 0 1997

1998

1999

2000

2001

2002

2003

Years

Meanwhile in response to the concerns on service delivery a number of surveys were carried out. The first series were at or around the inception of PRSP using data from late 1990s and early 2000 and the second generation came later around 2003. The first series were PETS (Public Expenditure Tracking Surveys) and CWIQ (Core Welfare Indicators Questionnaire).These studies revealed critical problems in service delivery. Expenditure in the essential services sector did not reach the target population (PETS 2002). The following shortcomings were noted; there are important discrepancies between allocations and actual public spending, users fund the shortages of revenues needed to run facilities, households support relatively more of recurrent expenditure than the government, delays in transferring public funds to users is a common phenomenon and is blamed on the cash budget system being used by the government and allocations do not reach the bottom (PETS 2002, CWIQ 2002). In the health sector allocations are made to regional health offices and in the education sector to provincial education centers. It is now in the education sector that attempts are being done through capitation grants to make sure funds reach the primary schools. Distribution of resources to the education sector show low allocation towards the poor requiring most of these services. Table 5.4. Functional distribution of current education - 1999 (in percentages) Primary Tronc education commun Management overheads 20.4 9.6 Service Delivery 79.6 73 -salaries 71.4 30.1 Student welfare 0 17.5 Source: World Bank (2004:65) Rwanda Education


public spending on Upper high secondary 10.7 75 35.5 14.3

Tertiary 7.8 43.2 48.9

30


The picture depicted in the Table 5.4 is that more money is spent on people who are not poor in the education sector i.e. salaries like teachers are in literal sense not poor people. This is consistent with the overall structure of the problem mentioned in the introduction. It is called leakage of funds in PETS. A substantial part of the expenditure (over 50% for the whole country) is used to pay salaries of teachers and administrative personnel. Over the years, despite a small decline, money resources go to the non-poor. Flow of resources for the health services has also been relatively low Table 5.5:Resource allocation to the health sector by region Province Number Population Amount Per Per of health by health received facility capita centers centre allocation allocation Butare 37 192,379 17,420,000 470,810.80 90.60 Byumba 25 352,134 16,400,000 656,000.00 46.60 Cyangugu 23 198,891 10,020,000 435,652.20 50.40 Gikongoro 22 220,141 14,600,000 663,636.40 66.30 Gisenyi 25 271,034 20,420,000 816,800.00 75.30 Gitarama 35 277,461 16,720,000 477,714.30 60.30 Kibungo 32 181,255 15,760,000 492,500.00 86.95 Kibuye 27 149,460 16,730,000 619,629.60 111.90 Kigali Ngali+City 52 216,104 17,720,000 340,769.20 82.00 Ruhengeri 33 253,343 20,180,000 611,515.15 79.65 Umutara 24 101,954 13,910,000 579,583.30 136.40 Source: PETS 2002 and our own calculations From the first set of surveys the service delivery function in the health and education sectors was still weak. After the launching of the PRSP a second wave of surveys were conducted. These also show that the service delivery function in Rwanda needs to be improved. A specific survey that has some indicative data on services is the QUIBB( Questionnaire de Indicateurs de Base des Bien-etre ) QUIBB is generally based on the opinion of beneficiaries and data from simple questionnaires. Most of its findings are consistent with the observation that indicates poor service delivery even during the two years of PRSP. Under health the most prevalent disease is malaria. In QUIBB (2004) malaria afflicts 17.3% of school children, 18.2 old people and 16.2 of women.. The rate of utilization of medical services is lower than that cited earlier. It is put at 17.6% and dissatisfaction with medical services delivery among respondents was 28.6%. The most dominant reason is that of cost. Visits to hospitals were noted among 24.8% of the respondents, 24.6 visited pharmacies, 23.1% visited health centers and 19.0% visited traditional healers. Only 13.7% have good access to health services The recorded rate of HIV prevalence reported was slightly lower than the one given for 2002.It was 12.2%Inly 32.1% have access to potable water, and 59.3% do not take precaution before drinking water. About 61.5% of households have latrines that are not covered (QUIBB 2004). 5ZDQGD&LWL]HQ¶5HSRUWDQG&RPPXQLW\6FRUH&DUGV)HEUXDU\

31


As regards education the figures are also on the high side. About 56.3% of Rwandans have access to primary schools and in rural areas the rate is 76.3%. QUIBB estimates that 14.4% have good access to secondary education and the rate in rural areas is about 9.8% Several data sources and government reports reveal that there is still need to monitor and improve health service delivery in Rwanda. Some data on education and health are presented in Table 5.6 (also in Fig.5.2) and 5.7. Table 5.6 . Some efficiency indicators of service delivery in education for P1 to P5 Indicators 1998 1999 2000 2001 2002 2003 Promotion 56.2 51.2 49.6 54 66.2 64.2 Repetition 2.1 38.4 37.6 31.8 17.2 20.6 Dropping 11.7 10.4 12.8 14.2 16.6 15.2 out Source: MINEDUC 2004 Fig.5.2 Efficieny indicators of service delivery in education for P1 to P5 Percentage improvements

70 60 50 Promotion

40

Repetition

30

Dropping out

20 10 0 1998

1999

2000

2001

2002

2003

Years

Table 5.7. Select health performance from Health Centre report Indicators 1999 2000 2001 2002 2003 Malaria 302,740 405,571 431,867 506,723 545,435 TB 2,784 2,375 2,248 2,350 2644 Diarrhoea 89,071 86,808 81,229 93,805 107,247 Measles 4,443 2,204 1,143 3,581 1,107 Source:HIS

5.3 GOVERNANCE AND SERVICE DELIVERY Good governance is the key approach in the third generation reforms. Decentralization policy adopted in 2000 in Rwanda is taken as a key governance innovation which is directly related to improving service delivery and reducing poverty. CRC and CSC is an attempt of monitoring and acquiring information that can improve service delivery and break a vicious circle that has developed.


32


It should be possible to break the following vicious circle (Schacter 2000:10). The governments do a poor job of delivering public services. Secondly citizens accustomed to years of unresponsive performance and attitudes on the part of the government feel little motivation to make demand for better services. Finally sensing little pressure from citizens feels little accountability to them and continues to deliver poor services

Decentralization in Rwanda has been implemented in Phases. During the first phase (2000-2003) the main preoccupation of the government was to put in place the policy and legal frameworks. Local governance structures, procedures and systems were established. Local governance structures were democratized through elections and some institutionalization capacity for operationalization of the policy was established. During the second phase (2004-2008) the main preoccupation is deepening and making decentralization deliver. In the current reforms the emphasis on improving service delivery and citizen’s participation makes CRC and CSC directly relevant as monitoring tools. The reforms have laid emphasis on the following; • • • • • • •

The desire of the government to enhance accountability Efficiency in service delivery Availability of services Quality of services Expenditure priorities Strengthening beneficiaries voice Demand for better services from providers through regulation, contracts-compacts, monitoring and evaluation systems

It is in this framework that CRCs and CSCs will play a big role in building capacities at decentralized bodies.


33


6. CITIZENS REPORT CARDS This chapter presents the Citizen Report Cards (CRCs) in three sections on education and health in pilot study area and plot distribution in Kigali city respectively. This exercise was carried out by following the methodology explained in 4th chapter.

6.1. EDUCATION Citizens’ evaluation of primary education services in the selected pilot study area is presented in terms of CRCs. The CRC in this respect covers characteristics of households, availability of educational services, access to education, cost, efficiency and quality of education, participation in school activities and interaction with school administration. 6.1.1. Geographic Distribution of Respondents The geographic distribution of the respondents contacted for the CRC survey in the pilot study area is presented in the table 6.1. Table 6.1 Distribution of respondents by provinces, districts and sector in the pilot study area. Province Districts Sectors No. of Respondents % Cyangugu Ville Kamembe 64 9.1 Cyangugu Shagasha 21 3.0 Gatare Cyato 24 3.4 Cyiya 18 2.5 Gisenyi Ville Ville 211 29.8 Gisenyi Byahi 46 6.5 Nyagisagara Ntagazwa 15 2.1 Kirengo 69 9.8 Kibungo Ville Rubona 36 5.1 Kibungo Mirenga Zaza 23 3.3 Nyange 28 4.0 Nyarugenge Biryogo 130 18.4 Kigali Butamwa Butamwa 18 2.5 Nyarubande 4 0.6 Total 707 100 The number of respondents chosen as per the methodology as outlined in chapter 4 is 800.However the actual number of respondents contacted as shown in table 6.1 are only 707 constituting 88.4 percent to the planned sample. It was mainly due to the non-responsiveness of the respondents due to their preoccupation with other tasks. The geographical variations are also seen in the respondents contacted due to the differences in the size of population of the selected locations.


34


6.1.2 Major characteristics of respondent households surveyed (Heads) The heads of the households are contacted for the needed information. A profile of the major characteristics of the households is presented in this section. Table 6.2 Respondent household by age groups Age group in years No. of respondents 2 15 - 19 26 20 - 24 87 25 - 29 130 30 - 34 114 35 - 39 97 40 - 44 75 45 - 49 176 50 & + 707 Total

(N= 707) % to total 0.3 3.7 12.3 18.4 16.1 13.7 10.6 24.9 100.0

Table 6.2 shows that majority of respondents belong to the age group 50 years and plus. It can also be seen that the respondents aged between 30 and 39 years constitute nearly 35 percent. Thus most of the respondents selected are matured enough to give responses to the questionnaire.

Fig.6.1Marital status of respondent households Single 11%

Widowed 14%

Other 19% Married 70% Divorced 5%

Fig. 6.1 shows that around 70 percent of respondents are married while 11% are s till single. A little over 14% are widowed and 4.7% are divorced.

Table 6.3 shows the details of children the respondents having. It shows that the respondents are having children up to a high number of 18.


35


Table 6.3 Percentage of respondent households by number of children Number of children % of respondent households 0 1.0 1 10.2 2 16.1 3 16.6 4 17.2 5 12.9 6 9.2 7 6.8 8 4.9 9 1.8 10 1.0 11 0.4 12 1.0 14 0.3 15 0.1 18 0.3 Total 100 Table6.3 shows that one percent of the respondent households are not having children while 0.3 percent of them have 18 children. The table shows a wide variation in the number of children per household. It can be attributed to the extreme demographic changes took place in the country in the recent past. Fig.6.2 Sex of children of the respondent households

Male 51%

Female 49%

Fig. 6.2 shows that majority are males (51.1%) while females are also almost in equal proportion. Table 6.4 Age of children of the respondent households (in Percentages) Age in Years % of Respondents 18.4 1 to 5 73.4 7 to 18 6.4 18 to 25 1.8 26 to 35 100.0 Total Table 6.4 provides the distribution of respondents’ children by age. With reference to age of the children, majority are in between 7and 18 years 5ZDQGD&LWL]HQ¶5HSRUWDQG&RPPXQLW\6FRUH&DUGV)HEUXDU\

36


followed by 18.4 percent in the age group of 1to 5 years. It is common the school children are below the age of 18 years. However 8.2 % of respondents have the children aged more than 18 years. Table 6.5 depicts the current schooling status of the children. It shows that 79.1 percent are currently in school while 5.8 % are dropouts. It can also be seen Table 6.5 Current status of schooling of the children Status of Schooling % of Respondents 15.1 Never attended 5.8 Dropped out 79.1 Currently in school 100.00 Total From the table that 15.1% of the respondents’ children never attended the school. This is common in a country like Rwanda that children are not often educated due to the obvious reason of poverty and social calamities. The level of schooling attained by the children of the respondents is presented in Table 6.6.The table is reflective of the fact that majority of respondents’ children (84.4%) have completed their primary education while only 8.8% respondent households have children who completed secondary education. The gap between the two is very wide. Table 6.6 Level of schooling attained by the children (N=707) Level of Schooling % of Respondents 15.1 No Education 1.0 Did attend but did not complete PS 74.6 Completed PS 8.8 Completed SS 0.5 Completed Post Sec 100.0 Total The table further shows that only 0.5% of the respondents have children with post secondary education. However it can be seen that around 1% of the respondents reported that their children are dropouts from the school while another 5.3% revealed that their children had no education. 6.1.3. Access to Education This section reviews levels of access the respondents’ children having to the education. It highlights the availability of education, distance to schools, and proximity of schools. Fig. 6.3 reveals that educational facilities are available at all levels staring from primary to tertiary. Primary and secondary level education is available both in government and private sectors where as tertiary, technical and vocational education is available only in government institutions. Highest


37


percentage of respondents (92.7%) state that the primary education in government schools is available followed by 61% revealing that it is available in private schools. Only around 49% of respondents agree that secondary education is available both in government and private schools. Fig.6.3 Availability of educational services by level and ownership of institutions 100

92.7

90 % of respondents

80 70

61

60 50 40

49.4 49

44.8

39.2

Government

32.8

Private

30 20 10 0

0

0

0

Primary Secondary Tertiary Technical Vocational Level and ownership of educational institutions

The range of distances to the educational institutions from the residential places of the respondent households is shown in table 6.7. The location of the educational institutions is varied by the levels of the education and also by ownership of institutions. It can be observed that nearly 50% of the respondents expressed that distance is less than 3 KM with reference to all levels of education. Similarly, around 30% of the respondents felt that all types of educational institutions are at a distance beyond 11 KM. Table 6.7 Distance to educational institutions as revealed by the respondents (in percentage of respondent households) Distance Govt. Pvt. Private Technical Vocational Tertiary in KM Primary primary Secondary Institute school school 36.7 24.9 33.6 22.5 25.7 24.2 0 to 1 22.3 22.4 16.3 25.4 20.6 27.1 2 to 3 09.7 12.4 12.0 06.2 06.6 06.3 4 to 5 02.7 09.2 07.8 09.1 09.1 09.7 6 to 10 16.2 19.1 09.0 18.6 18.0 14.1 11 to 20 12.4 12.0 21.3 18.2 20.0 18.6 Over 20 Total 100.0 100.0 100.0 100.0 100.0 100.0 It reflects the fact that the locations are chosen such a way that they represent different geographical locations to say the nearest to and farthest to the provincial capital. The respondents’ general appreciation was sought to know what they sum up about the distance of educational institutions from their residences. The details are presented in table 6.8.


38


Table 6.8 Proximity of educational services to the respondent households by level of education and ownership of institutions (in percentage of respondent households) (N=707) Level of Proximity to the Households Education Very Close Near Far Services Govt. Pvt. Govt. Pvt. Govt. Pvt. 51.0 50.8 37.9 37.9 11.0 11.6 Primary 29.5 42.5 38.3 33.1 31.6 24.4 Secondary 35.0 0.0 27.6 0.0 37.4 0.0 Tertiary 38.7 0.0 31.0 0.0 30.0 0.0 Technical 38.0 0.0 31.0 0.0 30.2 0.0 Vocational Table 6.8 discloses that majority of the respondents feel that the primary schools both in government sector and private sector are very close to them. Comparatively large percentage (42.5%) of respondents felt that the private secondary schools are very close to them than those in government sector. Only a little over 1/3rd of the respondents felt the tertiary, technical and vocational schools are very close to them. Nearly 1/3 rd of the respondents opined that all levels of educational services except primary schools are far from their residences. It can be construed from the above analysis that the distance and proximity to educational institutions is an issue to be pondered over. 6.1.4. Efficiency and Quality of Education The respondents’ appreciation of the quality and efficiency of educational services is presented in the following tables and figures. It covers school attendance, management of educational services, size of classes, quality of teachers and enforcing discipline, improvement in the performance of the children, quality of teachers and the overall performance of the school. The reasons for some children of respondents not attending the school are presented in the tables 6.9 and 6.10. Table 6.9 Reasons for children (all age groups) not attending the school (N=707) Reason % of respondents 76.3 Too Young 6.2 Long Distance 10.0 High Cost 4.5 Less Interest 1.8 Need Of Work 1.2 Other 100.0 Total Table 6.9 presents the reasons for not attending school with reference to children of all age groups. Majority of the respondents (76.3%) reported that their children are too young to attend school. High cost of school education


39


was the reason for 10% respondents while long distance was the reason for the children of 6.2% of respondents not attending the school. However 4.5% of the respondents reported that their children are abstained from attending the school as they are not interested. This needs an immediate attention to find solutions. Table 6.10 Reasons for children (below 18 years) not attending the school (N=707) Reasons % of respondents 5.7 Completed 11.8 Need Work 42.2 High Cost 4.6 Long Distance 16.6 Orphaned 2.7 Sickness 2.0 Lack Of Interest 1.3 Poor Quality 13.1 Other 100.00 Total On the other hand table 6.10 presents the reasons for not attending the school by the children below 18 years. This was attempted with a view to pinpoint the reasons why the children under 18 years are not attending the school. The table shows that the high cost is the reason cited by majority (42.2%) of the respondents. Hence this factor needs to be focussed much to find a sustainable solution. 16.6% of the respondents reported that some children are not attending the school because they are orphans. Long distance of schools is a reason for 4.5% respondents to reveal that their children are not attending the school. On the other hand sickness, lack of interest and poor quality of education were also reported as the reasons for the children not attending the school. Fig 6.4 Ownership and Management of Educational Services

NGOs 22%

Other 2%

Private 11%

Government 65%

Fig. 6.4 presents the ownership of the educational services from the view point of the respondents.66.3% of them felt the presence of government in 5ZDQGD&LWL]HQ¶5HSRUWDQG&RPPXQLW\6FRUH&DUGV)HEUXDU\

40


delivering educational services followed by 21.6% citing the role of NGOs. Only 10.6% of respondents revealed that private sector is in place of owning and managing educational institutions. Table 6.11 Respondents’ rating of the availability of basic inputs (teachers, teaching and reading materials) (% of respondent households) (N=707) Basic Inputs Always Available Sometimes Never Total Available 51.4 41.8 7.8 100 Teachers 19.7 44.5 35.8 100 Teaching and Reading Materials Teachers and materials for teaching and reading are the basic inputs required for operating schools. Table 6.11 reveals that teachers are always available for 51.4% of respondents while they are available sometimes for 41.8% of the respondents. 44.5% of the respondents reported that teaching and reading materials are available only for sometimes while only for 19.7% of respondents these materials are always available. But for a large percentage (35.8%) of respondents, these materials are never available. For the remaining (44.5%) the Materials are sometime available. It can be observed that the basic inputs are not always available. Table 6.12 Respondents’ rating of quality of school buildings (N=707) Quality % of respondents 45.5 Good 33.1 Fair 20.3 Poor 1.1 Don’t Know 100.0 Total According to table 6.12, the quality of school buildings is good only for 45.5% of respondents while 33.1% of them rated it as fair. For the remaining the quality of school buildings is poor. At the out set the quality of basic infrastructure like school buildings is not appealing.


41


Fig 6.5 Respondents’ rating of the cleanliness of schools

Dirty 9%

Very Clean 34%

Fairly Clean 19%

Clean 38%

As shown in Fig 6.5, the majority of respondents opined that the schools are very clean and clean. Around19% of them felt the cleanliness of the schools is fair while 8.6% of the respondents felt the schools are dirty. Around one-third of the respondents reported that the schools are not clean to the desired level. Table 6.13 Availability of the provision of extra curricular activities, lunch and other amenities at the schools (% of respondents ) (N=707) Provisions Available Not Available Don’t Know Total 69.3 23.4 7.1 100 Extra Curricular Activities 5.2 94.1 0.7 100 Lunch 62 33.7 4.3 100 Other Amenities According to table 6.13 extra curricular activities are in place in the schools as reported by around 69% of the respondents. Only 5.2% of the respondents reveal the presence of lunch facility to students.

Fig 6.6 Respondents’ rating of the cleanliness of schools

Don’t know 6%

Large 47%

Adequate 42% Small(few per class) 5% 5ZDQGD&LWL]HQ¶5HSRUWDQG&RPPXQLW\6FRUH&DUGV)HEUXDU\

42


Fig. 6.6 shows that almost equal proportion of respondents reveal that the size of the classes are large (47.8%) and adequate (41.6%).It is necessary to focus on the large classes as they may contribute to the ineffectiveness in learning. Table 6.14 Respondents’ rating of the quality of teachers and management and enforcing discipline (Percentage of respondent households) Rating of Qualities Quality of Total Good Fair Poor 68.7 27.5 3.8 100.0 Teachers 61.8 31.8 6.4 100.0 Management and Enforcing Discipline According to table 6.14 only two-third of the respondents rated both the teachers and management/enforcement of schools are of good quality while the rest rated those two are fair and poor. There is a need to pay attention to the quality issue of these basic inputs.

Fig 6.7 Respondents’ rating of the writing and reading skills of their children after attending the school Poor 15% Good 48% Fair 37%

As shown in Fig.6.7, only 48.8% of the respondents felt that the writing and reading skills of their children are good after attending the school. Around 34.7% Of them reported that these skills are fair while 14.5% rated them as poor. Thus a majority (51.2%) of respondents feel that the writing and reading skills of their children are not up to the mark. It reflects the poor quality of school education.


43


Fig.6.8 Respondents’ rating of performance of their children after attending the school Poor 10%

Excellent 27%

Fair 22%

Good 41%

On the other hand Fig 6.8 shows that 26.7% of the respondents reported that the performance of their children was excellent after attending the school where as another 40.8% of the respondents rated the children’ performance as good. Similarly 22,4% of the respondents rated the children’ performance as fair while around 10% rated it as poor. Thus it can be seen that the performance of the children after attending the school is not good after attending the school. Fig.6.9 Respondents’ rating of performance of the schools Don’t Know 9% Poor 13%

Good 25%

Fair 53% Fig. 6.9 reveals that the overall performance of the schools is good for only 25% of the respondents while 53% of them rated it as fair. The rest of the respondents rated the schools’ performance either poor or their ignorance of information. There is a need to through light on this issue of performance of schools.


44


Fig.6.10 Respondents’ Satisfaction with the Quality of Education offered to their Children

Can’t Say 4% Not Satisfied 34%

Satisfied 62%

Fig.6.10 reveals that 62% of the respondents are satisfied with the quality of education given to their children. However more than 1/3 rd of the respondents is not satisfied with the quality of education while the rest are unable to comment. It shows the need to find the reasons for it and to set them right. 6.1.5. Cost of Primary Education An analysis of the respondents’ reflections on the cost of primary education is presented in the following tables and paragraphs. Table 6.15 Cost of primary education met by the respondents Cost in RWF % of respondents 37.0 0 To 300 22.3 400 To 1000 31.2 1100 To 3000 9.5 Over 3000 100.0 Total Table 6.15 exhibits the cost of primary education met by the respondents. The cost ranges between RWF 300 and RWF 3000. Around 10% of the respondents revealed that they incur more than RWF 3000 as expenditure for their children education. The respondents’ appreciation of the level of fee paid them is presented in Fig.6.11. Large majority (52.1%) of them felt the fees are high while 34% of them seen the level of fees as fair. Interestingly 13.8% of the respondents felt the fees are low.


45


Fig.6.11 Respondents’ perception of the level of the school fee paid for their children

Low 14%

High 52%

Fair 34%

Table 6.16 presents the respondents’ suggestions on the additional requirements of school going children for making their education effective. They expressed the need for providing lunch, uniform and textbooks. Table 6.16 Additional requirements of school going children as revealed by the respondent households (N=707) Additional Requirements % of respondents 8.7 Lunch 15.4 Uniform 8.3 Textbooks 1.6 Other 6.5 Books 3.4 Lunch + Uniform 2.2 Uniform + Textbooks 24.1 Uniform + Books 2.7 Textbooks + Other 24.9 Lunch + Uniform + Books 2.2 Lunch + Uniform + Textbooks + Others 100.0 Total On enquiring whether the respondents are willing to pay extra fee for the better education of their children 48.9% of them responded affirmatively while the rest answered negatively as shown in Fig 6.12.Thus the majority are not willing to pay.


46


Fig. 6.12 Willingness of the respondents to pay for better educational services 51.1

51.5 51 50.5 50 % of 49.5 respondents 49 48.5 48 47.5

48.9

Willing

Not Willing Opinion

The respondents were also asked to answer whether any other payments are involved in their children education in addition to the school fees. The results are Presented in Fig 6.13. Nearly half of the respondents revealed the existence of some additional payments while the rest answered negatively. Fig. 6.13 Respondents’ answers to the questions whether additional payments are involved in their children education 51

51 50.5 50 % of 49.5 respondents 49 48.5 48

49

Yes

No Answers

The details of the additional payments involved are presented in table 6.17. Majority (47.4%) of the respondents are contributing to the construction or renovation of the school buildings. Nearly another quarter of respondents revealed that they are paying for extra lessons / coaching of English language to their children.


47


Table 6.17 Types of additional payments involved in children education of the respondents’ (N=707) Type of Additional Payment % of respondents house holds 23.4 Coaching / Extra Lessons Of English 47.4 Contributed To The Construction / Renovation 24.3 Other 4.0 Insurance 0.5 Coaching/Extra Lessons Of English + Contributed To The Construction 0.4 Coaching + Contribution + Construction +Other 100.0 Total 6.1.6. Participation in School Activities This section deals with the participation of respondent household in the school activities. It attempts to analyse the levels of participation of respondents in PTA meetings, sports and school day celebrations, how they interact with the school administration, approach to resolve the issues/problems with the school administration etc., Table 6.18 Attendance of PTA meetings by the respondents (N=707) Details % of respondents 92.8 Attending 7.2 Not Attending 100.0 Total Table 6.18 shows that a large majority (92.8%) of respondents are attending the PTA meetings. The reasons why the rest of them are not attending the

Fig. 6.13 Reasons for not attending PTA meetings Other 3%

Too Busy 41%

The School Does Not Have These Meetings 34%

Not Aware About Meetings 22% 5ZDQGD&LWL]HQ¶5HSRUWDQG&RPPXQLW\6FRUH&DUGV)HEUXDU\

48


PTA meetings are presented in Fig.6.13. Fig. 6.13 shows that 41.4% of the respondents gave the reason that they are very busy hence they abstain from attending the PTA meetings. Another 33.9% of the respondents reveal that the schools where in their children studying are not having the practice of organising PTA meetings. Yet another 22% of respondents expressed that they are not aware of the holding of such meetings. Table 6.19 Respondents attending sports and open day’s celebrations (N=707) Details % of respondents 44.1 Attending 55.9 Not Attending 100.0 Total Table 6.19reveals that only 44.1% of respondents are attending the sport/open day’ celebrations while the majority (55.9%) are not attending.

Fig. 6.14 Reasons for not attending sports and open days celebrations (N=395) Other 10% Too Busy 52%

The School Does Not Have These Activities 35%

Not Interested In Attending 3% The reasons for not attending the sports/open day’s celebrations are presented in Fig. 6.14. Around 52% of the respondents expressed their inability to attend sports / open day’s celebrations because they are otherwise very busy. A little over 35% of the respondents cited that the schools in which their children studying are not having such occasions. The rest of the respondents revealed that they are not interested in such meetings. 6.1.7. Interaction with School Administration This section deals with the ways and means by which the respondents interact with the school administration in the process of resolving any issue/problem.


49


Fig.6.15 Existence of any issue / problem with school administration about respondents’ children education

Exists 15%

Not Exists 85%

Fig 6.15 portray the existence of any issue or problem with the school administration with reference to their children education. It is good phenomenon that no issues or problems are in existence for majority of the respondents (85%). However 15% of the respondents expressed the existence of different issues/problem as listed out in table 6.20. Table 6.20 Type of issues / problems with school administration about respondents’ children education (N=106) Types of issues / problems To clear school dues Academic matters of my child To explain a medical condition Of my child Discipline problem Other Total

% of respondents 33.0 24.0 18.2 17.3 7.5 100.0

The majority of respondents (33%) revealed that they have the issue of clearing school dues of their children. And 24% of them revealed that they have academic matters to be resolved with the school administration. Explaining the medical conditions of the children and to deal with the disciplinary problems are the other two issues/problems to tackle by 18.2% and 17.3% of the respondents respectively. In fact these are very important issues to consider and resolve for the delivery of qualitative education. Table 6.21 Respondents answers to the questions whether the problem / issue was reported to school authorities (N=106) Answer Reported Not reported Total


% of respondents 89.2 10.8 100.0

50


Table 6.21 shows that around 89% of the respondents have reported the issue/problem to the school authorities while the rest did not.

Fig.6.16 Form of reporting issues / problems to school authorities Complaint In Group 11%

Other 3%

Other 8% Personal Visit 82%

Formal Complaint Letter 4%

Fig. 6.16 exhibits the form of reporting used by the respondents for reporting the issues/problems to the school authorities. A little over 81% of the respondents made an attempt by personally visiting the school authorities to present their cases face-to-face. However 11.3% of the respondents used group approach for reporting while 4.3% of them just wrote a complaint letter. Table 6.22 Respondents’ answers to whether the issue/problem was solved Answer % of respondents 77.1 Solved 22.9 Not Solved 100.0 Total The respondents answers to whether their issues/problems are resolved are presented in table 6.22.It shows that the issues/problems were solved for 77.1% of the respondents while for the rest they were not solved. The levels of satisfaction attained by the respondents are exhibited in Fig 6.7.

Fig. 6.17 Level of satisfaction among the respondents’ about the issue / problem solving by school authorities Level of Satisfaction Dissatisfied

1.5 29.7

Partly Satisfied Completely Satisfied

68.8 0

20

40

60

80

% of Respondents


51


It can be seen from Fig. 6.17 that around 69% of the respondents were completely satisfied where as nearly 30 % were partly satisfied. The remaining respondents were dissatisfied. There is a need to find ways and means to satisfy fully the partly satisfied and dissatisfied respondents.


52


6.2 HEALTH The CRC survey was carried to evaluate the performance of health facilities run by the government. As specified in chapter 4, 721 respondents were contacted with a well developed questionnaire. An analysis of the geographical distribution of the respondents, access and availability of health services, utilization of health services such as antenatal services, immunization of children, equity and fairness of services, efficiency and cost, quality of health services and the participation in health service administration is presented in this part. 6.2.1. Geographic Distribution of Respondents The respondents were chosen from three erstwhile provinces representing 7 districts and 13 sectors. The number of households selected from each sector and district is proportionate to the total number of households residing in it. Table 6.23 Distribution of respondents’ by districts in the pilot study area (N = 721) District % of respondents 12.8 Cyangugu Vile 35.1 Gisenyi Ville 11.2 Nyagisagara 7.1 Kibungo Ville 7.8 Mirenge 17.9 Nyarugenge 8.1 Butamwa 100.0 Total Table 6.23 presents the percentage of respondents chosen from each district in the pilot study area. The highest percentage (35.1 %) of respondents belongs to Gisenyi ville while the lowest (7.1%) are from Kibungo Ville. Table 6.24 Distribution of respondents by Sectors in the pilot study area (N = 721) Sectors % of respondents 11.4 Kamembe 1.4 Shagasha 28.6 Gisenyi 6.4 Byahi 3.9 Ntaganzwa 7.4 Kirengo 7.1 Kabare/Musamvu 3.1 Nyange 4.6 Zaza 14.0 Biryogo 3.9 Nyarugenge/Rugenge 4.0 Butamwa 4.2 Nyarubande 100 Total


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Table 6.24 depicts the sector wise distribution of percent of respondents contacted for the CRC health survey. Gisenyi ranks first with 28.6 % of respondent households while Shagasha represented by only 1.4 % of respondent households. 6.2.2 Access and Availability of Health Services This section evaluates the access and availability of health services from the stand point of the respondents.

Fig. 6.18 Availability of health services by category of facility 90 80 70 60 % of Respondents 50 40 30 20 10 0

82.8 63.9 53.3

52.4

45.9

Govt. Hosp

Pvt. Hosp

H. Cent

Disp

46.3

Pvt. Cln Phar

Category of Health Facilities Fig.6.18 exhibits that the highest percentage of respondents (82.8%) reveals that health centre are available followed by the government hospital and dispensary as reported by 53.3 % and 54.4% of respondents respectively. However, 63.9% of respondents revealed that pharmacies are available to them. Availability of private hospitals and private clinics is low as revealed by relatively less percentage of households. Table 6.25 Respondents’ answers to the question whether Health facilities at convenient distance to them (N = 721) Answers Gov Hospital Pvt. Hospital Health Centre Pvt. Clinic Pharmacy 70.1 80.9 75 83.9 83.5 Yes 29.9 19.1 25 16.1 16.5 No 100.0 100.0 100 100.0 100.0 Total According to table 6.25 relatively a large percentage of respondents revealed that private clinic (83.9%), pharmacies (83.5%) and private hospitals (80.9%) are at convenient distances compared to government hospitals (70.1%) and health centres (75%). It shows the need for expanding the government health facilities.


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Table 6.26 Incidence of family members visiting Government health facility / any other health service provider (NGOs / Healers etc.) (N=721) Details % of respondents revealing their family members visiting Govt. Health Facility Any other health service provider (NGOs / Healers etc.) 76.0 42.1 Visiting 24.0 57.9 Not Visiting 100.0 100.0 Total According to table 6.26 only 76% of the respondents visited the government health facilities while comparatively 42.1% of them visited other health services providers like NGOs / healers etc. thus it indicative of the fact that government health facilities continue to be the major utilities availed by the public. Table 6.27 Reasons for not visiting a government health facility since last year (N = 173) Reasons % of respondents 59.6 Nobody Has Fallen Sick During This Period 8.1 Lack Of Drugs At Facility 0.3 Impolite Staff 9.4 Long Distance To Facility 10.1 Can Not Afford Payment 1.7 Poor Quality Of Services 3.7 Don’t Provide Specialised Treatment E.G Hypertension 0.7 Lack Of Cleanliness 0.3 Long Waiting Time 0.7 Don’t Know 5.4 Other 100.0 Total The reasons for not visiting government health facility by 173 respondents are presented in table 6.27. Nearly 60% of the respondents reveal that they did not visit government health facility during the last year because no one from their family fallen sick during that period. Among the remaining respondents, the important reasons cited include, non-affordability to meet payment, long distances to health facilities, lack of drugs at facility and non-availability of specialized treatment. Table 6.28 Incidence of pregnancy, usage of antenatal services and delivering at health facility among the women belonging to respondent households (Since August 2004) Details % of respondents 33.2 Incidence of pregnancy (N=239) 68.5 Attending antenatal services ( N=164) 59.4 Delivering at health facility (N=142) Table 6.28 exhibits that 33.2% of respondents reported the incidence of pregnancies in their households. But only 68.5% of them were attending


55


antenatal services. Further it can be learnt from the table that only 59.4% of the women carried pregnancies actually delivered at health facilities. Fig. 6.19 Reasons for not attending antenatal services (N=75) Health Staff Are Not Polite Could Not Afford 12%

I Do Not Use Antenatal Care Services Needed More Advanced Antenatal Care Too Early In Pregnancy

27%

6% 6% 6% 6%

Went To A Private Health Facility Other

37%

Fig 6.19 explores the reasons why 75 women did not attend the antenatal services. Non-affordability of antenatal services is the reason for majority of the respondents (36.4%) followed by the impoliteness of health staff (27.1%) for not attending the antenatal services. Among the other reasons cited include 6.1% of them needed to have more advanced antenatal services while another 6.1% of them visited private health facilities. These reasons reflect the imperfections associated with the government health facilities. Fig. 6.20 Reasons for not delivering at health facility (N=97) Could Not Afford Was Not Treated Well At The Health Centre

3% 4% 28%

Health Centre Was Not Open Used A Traditional Birth Attendant Still Pregnant

37% 5%

Delivered At Home

1% 10% 12%

Went To A Private Health Facility Other

Fig. 6.20 presents the reasons for not delivering at health facility. 37% of the 97 respondent households delivered at home while 28.4% said that they could


56


not afford the facility. Around 10% of the respondents used a traditional birth attendant while 2.5% went to a private health facility to deliver. To some respondents (1.2%) the health facility was not opened at times needed while 4.9% complained that they were not treated well at the health centre. These reasons may be used for initiating necessary actions to make the health facilities more attractive to the users. 6.2.3 Immunization of Children This section throws light on the state of immunization of children below the age of five years in the respondents’ households. Table 6.29 Immunization details of Children under five in the household (N=721) Details Number % of respondent households 526 72.6 Respondents having children under five 504 69.9 Respondents availing immunization services at government facility 22 3.1 Respondents not availing immunization services at government facility According to table 6.29, 72.6% of the respondents have the children below the age of five years. Nearly 70% of the total respondents have immunized their children. Those who have not available the immunization services constitute 3.1 % of the total respondents. Fig.6.21 Reasons for not availing immunization services at government health facility (N = 22) Could Not Afford 14% Was Not Treated Well At The Health Centre

14%

14%

32%

9%

Went To A Private Health Facility

14%

Used A traditional Birth Attendant Still Pregnant

9% Delivered At Home 26%

Other

Fig.6.21shows the respondents reasons for not utilizing government immunization services. 27.4% out of 22 respondents did not deliver at health facility as they can not afford it. Followed by 13.6% of them delivered at home and also another 13.6% used a traditional birth attendant. Yet there are also women from respondent households who went to private health facilities


57


(13.6%) and did not use government facilities for immunization of children as they were not treated well (13.6%). 6.2.4 Equity and Fairness of Services The government health facilities are supposed to be impartial and maintain equity by serving first-come-first. Table 6.30 Respondents answers to question whether equal treatment of patients first-come-first served exists ( N= 721 ) Answers % of respondents 83.0 Yes 17.0 No 100.0 Total Table 6.30 shows that 83% out of 721 respondents admit that there exists equity and fairness of services by the health facilities in the pilot study area. However 17% of them complained that there is no equity and fairness in the rendering of health services. The reasons given by them are presented in table 6.52 Table 6.31 Criteria observed in prioritizing patients for treatment at the health facility ( N = 123 ) Criteria % of respondents 18.6 Relatives And Friends 14.7 Wealthy 12.5 Local Leaders 10.9 Older People As shown in table 6.31, the health facilities in the pilot study area are biased towards relatives and friends, wealthy people and local leaders as evidenced by 18.6%, 14.7% and 21 and 12.5% of the respondents’ respectively. But the majority of these respondents refrained from giving any reasons. 10.9% of the respondents’ reported that the older people are given priority. Prioritizing older people compared to the other categories cited above is admissible. 6.2.5 Efficiency and Cost The efficiency and cost of health services in the pilot study area are presented and analysed in terms of their characteristics, availability of drugs, curability of diseases and of cost paid.


58


Table 6.32 Characteristics of the services at health facilities ( N = 721 ) Characteristics of Health Services % of respondent households giving affirmative answers 92.9 Presence of Doctor / Medical Assistant / Nurse 97.3 Examination of the person 98.3 Politeness of staff 88.1 Explanation concerning the affliction 83.9 Providing counselling 95.9 Freedom to express one self 93.7 cleanliness at the health facility 92.6 Dispensation of drugs, syrup, ointment ,injection etc 95.2 Giving instructions on how to use drugs Table 6.32 presents the characteristics of health facilities offered at health facilities in terms of percentage of respondents giving affirmative answers. More than 90% of the respondents affirmatively agreed with the each of the following features of health facilities in an order. • Polite staff • Examination • Freedom to express • Giving advice on drug usage • Cleanliness of health facility • Presence of the medical staff and • Drugs dispensation However explanation concerning affliction and providing counselling was rated by 88.1% and 83.9% of the respondents respectively. Even though 100% affirmative answers are not present, it can be construed that the health facilities are being kept reasonably in good shape by the government of Rwanda. However, still it is needed to enhance the satisfaction levels up to 100% by introducing improvements. Fig.6.22 Major reason for not receiving drugs at the health facility (N= 54) Did Not Need 4%

4%

4%

4% Health Facility Did Not Have Drug Supplies

18%

Health Facility Could Not Treat And Referred To Other Clinic Could Not Afford To Buy Drugs Don’t Know

66%


Other

59


An enquiry into the reasons from the 54 respondents for not receiving drugs at health facility resulted in the results presented in Fig.6.22. 66.7% of the respondents did not need the drugs while another 18.5% of them have not received because the health facilities were not in the possession of the drugs prescribed. 3.75 of the respondents are not afforded to buy the drugs. Fig.6.23 Efficiency of the health services (N = 721) 5% Cured the disease

17%

Still Undergoing Treatment Disease not cured

78%

It can be learnt from the Fig.6.23 that the health services provided in the pilot study area are rated by most of the respondents as efficient. 78.1% of the respondents got cured the diseases followed by 16.6% of them still under treatment. Only 5.3% of the respondents reported that they did not get cure of diseases. Fig.6.24 Respondents’ answers to the question whether they visited another facility after visiting “X” health centre (N=721) No 83%

Yes 17%

According to Fig. 6.24 only 17.2% of respondents (124) visited another health facility after first consulting one health facility. It signifies the fact that there might be some referrals and some of the respondents might have no confidence in the first health facility consulted.


60


Fig.6.25 Persons or agencies paying the cost of treatment at the health facility(N=721) 4% Paid From Own Pocket 36%

Employer Refund Mituelle De Sante RAMA Direct State Funding

43%

Other FARG 9%

4% 1% 3%

As it can be seen from Fig.6.25, majority of the respondents (43.4%) meet personally the cost of treatment from their pockets while another 35.55 of them have the Mituelle De Sante followed by 9.3% covered by RAMA and 3.6% by FARG. Only 3.9% of respondents got refund from their employers. Less than 1% is receiving direct state funding in meeting their treatment costs.

Table 6.33 Volume of coverage of the treatment cost by employer (N=28) Level of Coverage % of respondents 41.6 Full Coverage 58.4 Partial Coverage 100.0 Total According to table 6.33 only 41.6 of the respondents out of 28 are getting full coverage of treatment costs from their employers. The rest were getting partial coverage which was supplemented by meeting the remaining from their pocket.


61


Fig.6.26 Range of amount paid for the treatment cost (N = 721 ) 37.2

40

% of Respondents

35 30 25 18.7 20 12.4

15

11.4

12.8

7.5

10 5 0

0-100

101-500

501-1000

1001-5000 5001-10000 10001 & +

Amount in RWF

The respondents were asked to reveal the range of amount they incurred as cost of treatment. The results are shown in Fig.6.26. The largest percentage of respondents (37.2%) incurred the treatment costs ranging between RWF 1000 and RWF 5000. Around 25% of the respondents are subjected to a treatment cost of RWF 5000 and beyond. 6.2.6 Quality The quality of health services is the focus of this section. Fig.6.27 Respondents’ opinion about the quality of services (N=721)

Features of Health Service

Cleanliness of Utilities

1.9 8

Helpfulness of Staff Availability of Drugs

65.8 Dissatisfied

27.2 10.2

2.4

81.5 26.2

6

Waiting Time

Overall quality

16.6

26.7 25.1

66.8

Partly Satisfied Completely Satisfied

63.1 72.5

% of Respondents

Fig.6.27 presents the respondents opinion about the quality of services rendered by the health facilities on different features. Nearly three quarters of the respondents (25%) are completely satisfied with the overall quality of health services, while 81.5% of the respondents are completely satisfied with the cleanliness of utilities. With reference to waiting time, drugs availability and staff attitude around 2/3rd of respondents are completely satisfied in each case. Around one-quarter of respondents are partly satisfied with reference to overall quality, waiting time, drugs availability and staff attitude. The highest rate of dissatisfaction is noticed in relation to waiting time among 10.2% of 5ZDQGD&LWL]HQ¶5HSRUWDQG&RPPXQLW\6FRUH&DUGV)HEUXDU\

62


respondents. At the outset there needs to be done a lot to convert the partly dissatisfied respondents into completely satisfied category. Available

Fig.6.28 Availability of toilet facilities (N=721)

Not Available Don’t Know

3% 1% 96%

1%

Fig.6.28 shows that large majority of respondents (96.4%) acknowledged the availability of toilet facilities in the health service units. Only 2.9% of them said the toilet facilities are not available. Table 6.34 Type of toilets available at the health facilities (N = 695) Type of Toilet Valid Percent 45.1 Flush Toilet 46.2 Pit Latrine 2.4 Don’t Know 6.3 Flush Toilet + Pit Latrine 100.0 Total The types of toilets as revealed by the respondents are presented in table 6.34 4.6.2% of the respondents acknowledged the existence of pit latrines while another 45.1% of the respondents testified the availability of flush toilets. Only 2.4% of them expressed their ignorance. Table 6.35 Sources of water available at health facilities (N = 721) Sources of Water % of respondents 64.5 Piped/Tap Water 8.0 Public Stand Pipe 13.1 Water Tank/Reservoir 1.2 Borehole 0.5 Other 2.8 Piped/Tap Water + Public Standpipe 7.7 Piped/Tap Water + Water tank / Reservoir 0.8 Public Standpipe + Water Tank/Reservoir 1.4 Piped/Tap Water + Public Standpipe + Water Tank/Reservoir 100.0 Total According to table 6.35 tap water, water tank and public stand pipe are the major sources of water facilities at health service units as evidenced by


63


64.8%, 13.1% and 8% of the respondents respectively. The remaining respondents have a multiple combination of the water sources. 6.2.7 Citizen Participation in Health Services This section portrays the level of citizen participation in health service administration; especially their association with health committees and reporting of the problem to the authorities. Table 6.36 Respondents answers to the question whether health committees are in place or not (N = 721) Answers % of respondents 91.2 Yes 4.5 No 4.3 Don’t Know 100.0 Total Table 6.36 reveals that more than 91% of the respondents know the existence of health committees. While only for 4.5% respondents (32) the health committees are not in place. Just 4.3 % of the respondents are not aware of the situation. Fig.6.29 Respondents’ knowledge of methods of electing health committees (N = 721) 7% 1%

At A Sector Meeting By All Sector Members

9%

By Local Leaders Don’t Know Other 83%

As shown in Fig. 6.29, the majority of the respondents (83.4%) revealed that the health committees are elected by all sector members at a sector level meeting. It shows the true democracy in the system to enable the citizens to voice their grievances to authorities. Yet another 8.6% of respondents reported that the health committees are constituted by the local leaders. It might be in some cases, only a temporary arrangement.


64


Fig.6.30 Frequency of meetings between health committee and community members (N = 721 ) Monthly

11% 13%

Three Times A Year They Interact Informally All The Time

53%

Don’t Know 14% Never 9%

The frequency of health committee meetings is varied among the respondents as shown in Fig.6.30. Around 13% of the respondents reveal that the health committee interact informally all the time. While around 54% of the respondents revealed that the health committees meet every month followed by 10.&% of them saying that the health committees meet thrice a year. However, 9.3% of respondents declared that they never meet. Interestingly around 14% of the respondents expressed their ignorance.

Table 6.37 Problems in the quality of health services and their reporting to authorities % of respondents Answers Existence of Problems Reporting to Yes No Total

In Health Services (N=721) 6.7 93.3 100.0

Authorities(N=48) 34.9 65.1 100.0

According to table 6.37, 93.3% of the respondents evidenced that there are no problems in health services while 0n 6.7% of them (48) felt their presence. Around 35% of the 48 respondents felt problematic to report those problems to the authorities while the rest have no problems in reporting. It is an important concern to be looked into why the respondents feel difficult to report their problems to the authorities.


65


Fig.6.31 Authorities to whom the problems in the health services are reported by the respondents ( N =17 ) 4% In Charge of Health Facility District Authorities

29%

Other

67%

When asked these respondents (17) who have problems in reporting, 66.7% of them said that they reported to the in-charge of health facility as shown in Fig 6.31. Another 29.2% of the respondents reported to the district authorities. It shows the need for these authorities to be more pro-active and quick in response to the users of health facility.


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6.3. PLOT DISTRIBUTION IN KIGALI CITY 6.3.0 Introduction Plots of land are distributed in Kigali city among the people for constructing their own houses. It is a subject matter of MINALOC to oversee the plot distribution is undertaken efficiently and effectively. The plot distribution services are evaluated to know the citizen’s reactions and appreciations. A total sample of 179 respondents were contacted with a questionnaire to scale their perceptions on how effective are the plot distribution services. 6.3.1 Characteristics of Respondents Respondents’ characteristics in terms of their sex and year of settlement in Kigali are analysed in this section. Fig. 6.32 Distribution of Respondents by Sex (N=179)

Female 28%

Male 72%

Fig. 6.32 depicts the sex of respondents as represented by males with 72% share and females representing with 28%. Fig. 6.33 Year of Settlement of the Respondents (N=179)

After 1994 35%

Before 1994 65%

Fig. 6.33 shows that 65% of respondents were settled in Kigali before 1994 while 35% settled after 1994.


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6.3.2 Availability of Plot Distribution Services In this part the availability, and types of PDS are analysed. Fig. 6.34shows that 21% of the respondents acknowledging the presence of PDS in Kigali while the rest 79% saying that they are not available. Fig. 6.34 Availability of Plot Distribution Services (N=179)

Available 21%

Not Available 79%

Table 6.38 Types of plot distribution services available (N = 38) Reason % of respondents 46.9 Surveying 18.4 Registration 14.2 Arbitration Of Disputes 4.1 Surveying + Registration 6.2 Surveying +Arbitration 10.2 Surveying + Registration +Arbitration 100.0 Total According to table 6.38 surveying (46.9%), registration (18.4%) and arbitration of disputes (14.2%) are the PDS available in Kigali city. The remaining 20% of the respondents said all of these services are available in three different combinations. Fig. 6.35 Reasons for Non-Availability of Plot Distribution Services (N=141) Other Structures 23%

PVK 77%


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79% of the respondents (141 in number) were asked the reasons the reasons for non-availability of PDS in Kigali city. As shown in Fig.6.35, 77% of the respondents are attributing it to PVK while the rest (22.6%) to other structures. 6.3.3 Access to Plots Respondents ownership of plots, category of plots owned and factors considered in accessing plots are evaluated in this part. Respondents’ ownership of a plot in the sector (N = 179)

Fig. 6.36 Respondents’ ownership of a plot in Kigali city ( N=179) Not Owning 41%

Owning 59%

Fig.6.36 shows that 59% of the respondents are owning a plot in the Kigali city while the rest 41% are not owning. Thos who are not owning a plot attributed the reasons to a variety of problems associated with PDS.

Table 6.39 Category of plots wished to access and actually accessed by the respondents (N = 106) % of respondents Category of Plots Wished to Access Actually Accessed High Density Medium Density Low Density

9.9 37.7 52.3

8.9 37.8 53.3

Table 6.39 presents a comparative picture of the plots wished to access by the plot owning respondents (106) and the plots actually accessed by them. It shows that three categories of plots are available high, media and low density plots. The table 6.39 exhibits no significant variations between what type of plots the respondents wished to access and actually they accessed. The only variation is found in high density plots where in actually accessed respondents are less by 1 % compared to those who wished to access.


69


Table 6.40 Factors considered in accessing plots by the respondents (N = 179) Factors % of respondents 37.6 Wealth 9.9 Authority 5.7 Corruption 23.4 Other 3.5 Wealth +Authority 6.4 Wealth +Corruption 1.4 Authority + Corruption 12.1 Wealth +Authority + Corruption 100.0 Total Table 6.40 list out the factors considered in accessing plots by the respondents. 37.6% of the respondents revealed that wealth is the major criterion, followed by 9.9% of respondents pointing out authority and 5.7%respondents revealing the presence of corruption. Thus around 54% of the respondents referred to wealth, authority and corruption are the factors considered in getting access to the plots in Kigali city. However 23.4% of the respondents mentioned about some other factors, which they did not explicitly mentioned. The remaining 22.6% of the respondents referred to different combinations of wealth, authority and corruption. There is a serious need to look into this scenario of factors that are considered in accessing plots. The government may be having a different list of eligibility conditions, but the citizens appreciations are totally on the opposite side. Genuine need for a plot, affordability to pay and availability of such plot as per technical and environmental feasibility standards of the government etc., may be the factors to be considered in the eligibility criterion but not the wealth, authority and corruption. 6.3.4. Payment The cost involved in getting the PDS are analysed in this section by focussing on the money paid, to whom it was paid and whether receipt was given. Fig. 6.37 Whether money was paid to get plot distribution services ? (N=106)

No 53%


Yes 47%

70


Fig.6.37 shows that 47% of respondents agreed that they have paid money to get the PDS why the majority did not pay money to get the PDS.

Fig.6.38 Money actually paid by the respondents to get plot distribution services (N=38)

0.2

Amount in RWF

Over 1 Million

28.8

100000-1000000

44.9

30000-100000 15.8

10000-30000 10.3

0-10000 0

10

20

30

40

50

% of Respondents

Fig.6.38 exhibits the money actually paid by the respondents to get PDS. A large majority of the respondents (44.9%) were paying between RWF 30000 and 100000 following by 28.8% respondents revealing their payment between RWF 100000 and 1000000. a small number of (0.2%) respondents reported that they paid more than a million RWF for PDS. Affordability of the payment Fig.6.39 shows that 42% of the respondents felt that the payment they made for PDS is enough but another 40% of them claimed what they paid is costly. However, interestingly another 18% said that they paid a little money for availing PDS. It shows a complex situation as the respondents expressed varied opinions about the money paid for the PDS. Fig.6.39 Affordability of the payment to avail PDS (N=38)

Little 18% Costly 40%

Enough 42%


71


Fig.6.40 Receiver of the money paid by respondents’ for plot distribution services (N=38) Management Committee 15% Other 42%

Local Authority 43%

It can be seen from the Fig.6.40 the receivers of the money paid for PDS are local authority as reported by 42.4% of the respondents, management committee (15.2%) and others (42.4%). The respondents refused to name the persons to whom they paid money under the category of others. Fig.6.41 On whether a receipt is given after making a Payment (N=38)

No Comments 21% Received 47% Not Received 32%

Fig.6.41 shows the results obtained from the respondents to the question whether they received a receipt for the payment made for PDS. 47% of the respondents revealed that they received which another 32% said they did not receive followed by 21% refused to comment. It appears that something is happening behind the curtains as to the availability and rendering of PDS against payment. There is a need to make the PDS more transparent and accessible to the public.


72


6.3.5. Efficiency The efficiency of PDS was assessed in terms of the time taken in getting plots by the respondents. Fig.6.42. The length of time taken to get a plot by the respondents (N = 179)

Days 24%

Years 32%

Weeks 12%

Months 32%

Table 6.42 reveals that it took years for majority of respondents (32.6%0 to get their plots while to 31.5% of them, took months. Around 12 % of the respondents reveal that they received their plots within weeks. Interestingly around 24% of the respondents declared that they got their plots within days. It appears that the issue of releasing plot is transaction specific and may vary from case to case in getting clearance. Fig.6.43 Respondents appreciation of the length of time spend to get a plot in Kigali (N=106)

Short 18%

Long 53% Not very long 29%

Fig.6.43 exhibits that to majority of the respondents (52.4%) it took long time to get a plot in Kigali and for 29.4% of respondents, the time taken is not very long while another 18.2% of them said it is short. It can be understood that in general the time taken in clearing the plots is relatively long. Hence, there is a


73


need to streamline the procedures and to shorten the time taken for the allocation of plots. 6.3.6. Plot disputes It was aimed to solicit information from the respondents about the frequency of plot disputes and the efficiency of their resolution. Fig. 6.44 Frequency of cases on Plot Disputes ( N = 38)

Many 36%

Few 36%

Not Many 28%

Fig. 6.44 exhibits that 36% of the respondents claim that there exists many disputes while 28% of them said that there exists disputes but not many. Another 36% of the respondents said there exists only few disputes. Fig. 6.45 Respondents’ views on the efficiency of plot dispute resolution (N=38)

Not Impressive 31%

Good 34%

Average 35%

Respondents view on the efficiency of plot dispute resolution is shown in Fig. 6.45 . 34% of responders revealed that the plot dispute resolution is good while another 35% of them rated its efficiency is average. But 31% of the respondents revealed that the plot dispute resolution is not impressive. Thus


74


majority of the responders are not happy with the plot dispute resolution mechanism, hence, there is a need to rationalize the system of plot dispute resolution. 6.3.7 Quality of services The quality of PDS is evaluated in terms of respondents satisfaction levels, the state of PDS during the last five years and about the issue of owning multiple plots. Fig. 6.46 Respondents’ levels of satisfaction about the quality of plot distribution services (N=179) Completely Satisfied 18%

Dissatisfied 53%

Partially 29%

Fig. 6.46 shows that only 18% of the respondents completely satisfied, 29% are partially satisfied and 53% are dissatisfied. It is obvious that a large majority to that extent of more than 80% have the lowest level of satisfaction with PDS. There is a need to make a clinical check on the various issues raised in this survey. Fig. 6.47State of the plot distribution services during the last 5 years (N=179)

Worse 31%

Improved 16%

Same 53%

Respondents were asked to comment on the state of PDS during the last five years. The result are presented in Fig.6.47 which shows that only a small 5ZDQGD&LWL]HQ¶5HSRUWDQG&RPPXQLW\6FRUH&DUGV)HEUXDU\

75


composition of respondents (15.7%) revealed that the situation was improved while the majority of the respondents (53.7%) claimed that there is no improvement as the same condition are prevailing. And nearly one-third of the respondents (30.6%) disclosed that the condition is worsening. They felt the depletion of the condition over the five year of period of time. It shows the immediate necessity to look into the issue to make PDS more transparent and reliable. Fig. 6.48 Respondents’ answers to the question whether they know the people who have multiple plots in Kigali (N=179)

No 45%

Yes 55%

According to Fig.6.48 majority of the respondents (55.1%) agree that they know the people who have multiple plots in Kigali while the remaining 44.9% of respondents are not aware of it. It is a serious concern to look into, because the ownership of multiple plots saw the equality. Then the respondents were asked to explain how multiple plots were acquired by those people. The results are presented in table 6.41. Table 6.41 Respondents’ perception about how multiple plots were acquired ( N = 99) Means of acquiring multiple plots % of respondents 7.6 Know Who 7.9 Kin Relative 5.7 Corruption 45.9 Other 3.5 Know Who+ Relation 3.5 Know Who+Corruption 25.9 Know Who +Relative + Corruption 100.0 Total According to table 6.41, majority of the respondents (45.9%) revealed that people used other means to acquire multiple plots. When asked to give details, they refused to do so. 7.7% of respondents said that they acquired multiple plots through know who followed 5.9% saying through kin relatives and 4.7% pointed it to corruption. Around 33% of the respondents gave one or other combination of know who, kin relative and corruption as the means of 5ZDQGD&LWL]HQ¶5HSRUWDQG&RPPXQLW\6FRUH&DUGV)HEUXDU\

76


acquiring a multiple plots. It shows an immediate necessity to subdue these unfair means of acquiring multiple plots.


77


7. COMMUNITY SCORE CARDS As already mentioned, Community Score Cards (CSC) are one of recent approaches that MINALOC and MINECOFIN, with support from development partners are adopting for improving efficiency, policy effectiveness, accountability and participation in decentralized levels of administration. They are qualitative monitoring tools that are used for local level monitoring and performance evaluation of services (World Bank 2004). The CSCs help to improve dialogue between frontline service providers and the users by providing feedback on services provided. This section presents the results of the CSC process conducted in former provinces Cyangugu, Gisenyi, Kibungo and Kigali City. The services covered by this pilot are health, education and land distribution, which was conducted in Kigali City only.

7.1. CYATO PRIMARY SCHOOL, GATARE, CYANGUGU 7.1.1. Overview In Cyato primary school, the CSC exercise was conducted with groups composing teachers, students, parents, local government officials and representatives of religious organisations. Teachers were 8 in number (3 females and 5 males), students were 13 (7 females and 6 males, parents were 12 (5 females and 7 males). There were 3 sector coordinators and 1 representative of the Roman catholic church. In general, all participants contributed equally to the discussion in their respective groups. However, in the interface meeting (combining all the categories mentioned above), pupils presented their opinions but did not participate in the discussions and arguments, which followed. Issues, which generated most discussion, were about poor teaching methodologies and low quality of teachers in Cyato sector, although when asked to score their teachers’ quality, the pupils’ score contradicted this judgment. Parents and students revealed the weaknesses of the teachers while the teachers tried to defend themselves. Finally, the teachers argued that their weaknesses were due to living too far from the school with no means of transport and inadequate teaching materials. The details of the CSC exercise at Cyato primary school are presented below:


78


Table 7.1. Input Tracking Matrix of Cyato Primary School, Gatare, Cyangugu INPUT NAME Teachers:

TARGET

ACTUAL

REMARKS/EVIDENCE

1: 64

1:50 (with two sessions) 1: 35

- In lower classes (P. 1-3), they have 2 sessions of 50 pupils each - Fewer pupils in some classes, others drop out

0

1

He has A3 level, but he is upgrading in order to attain A2 level

Furniture - Desks and chairs - Cupboards Buildings

Shared benches and desks

- Classrooms - Laboratories Learning materials - Blackboards - Teacher-ratio

1 per /school

5-6 pupils share one desks They have 5 cupboards Classes have (1:1) 0

- There are very few desks - They borrow chairs from the church - Other pupils sit on the floor - Cupboards are not enough -Class buildings are falling apart -Teachers have no offices/staff room - No laboratory

1textbook for 3 pupils 1 per class 1 for teachers

1: 2 1 per class 0

Continuous supply Separate toilets for girls and boys 53% 1

No running water at school There are 5 toilets which are dilapidated 65% 1

Only for French English and science (STE) subjects Books are not taken by pupils at home They are few. Only manuals (Syllabus) are available - Water drawn from ponds, 1 ½ km away

-1 account -1000RWF per pupil per annum - Written program

- 1 account - They have a budget

Qualified

Unqualified

Utilities - Water Sanitation - Toilets Girls admitted Parents Teachers Association -Account - Budget

ICT program

1 room/class

- They do not have the program


- 1 is for the staff 4 are shared by pupils of both sexes There are more girls- exceeding 53% -The PTA has 2 committees which do not know their duties - Money transfer is irregular

Program needed, still waiting for it

79


Table 7.2 Community Performance Score for Education by Teachers of Cyato Primary School, Gatare, Cyangugu INPUT NAME

SCORE REASON (100%)

RECOMMENDATION

Buildings

20

-Dilapidated - Insufficient - Incomplete buildings - No teachers’ office - No library -No teachers accommodation

Desks, chairs and cupboards

30

- Buildings needed: − Offices − Classrooms − Teachers accommodation/ quarters - Complete unfinished buildings (those under construction) - Provision of furniture

Teaching materials

20

- The teaching materials needed for other subjects as well

Sanitation − Toilet − Water

5 0

ICT – laboratory

0

- Pupils sit on the floor - Chairs borrowed from the church - Inadequate cupboards - No chairs, tables for teachers - No books apart from those for French, English – STE -Very few and old toilets shared by both girls and boys - Not available - Not available

30 10

- Salaries not enough - Long distances to school

- Increase teachers’ salaries - Loans to purchase motorcycles

75 50

- Poverty - Don’t provide adequate learning materials Pupils overworked at home - No follow up on their pupils progress - Lack of refresher courses - Long distances to school - Inadequate salaries - No playing ground - No sports equipment - No workshop

- Provide lunch at school Parents to observe responsibilities

Teaching welfare − Salaries − Transport Teaching − Pupils − Parents

−

Teachers

Sports

5

Vocational training Decentralization

6 40

- Failure to implement decisions (Non payment of salary appears; irregular salary payments; long distances to service providers) - Meetings held for from school with no transport facilities


- Provision of water and toilets

- Provision of computers, electricity and laboratory

their

- Facilitate long distance education - Provision of transport means - Salary increment - Provision of playing grounds and sports equipments - Construction of workshop and provision of necessary equipment - Implementing decisions - Service delivery to be closer to beneficiaries

80


Table 7.3 Community Performance Score Card for Education by Pupils of Cyato Primary School, Gatare, Cyangugu PERFORMANCE SCORE (100%) CRITERIA Teaching

20

Buildings

10

Classroom facilities

15

Sanitation and other utilities

0

Teacher – relationships

25

pupil

School Parents Association

0

Sports

0

REASON

RECOMMENDATION

-Poor teaching methodology -Lack of punctuality - Absenteeism -Poorly constructed - Leaking - Mud walls

- Lack of teachers accommodation at school - Appropriate teaching methods - Motivating teachers - Construct of strong and permanent buildings

- Inadequate chairs, desks and cupboards - Inadequate books - No adequate toilets - No water - No electricity - Punishments which lead students Severe punishments - Parents don’t visit pupils at school They don’t participate in solving problems at school -No playing grounds - No sports equipments

- Provision of adequate chairs, desks, cupboards and books


- Provision of water and electricity at school - Construction of adequate toilets - Fair punishments

- Parents should regularly visit pupils at school

- Provide sports equipment - Construct playing grounds

81


Table 7.4 Joint action plan of Cyato Primary School, Gatare, Cyangugu ISSUE

ACTION

PERSON RESPONSIBLE

Buildings 1.1 Inadequate and dilapidated classrooms

- Building and maintenance

1.2 Toilets which are very old and not sufficient 1.3 Library, workshop and laboratory - Not available -School/teachers office Inadequate equipment and facilities 2.1 Pupils -Books -Desks -Sports facilities 2.2 Teachers -Office furniture -Teaching materials -Meeting room -Books Teacher- Pupils welfare Pupils: -Lunch, First aid kits

-Construction

- Local authorities and parents

-Construction


Procurement Procurement Procurement

School Head and parents

Teachers: -Salaries -Accommodation Transport facility Teaching - Lack of Motivation - Incompetence

Parents - Ignorance on their responsibilities - Poverty Inspection -Government inspection poorly done Sanitation -Lack of toilets and

TIME FRAME (WHEN)

SUPPORT NEEDED


April 2006

April 2006

Local authority and Parents

- Corrugated iron sheets - Cement -Technicians (Government, Roman Catholic church – owner of the school and NGOs)

Funds needed to purchase them (MINEDUC)

Procurement Jan 2006

Funds (MINEDUC, NGOs) Food, medicaments

Procurement

Local authority

Jan 2006

School Head and church representative

Jan 2006

Procurement

(MINEDUC, NGO, Parents, MINISANTE)

Funds, motor cycles (MINEDUC, MIFOTRA, & Parents)

-School Head --church representatives – School Inspector

Jan. 2006

Refresher courses (MINEDUC, church – NGOs)

Local authority

Jan 2006

Find out reasons why inspection Doesn’t take place

-Local authorities -Parents

Jan 2006

-Training organized -Establish income generation projects (MINALOC, MINEDUC) Transport means for inspectors (MINEDUC) Proper roads (district – sector authorities)

-Construction of

-Parent & school head

Up to Jan

-Counseling needed -Refresher courses and provision of long distance teaching program -Training -Implement poverty reduction strategies


Funds (MINEDUC,

82


water

toilets -Provision of water

ICT - No ICT program - No computers - No electricity - No telephone network - No teaching capacity Sports - No play grounds and sports facilities Vocational training - Not taught

-Procurement of all needs

-School head -Inspectors -Local authority

2006

NGOs)

Jan 2006

Funds needed (MINEDUC, NGOs)

-Capacity building for teachers in ICTs

(MTN – TERRACOM)

Procurement

School head -local authority

Jan 2006

Funds (local authority, parents, RC church an MINEDUC)

-Procurement of facilities -Construction of workshop

School head and parents

Jan 2006

Funds (Parent, MINEDUC)

7.2. UMUBANO 1 PRIMARY SCHOOL-GISENYI 7.2.1. Overview At this centre the number of participants and their composition was as follows; 13 pupils, 7 Parents, and 8 teachers. Other participants were the school inspector of the District, head of the school, 4 members of Parents’ Committee, 4 heads of other schools and 4 Representatives of the religious organizations. The inspector, school head and some teachers were dominated the CSC session. Main issues that generated most discussion or disagreement among the participants were the lack of books, large numbers of students especially primary one (P.1) and the lack of a playground. Major constraints mentioned was maintenance of infrastructure, physical expansion of playgrounds and establishing international cooperation with bodies like ADB for financial support and lack of capacity to producing teaching manuals by CNDP.


83


Table 7.5 Input tracking matrix of Umubano 1 Primary School-Gisenyi INPUTS Teachers - Qualified - Unqualified

REQUIRED

ACTUAL

1 :64 0

P.1-P.3 : 1 :70 (double vacation P.4-P.6: 1: 50

FURNITURE - Desks - Teachers’ cupboard

-

P.1-P.3, 3pupils per desk P.4-P.6: 2 pupils per cycle - Each class has a room - No laboratory

BUILDINGS - School - Laboratory

LEARNING MATERIALS - Books -Blackboard Teachers manual

REASON The primary school is split into two because of so many pupils -

Blackboard Desks

1 room per class

- 1 book for 3 pupils -1 manual for 1 teacher

-

Centre built by support from ADB. The director and parents are dynamic

Lack of space and means to set up laboratory. Even if funds available space would be a problem

-P.1-P.3: No books -P.4-P.6 1 book -1 kinyarwanda/2 pupils -1 STE /2 pupils -2 blackboards/class

UTILITIES -Water -Electricity

Running

Rain water (4 tanks) No electricity

-

Water is enough but not portable No electricity

SANITATION - Toilets Toilets for boys and girls

GIRLS COMPOSITION PARENTS COMMITTEE ACCOUNT AND BUDGET ICT PROGRAM

53% 1 -

Account 1 1000 Frw per pupil Writen program


4 for girls 4 four boys 8 urinals 8: 4 for female teachers 4 for male teachers 294/620 = 47.7% 1 : functioning -

Account in Banque Populaire 1000 Frw/pupil No written program Two laptops No teaching program

Division of school into 2 Responsive to school activities Delay in depositing but helpful in management No electricity

84


Table 7.6 Community Performance Score Card for education by Teachers of Umubano 1 Primary School-Gisenyi PERFORMANCE CRITERIA Teachers capacity - P.1-P.3 English - P.4-P.6 Cycle English Books - History - Geography - Civics - Maths - French - Morale/Religion - Arts FURNITURE - Desk - Tables - Cupboard - First Aids Kit

SCORE

REASON

No training No training

Training and study tours

20% 20% 20% 20% 20% 20% 20%

No books No books No books No books No books No books No books

Prepare manuals Prepare manuals Prepare manuals Prepare manuals Prepare manuals Prepare manuals Prepare manuals

60% 100% 100% 0%

ADB assistance ADB ADB ADB

-

30%

Few

50% 0%

No portable water No electricity ADB

Installation for water and electricity in progress

School drop out - Job seeking Responsivene ss to school activities - Delays in budgeting - Little - No electricty - 2 computers only - Cost of living high - Long working hours

-

Sensitisation Sensitisation

-

Training Study tours

-

Regularity Rise from 1000 t0 3000 frw

-

Electricity will be intalled soon Need at least 20 machines

TEACHING MATERIALS

UTILITIES - Water - Electricity SANITATION DISTRIBUTION BY SEX - P.1-P.3 - P.4-P.6

50% 47.7%

PARENTS COMMITTEE

80%

ACCOUNT AND BUDGET

100%

ICT

TEACHERS REMUNERATION

RECOMMENDATION

100%

0%

5%


-

Increase number o f rooms to 6 Conference room Laboratory Play ground Dispensary To increase the materials Rwandan Maps World Atlas Globes

Closing doors of the toilets

-

-

Teachers need their own scale Raise should be up to 100%

85


Table 7.7 Community Performance Score Card for education by Pupils of Umubano 1 Primary School-Gisenyi PERFORMANCE CRITERIA ROOMS

SCORE

REASON

RECOMMENDATION

55%

In P1 very many pupils Very few. Borrowing from other schools is common 1 teacher the whole school. Paid by parents. When they do not pay him he does not teach Use a play ground belonging to police station Water for cleaning is available but no portable water No electricity but there are high expectations Some science posters but no laboratory 2 pieces but they are not operational because of lack of electricity We have to buy own equipment or bring some from home Teachers borrow material from each other Its classrooms that act as enclosure but there is still a need for a fence.

Increase number of rooms

BOOKS

30%

ENGLISH TEACHERS

10%

PLAY GROUNDS

15%

CLEAN WATER

60%

ELECTRICITY

10%

LABORATORY

5%

COMPUTERS

30%

SANITATION EQUIPMENT

10%

TEACHING MATERIAL

40%

FENCING THE SCHOOL

5%


Raise number of textbooks at least 1 book per 2 pupils Each class should have a teacher of its own

Need for support to build the grounds and footballs Need to get water supply from Electrogaz Electricity supply Setting up a lab and equip it There is need for supply of electricity

Getting adequate sanitation equipment Increase teaching materials Fencing required

86


Table 7.8 Community Performanace Score Card for education by parents of Umubano 1 Primary School-Gisenyi

INDICATORS Teachers capacity Teaching materials

SCORE REASON 80% Capable but lack materials 25%

School materials

90%

BUILDINGS

80%

UTILITIES - Water

40%

-Electricity

0%

PARENTS COMMITTEE MANAGEMENT OF SCHOOL ASSETS ICT

80% 80%

0%

-

RECOMMENDATIONS Procuring materials

A lot of materials lacking Books available but in small quantities When there is money, they are usually purchased - No play ground - No fencing

Raising number of teachers’ and pupils’ textbooks

Water is available but not tap Project of piped water is underway None Contributed in building the school Depositing is slow

The utilities should be made available as soon as possible

Telephone and computers are available but no electricity

Electricity supply and telephone connections are needed


Replacing old materials -

Build a playground Put a coat of paint Build conference hall Put up a fence

Should continue their good job Collaboration with administration will make work better

87


Table 7.9 Joint action plan of Umubano 1 Primary School-Gisenyi

ISSUE 1

2

3

4

Lack of capacity in teaching English

ACTION

RESPONSIBLE

Refresher Headmaster of courses on Umubano I/B English - More talks on English on Radio - Newsletter - Study tour to Anglophone countries Lack of teaching To procure - Parents materials - Head Master Umubano I/B - CNDP Few class rooms, no To construct - Parents conference room, no - Headmaster fence, no play - Teachers ground, no - Inspector laboratory

Lack utilities

-

To make the Water utilities available - Headmaster - Inspecteur Electricity - Headmaster Communication - Headmaster


TIME FRAME Three (3) years (December 2005Decemeber 2008)

SUPPORT NEEDED UNICEF MINEDUC Contribution of school

One year (1) (December 2005December 2006)

----

-Play grounds (December 200531 March 2006) -The rest (5 years ie December 2010) -

Parents community work Construction stones from district ADB and UNICEF Water: December Parent’s 2007 contribution Electricity: January 2006 Communication Janvier 2006 (mobile)

88


7.3.RUSIZI I HEALTH CENTRE - CYANGUGU 7.3.1.Overview Rusizi I (St. Francis) health centre is one of the two Health Centres in Cyangugu Town. It is located at the border with the Democratic Republic of Congo, on the Rusizi River. It is government owned but run by nuns from the Catholic Church. It is widely perceived as having highly quality services as manifested by the large number of people seeking them, both from the DRC and Cyangugu City. This perception was the reason why it was selected for the Community Score Card exercise in order to offer lessons that other health centres could learn from. The health centre provides both on-site and field services to the community. These services are provided within the framework of the “Contractual Approach”. This is whereby the population forms health associations, which enable them to acquire bank loans through their district or city offices so that they can receive health care by the latter providing a form of health insurance (Mutuelle de sante). Under this approach, the health centre enters into a contract with the District/city to provide specified medical services to the population. In turn, the district/city enters into a contract with the bank (Banque Populaire). The former serves as an intermediary between the people and the bank to ensure that loans are repaid as agreed. The health centre sends the medical bills to the district/city Mutuelle de sante representative on a monthly basis for reimbursement. Under this arrangement, the patients also pay a standard fraction of the bill (Frw 300), known as “ticket moderateur” for every visit. Although this fee is considered to be too high by some users of the health centre, in the words of the health centre officials, this arrangement had has increased the number of people who use the health services provided.


89


Table 7.10 Input Tracking Matrix of Rusizi I Health Centre - Cyangugu INPUT NAME Staff: -Doctors -Nurses -Technicians

Buildings - Reception area - Laboratories - Examination room

STANDARD

ACTUAL

1 2 1

0 8 1 (Social worker)

1 1 1

1 2 1

Utilities -Electricity -Water Equipment -Maternity Unit -X-ray unit -Dental unit -Microscope

Regular supply

Regular supply

1 1 1 1

1 0 0 2

Ambulance

1

0

Drugs -General -Life Saving -Others

Furniture -Beds -Chairs -Others Toilets

REMARKS/ EVIDENCE - For doctors, MINISANTE did not provide this number because they are very few in Rwanda and they are reserved for hospitals. - Number of nurses is high due to a very large number of patients (including those from Congo), attributed to their high quality services. - One technician is not enough, no backup.

-The reception area is too small for the number of patients nd -VCT constructed a 2 lab Close to the source (Rusizi river) -They have equipment but are no doctors to use it (e.g. Xray) -No dental unit but they use their minor surgery unit for dental problems -1 microscope is not enough because they provide field services Health centre cannot afford, patients find their way to the health centre in case of emergencies -Essential medication is available i.e. for common diseases such as malaria, colds, etc -Some life saving drugs are not available at the health centre, either because of scarcity or because MINISANTE does not permit them to provide these drugs at the health centre level and therefore are not provided. Based on the buildings available, the furniture is sufficient

Separate for men and women

There is one for each


Though they are separated, they are too close to each other that it is not easy to distinguish them. So patients use any

90


Table 7.11 Community Performance Score Card for Health by Providers of Rusizi I Health Centre - Cyangugu ISSUE

SCORE OUT OF 100 30

REASON

1

Consultation room

2

Hospitalization

60

3

Toilets

50

4

Ambulance

0

5

Maternity (delivery room/equipment)

50

6 7

Incinerator HC staff (adequacy, availability, punctuality, commitment, motivation, etc)

0 Availability=95 Commitment=80 Motivation=50

8

Relations with patients, local leaders and community

75

9

Materials (drugs, surgical equipment, clothing, etc)

70

Some materials missing

10

Casualty, inpatient and outpatient services

80

Number of patients outweighs the services available


Small but better than nothing

The ward is small yet beds are many (overcrowding) Few and too close to each other i.e. men’s and women’s Needed but not available. Ambulances are under controlled by Health districts Some materials missing and existing one are not adequate

None at HC -They are sacrificial (availability) -No absence without reason (commitment) -Salary not meeting needs (motivation) They receive many patients because of the good relations

RECOMMENDATIONS At least 3 rooms are needed to cover patient’s needs in the shortest time possible Construction of another ward

Construction of other two toilet facilities that should exclusively be used by patient of the same sex MINISANTE should provide one

-Expansion of delivery room -Ventouse -Protective materials e.g. gloves -Increase delivery beds from 1 to 2 Construct one Government should revise the current salaries and increase them

Provide better consultation room and equipment so that they can serve community better Materials for the maternity section needs to be improved and increased Expansion of HC to meet needs of users

91


Table 7.12 Community Performance Score Card for health by women of Rusizi I Health Centre - Cyangugu ISSUE

SCORE OUT OF 100 80

1

Infrastructure (adequacy, availability)

2

Quality of infrastructure

40

3

Hospitalization (adequacy of resources) Adequacy of materials/materials at HC Ambulance

100

4 5

65 0

6

Staff (training, experience, quality)

90

7

Materials/equipment

70

8

Cost of health services

95

REASON

RECOMMENDATION

The number of patients coming for consultation is too large to fit in the reception area The consultation area is poorly constructed and patients can hear each other’s conversations with nurses on their health conditions The sanitation is very good and the beds are enough Storage area in the wards is not enough There is none yet it is badly needed The ratio of patient to nurse is not proportional.

The reception area needs to be broadened (more construction)

Some diseases are not tested (typhoid and stomach ulcers) -No charges for hospitalization - MINISANTE lowered greatly - Poor people in the community are treated free of charge


Increase the size and privacy of the reception area

More cupboards needed MINISANTE should provide one -As a result of Mutuelle de sante, more people are using the HC, thus need to increase the number of nurses -Equipment to test these diseases in needed and the doctors to use it However, the blood stock needs to be increased

92


Table 7.13 Community Performance Score Card for health by male of Rusizi I Health Centre - Cyangugu ISSUE

Infrastructure (adequacy, availability and quality) - laboratories -Sanitation/Water

SCORE OUT OF 100 90

Staff performance (availability, adequacy, punctuality)

95

Training, experience and quality of health staff

95

Availability and quality of materials and equipment at the HC (drugs, surgical equipment, clothing, etc) Process of health services: consultation, testing, diagnosis, etc (availability, adequacy, and quality) Casualty, inpatient and outpatient services Cost

100

Effectiveness of health services (time management, quality of services, success, etc)

REASON

RECOMMENDATION

Generally good but male and female toilets are not clearly designated

Construction of more toilets

-There is a tendency not to receive Mutuelle de sante users as quickly as those who pay from their own pockets - The Mutuelle de sante representative at HC sometimes hostile to patients They try their best but lack enough experience Health Centre is well stocked

-On one hand staff need to be trained on how to handle patients generally -On the other, patients also need to be sensitized on what Mutuelle de sante can or cannot do for them More training for staff

100

All is perfect

100

Patients get enough Keep it up attention Mutuelle de sante and The “ticket FARG have generally modérateur” should made costs affordable be reduced from 300 but the “ticket Rfr to 100 Rfr modérateur” (300Rfr) is not affordable for all categories of people in the community They do very well, that is why many people (including those from Congo) walk long distances to visit the health centre

90

100


93


Table 7.14 Joint Action Plan of Rusizi I Health Centre - Cyangugu

Health centre representative

June 2006

SUPPORT NEEDED Funds for Mutuelle de sante, MINALOC and MINISANTE Kamembe district

Mutuelle de sante officials at the district and provincial level MINISANTE

February 2006

Cyangugu Province

January 2006

MINISANTE

Health Centre representative

January 2006

-Purchase of lacking equipment -Training of staff to use it

Health district representative

April 2006

-Financial support (MAP could intervene here) -Training health district

Purchase/donation of ambulance

Health District

January 2006

Inadequate area for hospitalization

Construction of another ward


May 2006

Inadequate materials/equipment in the maternity section Poor garbage disposal facilities Staff salaries

Provision of more delivery beds and protective materials


January 2006

Construction of an incinerator

January 2006 January 2006

Staff living far from Health Centre

Construct houses for them closer to Health Centre

Health Centre representative Health Resource person at provincial level District officials

ISSUE

ACTION

Health service costs

Reduction of ticket modérateur from 300 to 100 Rfr

Inadequate toilet facilities

Construction of more toilet facilities, clearly distinguished for men and women -Populations needs to be made aware of what Mutuelle de sante can or cannot do for them -Train mutuelle de sante staff HC to be assigned a doctor/nurse with A1 qualification Construction of more space

Mutuelle de sante services

Lack of doctor at Health centre Consultation area not adequate

Lack of equipment to test certain diseases (diabetes, ulcers, typhoid) No ambulance

Increase staff salaries


PERSON RESPONSIBLE Person in charge of mutuelle de sante at district level

WHEN January 2006

March 2006

Funds or ambulance provided by MINISANTE or its supporters -Plot of land (district) -Funds -Communal work VCT Intégré

MINISANTE MIFOTRA and MINISANTE -Plot of land (district) -Funds (NGOs)

94


7.4.BUTAMWA PRIMARY SCHOOL - KIGALI MUNICIPALITY 7.4.1.Overview Butamwa is a semi urban district. It was selected as a typical district farthest from the Central Business District of Kigali City. While it has the classification of an urban district, its apparent that it shares many features with rural areas. There are no programme books, classes are overcrowded and the school has no computers training programmes although the computers are available. However unlike the rural schools, it is apparent that electricity supply is available and piped water used to be available before the system broke down. The community scores show also problems that are common in many other rural areas. Lack of school lunches, few toilets, lack of running water and unlike in input matrix electricity was also cited as a problem, understandably because these are mainly respondents from individual households away from the school. On the positive side the community score highly availability of desks, possession of uniforms by pupils and availability of qualified teachers. Service providers - teachers rate very lowly most of the education services. Books availability very low, less than 50 per cent score to each of school performance, training and viability of extra income generation activities. The joint action plan reflects the needs of the area as typical of many Rwandan districts. Priorities are given to improving the pass rate at the school, providing lunches at school, increasing the number of toilets, water supply, getting replacement teachers due to frequent absence of teachers on maternity leave and getting health insurance for pupils. While it is possible to think districts on the periphery of the City may be having better services than rural areas, the survey shows that they may not be very different from rural districts after all, in terms of services availability in the education sector.


95


Table 7.15 Input Tracking Matrix of Butamwa Primary School - Kigali Municipality PERFORMANCE CRITERIA 1. Qualified 2. Unqualified Desks Benches Cupboards Classrooms Laboratory

REQUIREMENTS

ACTUAL

REASONS

1 :64 0

1 : 64 0

Government retrenched unqualified teachers

1 1

3 pupils per desk 3 per bench Adequate

All pupils have classrooms No lab demonstrations

0 Books Blackboard Program books

Toilets Water Electricity Girls Parents Committee Account ICT

1 :1

For males For females Continuously available 53% 1 1

1: 3 1 board in each class No program books 4 for all 0 0 55% In place In place None


Some courses have no programs

Water supply broke down every pupil fends for her/himself Girls more numerous

Computers are there but no program

96


Table 7.16 Community Performance Score Card for education by Pupils of Butamwa Primary School.Kigali Municipality PERFORMANCE CRITERIA Lunch

2%

Electricity Toilets Water

0% 5% 0%

Some pupils do not come back for afternoon sessions due to lack of lunch at home None Few None

Computers

2%

In supply but not in use

Books

50 %

Very limited 1:3

Cupboards Sanitation requirements

2% 4%

None Inadequate

Desks

80 %

Adequate

School materials

8%

Inadequate. Many pupils do not have materials

Qualified teachers

90 %

Adequate classrooms

80 %

Adequate but problems are when they are sick or are in maternity leave replacement difficult and sometimes brings teachers unqualified for the subjects They are old and have no windows

Insurance.

0%

None

80 %

Not all children have uniforms

Uniforms

SCORE

REASON


RECOMMENDATION School lunch

Supply Increase number Supply. Rain water harvesting tanks Raise supply and train how to use Increase supply, of books in English, French, Kinyarwanda School should get some Increase through collaboration between school and parents All pupils should sit on desks and 2 pupils per desk Parents should buy and school provide special ones like those for geometry Replacements

Glass panes. Raise number of classrooms. Build new schools School administration and parents can arrange for the insurance All kids to have uniforms

97


Table 7.17 Community Performance Score Card for education by Parents of Butamwa Primary School.Kigali Municipality PERFORMANCE CRITERIA School performance

SCORE

REASON

RECOMMENDATION

20 %

Low pass rate compared to other schools

-Inspect teachers and train them -Revision sessions for poorly performing pupils -Raise number of qualified teachers -Awareness raising for parents and teachers on requirements of pupils -Managing time better -Pupils who have not paid allowance money should not be harassed

Good buildings

50 %

Modern schools. Needs a laboratory and working computers

Clean water

10 %

Cleanliness

50 %

Doors and windows not in good condition. Rooms are small compared to number of pupils No safe water. The available water sources cater for so many other local people Few toilets for both sexes

Adequate number of teachers

60 %

High pupils: teacher ration

Qualified teachers

30 %

Low incentive Little training

-Experience should be considered -Teachers should reside near schools -Salary raise

Materials required at school

20%

ICT lacking Parents too poor to get materials for their children

Payment capacity

70 %

Some parents are not proactive to school activities others are just poor

Job creating projects to enable parents get money to buy materials for their children Parents to form associations Meetings between teachers and parents


Water supply system needs to be repaired and water tanks cleaned regularly Build more toilets Parents should be responsible for cleanliness and hygiene of their children 30 pupils per teacher

98


Table 7.18 Community Performance Score Card for education by Teachers Butamwa Primary School.Kigali Municipality PERFROMANCE CRITERIA School performance

SCORE OUT OF 100 40 %

REASON

Lower grades passing well than higher ones

Incentives

10 %

Very low salary No working over time

Books

5%

Low supply

Training

40 %

Employment generating activities

30 %

RECOMMENDATION

Lunch Pupils to be given materials Parents to follow up pupils’ progress Local leaders should sensitize parents on school activities Teachers should teach near their homes Salaries should be reviewed Government could assist in supplying textbooks All levels and forms at least each semester

No investors


Creation of the opportunities for parents who are poor

99


Table 7.19 Joint Action Plan of Butamwa Primary School - Kigali Municipality ISSUE

ACTION

RESPONSIBLE

Low pass rate of pupils

-Sensitize parents on how their pupils are taught 1) Weekly in gacaca traditional courts 2) Monthly on days of umuganda-collective work day 3) Every week in churches

Local leaders: executive officer of the sector

-

-

Homeworks every day Call parents of the pupils who are absent many times

Lunch at school

-Sensitize on listening to radio Look for donors

Number of toilets

Learn from other areas where lunch programs are in practice e.g. Bugesera, Gitarama Build more latrines

TIME FRAME Decembe r 2005

Education in charge at sector level

January 2006

Teacher Parents and Guardians

January 2006 December 2005

Headmaster January 2006

Headmaster and Parents Committee Parents

January 2006

School materials

Parents should give materials to their children

Lack of enough teachers

Look for qualified teachers who can replace those ill or on maternity leave

Head master and parents committee

January 2006

Pupils insurance

Get adequate information on insuring modalities -Parents sensitization

2006Academi c year

Water supply

Repair

School administration together with Chairman Parents Association Executive secretary of Sector to bring it to CDC


Notice boards

Leaders to remind teachers on these

School administration

Head master of the school

REQUIREMENTS

January 2006

Time new District structures 2006 March

Attendance records to show pupils who have missed school 3 times

Write project and send it to CDC of district -Look for addresses of NGOs

To be agreed by Parents Committee next years budget Each pupils will have an exercise book wherein the teacher communicates with the parents -Plan how to get money to pay the replacements -Write to MINEDUC for support Required funds

Put it in Annual Report

100


7.5 NYANGE HEALTH CENTER – KIBUNGO PROVINCE 7.5.1 Overview Some unique findings expressed by the participants in the Nyange Health Centre CSC process included the absence of HIV/AIDS testing equipment and trained staff in the field. The participants also noted that there was a high number of mothers who deliver at home with the help of trained traditional midwives but who were originally trained to help the mothers get to the health centre. However, the mothers prefer to deliver at home instead of going to the health centre. On the availability of drugs, it was noted that for some important drugs such as the ones used to induce faster labor for expectant mothers, the health centre did not have the right to administer them although they would like to be granted this authority by the Ministry of Health. The issue of very low salaries was also one that dominated the discussions. Table 7.20 Input Tracking Matrix of Nyange Health Center

1

NAME OF INPUT Doctor Nurses Lab Technician

1 2 1

0 3 0

2

Surgery

1

1

3

Reception

1

1

4

In patient room

1

1

5

Consultation room Maternity unit Electricity (Solar)

1

1

1 Always available

1 0

6 7

STANDARD

ACTUAL

8

Water

Always available

1

9

Maternity equipments X- Rayon Dental unit/equipment s

1

1

1 1

0 1

10 11


REMARKS/EVIDENCE - The government did not provide a qualified doctor to the health centre - The patients who visit this health centre were so many that two nurses could not serve all of them. Reasons why Health committee in collaboration with the District authorities decided to recruit a third nurse whose salary come from the receipts of the health centre. - There is no laboratory (assistant) technician by profession. However, there is a lab assistant who has been locally trained (by nurses). There is no surgery except a small room for injury treatment. The reception room was already planned, but it is not used for its role. In patient rooms are available but not enough Available Available Electricity is always available except during the rain period. During rainy period power is not enough because of poor solar energy. In the dry season water from the main source is not sufficient. Then, the health centre use the rainwater kept in tanks. Maternity equipments are not sufficient Not available Dental equipment is available but the H. C. does not have a dentist

101


12 13 14 15

Microscope Anesthesia Ambulance Drugs

16

Chairs & Benchs Beds Offices Consulting beds Toilets

17 18 19 20

1 1 1

1 1 1 Available

1

Available Available Available Drugs are generally sufficient except those necessary prescribed by Doctors for common and minor diseases Available

1 1 1

Available Available Available

1

Separated toilets are available

Table 7.21 Community Performance Score Card for health by Women of Nyange Health Center PERFORMANCE CRITERIA Number of staff

SCORE

REASON

RECOMMENDATIONS

35%

The available number is insufficient Not available at the health centre

We need at least a Doctor especially a pediatrician, a gynecologist, a lab technician and equipments of AIDS test. Because of a great number of pregnant mothers in this health centre we need drugs to help them at the centre instead of transporting them far to the main Hospital at Kibungo for the same services Oblige people especially mothers to show their proof of payment for mutuelle de sante before being consulted or getting treatment. Bring us equipment for HIV/AIDS test and drugs for treatment, and drugs against HIV mother – child transmission. We need more beds for delivery

Drugs for pregnant women (to induce labor)

0%

Adhere to the Mutuelle de sante de santé

25%

People are not motivated

Staff and equipment for testing HIV/AIDS

0%

Don’t exist

Beds for delivery

55%

Maternity and mother’s room

12%

Beds are not sufficient They are very closed


Separate maternity and mother’s room. They are very closed and it is not desirable.

102


Table 7.22 Community Performance Score Card for health by men of Nyange Health Center PERFORMANCE CRITERIA Child nutrition at the H.C.

SCORE

REASON

0%

Doesn’t exist

Adhere to Mutuelle de sante de santé

15%

Delay in welcoming patients

62%

People are not aware of the importance of mutuelle de sante de santé Before starting consulting patient there is a session of health education

Antenatal services

60%

Immunization

50%

A little number of pregnant mothers come to the Health centre for antenatal services A little number of pregnant mothers come to immunize their children

RECOMMENDATIONS We need support from the government. We just need training and equipment. Sensitize them

Increase number of nurses so that some should care of a group of patients when other nurses train or inform other group. They merit punishment, because they are already aware of the importance of antenatal services They merit punishment, because they are already aware of the importance of child immunization

Table 7.23 Community Performance Score Card for health by providers of Nyange Health Center PERFORMANCE CRITERIA Maternity and mother’s room Salary

SCORE

REASON

RECOMMENDATIONS

50%

Not enough

Increase the number of rooms.

30%

No overtime allowance

Meeting between staff and community Equipment

20%

Proportion between needed budget and receipts Hygiene

30%

Too much work gives very limited time for frequent meeting with community We have a big number of equipment without enough specialists to use them Receipts are not sufficient to cover all needs.

We need an overtime allowance or recruitment of other nurses. Increase the number of staff

Government /MINISANTE should give them a subsidy.

95%

Workers put in a lot of effort

Increase the number of workers

Consultation of patients Children immunization Mortality rate of children of 5 years and below

50%

Ignorance

Sensitize them

40%

Maternal Mortality of mothers

0%

- Ignorance of parents - Insufficiency of staff for immunization At the health centre the rate is low but we don’t know the rate of those who deliver at home some due to ignorance and others due to poverty Complicated cases are immediately sent to the Hospital.

Sensitization of parents and increase the number of nurses Those who don’t visit the Health centre need to be sensitized, and especially to adhere to the mutuelle de sante de santé Need gynecologist doctor at the health centre.

98%

5%


Increase the number of staff

103


Table 7.24 Joint Action Plan of Nyange Health Center ISSUE

ACTION

The main Hospital is very far; a great number of patients

Transform the health centre in Hospital, to increase the number of nurses and recruit at least two doctors. Refer to the government

No lab technician; No equipments for HIV/AIDS test drugs for treatment. Children suffer from malnutrition

Insufficient budget

PERSON RESPONSIBLE Health committee and the Mayor.

WHEN

2006

SUPPORT NEEED Many and community manpower; support from the Government and NGOs.

Health Committee

Decembe r 2005

Government, and NGOs.

Centre for nutrition must start soon.

Health Committee

Decembe r 2005

Support from the government

Health Committee

2006

Health Committee (Training about nutrition to some literate women, and looking for equipments. Subsidy from the government

7.6. MUHIMA HEALTH CENTRE 7.6.1. Overview The Community Score Card meeting involved 35 people including doctors, nurses, patients and local leaders. A special participant who attended unexpectedly was the coordinator of ‘Mutuelle de Sante ’ of the district. With regard to participation, it was clear that the director of hospital and five women patients dominated the discussions. The most topical issue that generated heated debate was payment of hospital dues by patients. The main problem was that most patients were not part of Mutuelle de sante and the agreement was that people without Mutuelle de sante should be considered as a special case. A common fear among focus group members was that of availability of funds. These were in relation to ideas of building wards or generally expand the hospital because M V K was represented and they have the main say. The focus groups were not separated by sex because there are very few men at the hospital. Major issues expressed were; hospital dues, space (wards are very small), lack of enough drugs, mistreatment by the nurses and lack of proper direction on what to do on health matters as a community. Providers had a set of almost similar concerns. These were payment of hospital dues, mixed services and lack of enough drugs.


104


Table 7.25. Input Tracking Matrix of Muhima Health Centre INPUT NAME - Staff: - Doctor/MA - Nurses - Technicians Buildings: - Reception area - Laboratories - Examination room - Pharmacy Utilities: - Electricity - Water

STANDARD

ACTUAL

1 2 1

13 A2 85, A120 2

1 1 1 1

1 1 1 1

- Not adequate - Small laboratory - Not adequate - Not adequate

- Regular - Supply

- Regular - Supply

- Generator supply

- Available - Available

- Enough - Not enough

- Available

- Anesthesia drugs (not enough)

- Not adequate

- Adults only - Sometime babies can share a bed

Drugs: - General - Life saving - Special drugs ARV - Others Furniture: - Beds - Chairs - Other

REMARKS/ EVIDENCE -Not enough - Correct (enough) - Correct (enough)

- Available - Available Toilet

Equipment: - Maternity Unit - X- ray Unit - Dental Unit - Microscope - Physiotherapy - Ambulance

Separate for men and women

Yes

1 1 1 1 1 1

1 1 1 1 1 1

- Only for the dispensary - Only women are admitted

- Not enough - Enough - Not enough - Enough - Not enough, limited space - Sharing with other (Hospitals, Health Centres)

.


105


Table 7.26 Community Performance Score Card for Health by user groups of Muhima Health Centre PERFORMANCE

Availability of Doctor/Nurse Information about directions to the hospital

SCORE OUT OF 100% 70 50

REASON

RECOMMENDATION

- Every morning - Ward visits on an hourly basis - Sign posts not available - No information desk

- Mostly available in the nights

Reception

80

-Receive many people in short period of time -Willing to work (do their job)

Availability of drugs

40

Payment of hospital dues

35

Conduct/behavior of doctors/nurses/ staff Waiting time to see the doctor

60

Infrastructure

40

- Little stock - Few general drugs (no Special drugs) - Hospital caters for mothers, but health centre specialty is maternity - Not willing to pay Mutuelle de Sante - People’s lack of understanding on the importance of Mutuelle de Sante - Impoliteness - Some mothers who have given birth sleep outside or on the floor - Come on time for consultation and ward visits - Receive patients warmly - Insufficiency of buildings

Personnel Equipment

65 30

Qualification/ Training

80

Living conditions

40

- Inadequate salary - No accommodation, transport and leisure

Availability of drugs

70

- Essential drugs are available - Lack of some drugs in stock and linkage with CAMERWA

90

- High ratio of patients to doctor -Insufficiency of basic materials needed for Muhima Hospital -Better functioning (sterilization, laundry, etc) - Qualified staff - Some training needed in ARV knowledge


- General reception office with staff who can used the 3 languages - Enough sign posts with direction arrows o - To increase the n of people working at the reception area - Personnel needed for RAMA/Mutuelle de Sante and other services - Buy enough stock of drugs - Drug stock reserve - Separate centre de santé from the hospital

- Mobilizing the citizens to understand the importance of Mutuelle de Sante - Citizens to value the importance of Mutuelle de Sante - Nurses should change their behavior towards patients (bad language) - Continue the spirit - Safety behavior should be practiced by nurses - Build / urgent extension of the Hospital - Train and recruit more doctors - Build and provide necessary equipment to those services - Training NB: Muhima health centre staff needs more trainings than Hospital staff - Salary increment - Credit facilities (based on qualification, grade, experience ) - Set up the minimum alary scheme - Increasing special drugs storage capacity e.g.: anesthesia products

106


Table 7.27 Joint Action Plan of Muhima Health Centre ISSUE

ACTION

Extension of Muhima health centre

- Construction

Equipment

- Reveal the needs - Purchase needed equipment - Rehabilitate old equipment

Medical insurance

Staff

Reception and orientation of patients Living conditions of health centre staff

-Sensitization to join medical insurance - Assistance to those who cannot afford insurance - set up a uniform insurance contribution -Recruitment of additional staff

- Creation of a reception area - Put up directioins to the reception area - Raise salary - Facilitate credit aquisition - Incerase allowance based on market prices on basic goods - Improve skills for career development

PERSON RESPONSIBLE - Kigali city: Théoneste Mutsindashyaka - André Sibomana - Elisaphan Hakizimana - Health centre authorities (Dr Sengorore) - Kigali city (see above) - MINISANTE (Dr Sekabaraga J.C) Local authorities. - MINALOC (Nyatanyi Christine) - Cabinet: PRIMATURE MINISANTE MINALOC MINICOFIN

WHEN 2007

January 2006

May 2006

May 2006 2006 2006

SUPPORT NEEDED - Money - Time - Community contribution - Belgium cooperation to the Health centres. - TRAC / MCAP - List of needs and price - Health Centre cordinator - Money

- Money - Project Turwubake (Intra -health) - MINISANTE Other NGOs

- Health centre authorities - Kigali city authorities - MINISANTE - MINIFOTRA - Health centre authorities (Dr. Sengorore Athanase)

2 Months

January 2006

- Revenue from Health centre receipts

- PRIMATURE - MINIFOTRA - MINISANTE - MINICOFIN - MINISANTE - Kigali city - Health centre authorities (Dr Sengorore) - MINISANTE

2006

- Money


- Money

12 Months

2006

107


7.7.NTAGANZWA HEALTH CENTER 7.7.1 Overview The CSC exercise at Ntaganzwa Health Centre involved 28 participants including the health centre staff, neighboring community and local authorities. Issues that generated most discussions were the lack of an ambulance, poor condition of toilets and the lack of a doctor or medical assistant allocated to the health centre. The issue, which generated most disagreement, was health insurance, “Mituelle de Sante”. It was clear that the community members were not convinced by the explanations given by the district Social Affairs official on how they were supposed to benefit from their contributions. Based on the discussions and arguments held, it appears the root cause of the problem was a lack of sound communication between the stakeholders and the lack of involvement of cell coordinators in sensitizing the people on the partnerships involved in the Mutuelle de Sante and its advantages. Below are the results of the CSC exercise:

Table 7.28 Input Tracking Matrix of Ntaganzwa Health Center INPUT I

REQUIRED

ACTUAL

REMARKS/EVIDENCE)

(Medical 1 Doctor/ Medical Assistant – A1 level) Nurses 2

0

In general, no HC in Rwanda has got a medical doctor

3

The HC receives big number of patients. The extra nurse is paid by the HC itself. Among the three is also the manager of the HC

Technician 1 s

1

Assistants to nurses Other personnel

2

The technician is paid by the HC They are paid by the Ministry of health

3

1 accountant, 1 cashier, 1 guard They are all paid by the HC

1 Pharmacy staff BUILDINGS

Reception area Laboratory Examinati on room Maternity unit X-ray unit

One of the nurses provides pharmacy services 1

1

It is “open space”

1 1

1 1

Available Available

1

1

Available

1

0

Dental unit 1

0

Though it is needed, the HC does not have a qualified doctor. Patients have to travel to Mutobo Hospital or Kabgayi hospital to receive dental care

EQUIPMENT


108


Microscop 1 e Thermome ter Centrifuge use

1

TV set +VCR

1

Ambulanc e

1

Referedge rator for drugs Weighing scale Stethosco pe

Available

2 1 Donation from UNICEF

0

Donation from UNICEF It is strongly needed. Pregnant ladies are transfered to Mutobo or Kabgayi Hospitals. Often they die before they reach the hospitals

1

6 2 2

Delivery tables beds

TOILETS

Benches Chairs Toilet facilities for patients

22 12 5 Separate toilet facilities for men and women

Not separated

The HC lacks matresses Enough Metalic chairs given by UNICEF Three flashing toilets but blocked 1 pit latrin outside the HC

2 Toilet facilities for staff Drugs

Available

Essential drugs available: for malaria, diarrhoea, ARV to protect HIV transmission from mother to child

HC : Health centre


109


Table 7.29 Community Performance Score Card for health by Women of of Ntaganzwa Health Center ISSUE

SCORE (%)

REASON

Expectant mothers

30

Patients with dental problems

0

No dentist at HC, patients are forced to resort to illegal practitioners

Heath advisors

25

Perception that private clinics (Ngororero, Gatumba) provide better and faster services

Few toilets

20

-Too many patients use the same toilet, which cause faster spread of disease especially epidemics

Maternity equipment

25

General reception of patients

90

-

No doctor at HC No ambulance

- Patients’toilet is outside the HC boundaries which makes access difficult especially for the very sick The number of mothers seeking these services is not propotional to the available beds, matresses and blankents

RECOMMEN DATION Doctor and ambulance needed A dentist and the appropriate equipment and drugs should be provided Advising people on disease prevention measures and proper diet Unblocking blocked toilets or constructing others inside the HC compound Increase in the number of beds, matresses and other maternity equipment

Reception is generally good, patients receive enough care


110


Table 7.30 Community Performance Score Card for health by men of of Ntaganzwa Health Center ISSUE Toilets

SCORE (%) 30

HC materials (mattresses, blankets, etc) X-ray services

20

Electricity

40

Communication

0

Staff houses

30

Mutuelle de sante

95

Dental equipment

0

0

REASON

RECOMMENDATION

- The toilets are blocked and there is no technician to repair them –They are also mishandled They are not adequate

We need technicians to repair the blocked ones and also to teach patients how to use them Financial support is needed to purchase them Financial supoort is needed for HC to buy one

The HC does not have one so patients have to travel long distances to find them Electrical equipment is too -Renovation and old expansion of equipment -Increase the number of solar energy panels -No mobile telephone Extension of MTN network coverage network and radio - No radio communication facilities (walkie- talkie) 7 are needed but there Preparation of a are only 2 available project to construct staff houses It is helpful but restrictive Mutuelle de sante ie patients can only use should be accepted Ntaganzwa and Muhororo countrywide HC which is not convenient for all patients No dental equipment is HC should be availble at the HC which provided with dental may cause people to get equipment HIV infection because they seek illegal dental practitioners


111


Table 7.31 Community Performance Score Card for health by providers of of Ntaganzwa Health Center ISSUE 1 Drugs

SCORE (%) 80

2 Training

80

3 Staff salaries

60

4 Compensation for work done

20

5 Materials

60

6 General reception and treatment of patients

90

REASON Sometimes drugs are not available at the Health District Training is conducted in relatively sufficient proportions such that it does not conflict with other HC activities while at the same time giving the staff a chance to practice what they acquire in the training Too many HC employees to pay without enough resources to do so The HC has no capacity to compensate staff

RECOMMENDATION Drugs should always be made available at the Health District Regular training

Government should appoint and pay all employees Health district should have compensate workers for work done HC generally lacks sufficient The district (health materials and administrative) should be more supportive in providing materials Although there are few Increase in the employees, patients number of staff generally receive sufficient care and attention


112


Table 7.32 Joint Action Plan of Ntaganzwa Health Center ISSUE ACTION PERSON WHEN RESPONSIBLE Inadequate staff

Recruit atleast 2 goverment- paid nurses Low capacity to Government to pay 2 pay staff nurses who are presently being paid by the HC Transporting sick Support people to hospital “Dutabarane” Association to buy ambulance and its accessories, flash lights, umbrellas, working boots, rain coats Submit “Dutabarane” proposal to district offices for funding Dental equipment Forward the problem to sector executives to find means of obtaining dental equipment for the HC No curtains, Addressing the issue blankets, bed within COSA (health sheets committee) so that the materials can be obtained Few matresses ; 12 Proving 4 matresses are needed for FOSA Providing 8 matresses for FOSA Blocked toilets Anticeptics + a technician to unblock toilets

SUPPORT NEEDED

Muhororo Health District

December 2006

District doctor + Sector cordinator

MIFOTRA

December 2006

District doctor + Sector cordinator

Muhororo Health District

May 2006

Health District doctor + Sector cordinator

The district official in charge of social affairs

December 2005

Sector cordinator + elected health official at district

Sector Coordinator

December 2005

Health Centre incharge

COSA (health committee)

July-August 2006

Titulaire FOSA

Muhororo Health January 2006 District COSA (Health Comitte) December 2006 Muhororo Health January 2006 District

FOSAin-charge+ sector cordinator Elected health offiical at sector FOSA incharge+elected health official at sector level Cordinators of Bweramana+ Muyaga celles + COSA

Construction of a pit Residents of January 2006 latrin using Bweramana and communal labor with Muyaga cells the help of the technician Lack of a Conduct meetings in The official in charge of December Ntaganzwa sector common all cells of social affairs at 2006 cordinator understaning on Ntaganzwa sector so Nyagisagara District Mituelle that the people understand how Mituelle, COOPEC and Ubudehe interact HC: Health Centre, FOSA : Formation Sanitaire, COSA : Comité de Santé (Health Commitee)


113


7.8 RUBONA PRIMARY SCHOOL- KIBUNGO 7.8.1 Overview The Rubona Primary school CSC exercise revealed that although it performs well in national primary leaving exams, it is very poorly resourced. The school lacks sufficient teaching staff compared to the number of students, teaching materials (textbooks, teachers’ guides, chalkboards, etc) and classroom furniture. The school has no electricity, no running water, and the few toilets available were poorly constructed. Below are details of the school’s scores on key requirements for the proper functioning as well as recommendations from the school staff on one hand as service providers and the community as service users.

Table 7.33 Input Tracking Matrix of Rubona Primary School- Kibungo Input name Teachers

Standard P.1-P.3 1: 56 P.4-P.6 1: 45 Qualified teachers

Actual 1: 90 1: 37 The ones available are all trained

Chairs

1: 2 per desk

P.1-P.3: 4 to 5 per desk P.4-P.6: 3 per desk

Teacher’s guides Toilets

All classrooms should have a teacher’s guide At least 12 toilets; 6 for boys and 6 for girls, clearly marked by sex

There are no text books: both for teachers and pupils -There are only 3, and even these are very shallow which -causes them to fill up very fast. -They are not marked by sex

Electricity

No electricity

Text books

Ideally, electricity should be available and constant -1board permanently fixed to the wall -I portable board i.e. 2 boards per class 1 per pupil

Laboratory

1per school

-There is one science kit

Library Water

1per school 1 tap

None None

Chalkboard

1 Chalkboard on the wall

P.1-P.3; French and English are available P.4-P.6 no books for pupils i.e. 4,5,6


Remarks/Evidence - Students are very many, yet we are prohibited from recruiting more teachers - For the P.4-P.6, the pupils are few because some fail and drop out, others transfer to other schools while others drop out due to poverty The desks are not enough yet the students are very many in P.1-P.3, although they reduce as they move to the higher classes Need to buy both textbooks and teachers’ guides - Completely unacceptable: They are constructed through unpaid labor ; the result is very poor quality toilets with very shallow holes We are very far from all basic infrastructure Government did not provide any chalkboards

Teachers do everything possible to get those books from somewhere else, but nd even this is only for the 2 cycle (P.4-P.6) No financial means to construct one but even if it was constructed, there would be no materials to equip it ” Our closest water source is 4km away and we have no means to bring it to the school

114


NB-: The holes for the toilets we dug but are exposed which puts the pupils at risk. - This school performs very well, last year 31/32 pupils passed their primary leaving exams - Teachers had to find their own books for environmental studies and history

Table 7.34 Performance Score Card for education by pupils of Rubona Primary School- Kibungo Performance Classrooms

Percentage 20%

Reason -only 2 rooms in good condition -2 have leaking roofs -10 are destroyed - No text books - No chalkboards - No chairs

Recommendation -Repair those with leaking roofs -reconstruct the ones that are destroyed - Government should provide enough books and which are appropriate for the curriculum - Find chalkboards and chairs

Materials: - Textbooks for French and English for P.4P.6 - Portable chalkboards -Chairs Water

2%

0%

It is very far and there are no pipes

Toilets

10%

Laboratory

0.5%

The one in place fills up very fast and it is poorly constructed There is a science kit

-Construction of a water tank -Construction of facilities to tap rain water Construction of more and better toilets

Workshop

0%

None

Spots field/play ground Library

0%

None

0%

None

Security

30%

School has no fence


Construction of a laboratory and provision of its equipment Construction of a workshop Leveling of spots field /playground Construct library and provide books Construction of a fence

115


Table 7.35 Joint Action Plan of Rubona Primary School- Kibungo ISSUE Schools

ACTION To renovate To construct

To renovate Toilet facilities To construct

Laboratory

PERSON RESPONSIBLE Sector coordinator Parents committee in collaboration with the coordinator of sector The school principal (Director/headmaster) The school principal (Director)

To construct

Workshop

To construct

Equipment Sports fields / Play grounds

To buy Leveling the ground for fields

WHEN Five months Twelve months

District

- To be reported to authorities within 2 weeks

The district (ViceMayor

2 weeks

The ministry of education

The school principal should be in charge

The school principal and the sector coordinator


SUPPORT NEEDED District

Takes no time

Government to provide tractors to level the ground

116


7.9 PICTORIAL PRESENTATION OF COMMUNITY SCORE CARDS Fig.7.1 Community Score Card for Education by Teachers of Cyato Primary School - Gatare, Cyangugu 40 How decentralsiation is working in the area Desks Chairs etc

30 40 Teachers Scores in Percentages

35

20

Existence of education buildings AvailabilityTeaching Material

20

30 25 20

6

5

15

Availability of vocational training failities Availability of sufficient toilets in quantities Availability of water facilities

5 0

10 5

Availability of water

0 Performance Variables

Fig.7.2 Community Score Card for Education by Pupils of Cyato Primary School - Gatare, Cyangugu 25 20 25 Pupils Scores in Percentages

Teacher - pupil relations Teaching in general

15

Classroom facilities 10

20

Buildings Sanitation and utilities

15 0

10

0

0

PTAs Sports facilities

5 0 Performance Variables

Fig.7.3 Community Score Card for Education by Teachers of Umubano Primary School - Gisenyi Sanitation

100 87 Teachers Scores in Percentages

100

Furniture

80

PTAs Teaching Materials

80

Utilities Availability of Books

60 30 40

25

Remuneration of teachers 20

5

0

ICT



117


Fig.7.4 Community Score Card for Education by Pupils of Umubano Primary School - Gisenyi Clean water 60

Rooms

55

60

Teaching Materials 40

Pupils Scores in Percentages

50

Books 30

40

Computers

30

Playgrounds English

15

30

10

10

10 5

20

Electricity 5

Sanitation Laboratory

10

Fencing the school


Fig.7.5 Community Score Card for Education by Parents of Umubano Primary School - Gisenyi School materials

90

80

80

80

80

Teachers capacity

Parents Scores in Percentages

100

PTAs Management of Schools

80

Buildings 25

60

Teaching materials

20

Utilities

40

0

ICT


Fig.7.6 Community Score Card for Education by parents of Butamwa Primary School 70 70 Parents Scores in Percentages

60 50

Payments 60

Adequate number of teachers 50

50

Buildings Cleanliness 30

40

Qualified teachers 20

Schools performance

20 10

30

Materials required at school Clean water

20 10 0 Performance Variables


118


Fig.7.7 Community Score Card for Education by Teachers of Butamwa Primary School 40

40

School performance

30

Training

Teachers Scores in Percentages

40 employment generating activities Incentives

35 30 10

25

5

20

Books

15 10 5 0 Perormence Variables

Fig.7.8 Community Score Card for Education - Rubona Primary School, Kibungo 100

100

100

99.5

98 90

Scores in Percentages

80 100 90 80 70 60 50 40 30 20 10 0

70

Water Workshops Sports Fields Laboratories Materials Toilets Classrooms Security General

Performance Variables

Fig.7.9 Community Score Card for Health - Rusizi Health Centre,Cyangugu 80 80

70

75 70 60

Casualty,inpatients,outpatients Relations with parents,local leaders etc


60

50

50

Materials-drugs etc Hospitalisation

50

Toilets Matenity 30

40

Consultation rooms Incineration Ambulatory services

30

20 0

0

10



119


Fig.7.10 Community Score Card for Health by Men - Nyange Health Centre 62

60


50

Time before receiving a patient

70

antenatal services

60

Immunisation Mutuelle de sante

50

Child Nutrition

15

40 30

0


Fig.7.11 Community Score Card for Health by Providers- Nyange Health Centre Equipment

98 100

Maternity and mothers room


90 Child immunisation

80 70

50

60

Salary 40

50

30

Proportion of budget received

30

40

20

30

5

20

Meeting between staff and community Child mortality


Fig.7.12 Community Score Card for Health - Muhima Health Centre,Kigali

30 35

Equipment Payment of hospital dues

40 40

Living conditions of personnel 50


Availability of drugs 60

information on location of health centre 70 70

Bahaviour and conduct of doctors Availability of drugs

80 80

Availability of doctors 90

Qualified personnel Reception

0

20

40

60

80

100

Waiting time



120


Fig.7.13Community Score Card for Health by Women - Ntagazwa Health Centre,Nyagisara 90


90 80

General reception Expectant mothers

70 60

Health Advisors 30

50 40

Maternity equipment

25

25

20

Number of toilets

0

30

Dental problems


Fig.7.14 Community Score Card for Health by Men -Ntagzwa Health Centre


95

100 90 80 70 60 50 40 30 20 10 0

Health Mutuelle Electricity 40

Toilets 30

30

Staff Houses Materials in general

20 0

0

X Ray facilities 0

Communication Dental equipment


Fig.7.15 Community Score Card for Health by Providers - Ntagzwa Health Centre 90 80

80 General reception Drugs

90 Scores in Percentages

80

60

60

Training

70

Staff salaries

60

Materials

50

Compenastion for work done 20

40 30 20 10 0 Performance Variables


121


8. POLICY IMPLICATIONS The CRC and CSC reports are numerical and descriptive presentations of the outcome of the pilot survey. However what is important is what these findings provide for policy improvement in service delivery.

8.1 GENERAL INFERENCES A number of general inferences can be made under a number of headings as follows; •

•

•

Access. Access to services can be seen in various perspectives. Physical access is in this study reflected by distance in kilometres to the nearest primary school or in minutes to the nearest health facility. In this regard both for education and health access is high. In education the most frequent distance was that between 0 and 1 km. In health the most frequent was distance of not more 30 minutes from the health facility. Citizens responses on very close and near the household were satisfactory with education rate being about 68 per cent while in health 70.1 per cent perceived that the distance was convenient. In education 91.7 responded that they have a government primary school while 53.3 responded that they had a government health facility near them. The apparently fair rating of access to educational and health facilities offered by government is mediated by a number of other aspects of service delivery that inform policy. The first is cost. Cost. In both services the issue of cost seems to be problematic. In education a relatively high rate of citizens responses of 32 per cent visit other education facilities because of cost. This of course needs to be received with caution because government primary education services are supposed be the least costly. In health too some respondents (10 per cent ) indicated that they visited other non government centres because of high cost. On why some women did not attend antenatal services 41.2 per cent cited that they could not afford the costs. About 37 per cent of respondents indicated that women who were pregnant delivered at home and not at the health facilities. Out of these 28.4 per cent indicated that it was because they could not afford the costs. In health 42.3 per cent (the most frequent) state that most of the payments are from their own pockets. In health the most frequent amount paid is between Rwf 1001 and 5000 at a time. Cost in terms of paying for basic service is a common and complex problem that may be tied to poverty and the rates charged. Efficiency. Efficiency may be measured by different techniques. The rating by citizens’ responses for views on how schools are managed in terms of discipline is fairly good, as expressed by 55 per cent of all respondents. However as noted above some households noted that children still drop out of schools because of cost, to look for work or because of being orphans. Many respondents (63.1 per cent ) stated


122


•

•

that the waiting time is not long. Some 96.1 per cent of health respondents state that there are toilets at health facilities they visit. Quality. Both education and health rate quality of services favourably, but of course with space for improvement. Among respondents 67 per cent believe the quality of education delivered is good. The rate of satisfaction with education given to different children in a household is higher that 57 per cent as a whole. For health more than 72.5 per cent are completely satisfied by the services delivered. However again these are very general ratings that are mediated by community perceptions in Community Score Cards where the quality in specific terms is not, in all cases, given a high score in focus group discussions. Participation. The basis for participation seems to be in place. In education PTA are almost ubiquitous. However we see that a large number of parents do not attend meetings regularly because of being in most cases busy. About 83.4 per cent of respondents indicate existence of health committees in their respective areas but a meeting being held monthly was indicated by 53.4 per cent.

The results are from 8 sampled Districts belonging to four provinces. It is clear that some structure, institutions and functions for service delivery is in place and general opinion is fairly positive. However this suggests policies that deepen and broaden services and enforce more efficient service delivery mechanisms. Participation facilities seem to be in place. However as seen they still need to be strengthened with the view of making them better tools of demanding efficiency from service providers. The Community Score Cards shed light also on the need for strengthening policy instruments and interventions in relation to service delivery. Indeed except some differences between urban and rural service facilities they present a clearer picture of weak spots that need to be focussed on. In Education almost every centre has lack of laboratories and equipment. In some areas like rural Cyangugu, school buildings are dilapidates. Furniture and books are still indicated to be in short supply with very low scores. The sizes of classes are large and in most facilities double sessions have been improvised as temporary solution. In most educational centres the differences in access between girls and boys is not very significant but in one centre this was cited as a problem. Lack of school lunches is a common problem also. While there are school accounts everywhere there is a general complaint of delay of transfers to the account. An area that is interesting is absence of complaints of corruption or financial accountability. ICT is a concept that is appreciated but computers have still to be acquired and electricity supply ensured. Toilets are available but in many places separation between boys and girls has not been ensured and in some cases rooms are said to be few. Health facilities seem to be generally good especially in towns. In Cyangugu a health centre caters also for populations from DRC. Except for the resulting overcrowding the services have been said to be relatively good. In this particular case credit is given to a new and innovative contractual approach in


123


practice there. Score for a health facility in Kigali City also show this difference. In almost all other centres common problems are lack of ambulances, health insurance, salaries that are low and in some cases like Mirenge district nutrition and maternal mortality. Otherwise as a whole health services seem to be rated better than education in the community score cards. There was a short CRC on plots in Kigali City. The CRC was administered for Kigali only. Access to be easier to wealthier people 37.6 per cent and since it may take years to get a plot932.6 per cent and majority) it is an inefficient service. More than 53.2 per cent are dissatisfied with the plot distribution services.

8.2

RECOMMENDATIONS

For Citizens Report Card and Community Score Cards the simple data is almost self explanatory. Policy makers may assemble a lot of lessons from the responses. The following recommendations may be useful to consider. • • •

• • • •

•

To roll out a national survey for one or both health and education Follow up action plans set by communities as a monitoring system for the community role and empowerment Address the problems related or resulting into to poor service delivery particularly supply of equipment, laboratories, books, furniture, school lunches, flow of funds to accounts and ICT policy implementation for education. For health there is lack of ambulatory services, shortage of skilled personnel, low coverage of insurance schemes and low salaries Contractual schemes like those observed in Cyangugu and participatory programmes in Gisenyi could be rolled out in the rest of the country. Efforts to promote efficiency, access and equity as well as accountability need to be accelerated. Citizens’ voices need to be heard and mechanisms to empower them enhanced so that they can have a better say and participation in matters of demanding service from providers and working out own strategies. Decentralised organs will need to be strengthened to promote this demand for better service delivery


124


BIBLIOGRAPHY

Chossudovsky(1998) Globalisation of poverty. Zed Books. Fukuda-Parr and Pozzio(2002) Governance,Past,present,future. Setting the governnce agenda for millennium declaration. Maryssee,Herdt and Ndayambaje(19930 MINECOFIN (2002). Public Expenditure Tracking Survey.Kigali MINECOFIN(2004) Core Welfare Indicators Questionnaire .Kigali MINECOFIN(2004) Questionnaire Integre de Bienetre de Base(QUIBB) MINECOFIN(2004) Poverty Reduction Strategy-Annual Progress Report. MINALOC(2002). Decentralisation Policy.Kigali MINECOFIN(2002). Poverty Reduction Strategy Paper. .Kigali Reinikka, R. and Svensson,J.(2002). Assessing frontline service delivery. World Bank Schacter, M. (2000). PSR in developing countries: Issues, Lessons and future directions. Ottawa. Institute on Governance. World Bank(2004) Rwanda.Education.Rebalancing resources for poverty reduction in post conflict reconstruction. Washington D.C.


125


ANNEXES

RESEARCH TEAM The team has been determined according to three criteria. •

Continuity and learning process.

All members who participated in the First Pilot Study Team have been incorporated. The previous instruments were also improved. •

Capacity building

A group of young associate researchers was incorporated to expose them to practical research activities on the one hand and the CRC/ CSC process on the other. •

Responsiveness, rapid intervention and meeting deadlines

The plan was to involve as many members of OSSREA as possible. The strategy is within the spirit of OSSREA of inclusion but also getting rapid results on limited resources. Only 4 members of the team will be on the project fulltime as mentioned earlier. See number of working days per member.

4.6.1. Coordination and Advisory Team 1.

Dr Herman MUSAHARA

PhD

Liaison Officer OSSREA

2.

Dr Rama RAO

PhD

CSC Advisor

3.

Mme Sharon HABA

MSc

Deputy Liaison Officer

Team Leader

Deputy Team Leader

4.6.2. Core Team Qualification

Responsibility

1.

Mme Marie Therese KAMPIRE

Name

MSc

Head District Team.- Gisenyi Ville

2.

Mr Pierre Claver MUTAMBUKA

M.Phil

Head District Team-Kibungo Ville

3.

Mr Bernard RUTIKANGA

M.A

Head District Team-Gatare

4.

Mr Pierre Claver RUTAYISIRE

DEA

Head District Team-Cyangugu

5.

Mr Joseph HAHIRWA

M.A

Head District Team-Hahirwa

6.

Mr Gerard NYABUTSITSI

MSc

Head District Team-Nyagisagara

7.

Miss Susan MUTONI

M.A.

Head District Team-Nyarugenge

8.

Mme Therese MUSABE

MSc

Head District Team-Butamwa


126


4.6.3 Associates Name

Qualification

Responsibility

1

Mr Telesphore NGARAMBE

M.Sc

Associate Researcher

2

Mr Richard NIYONKURU

M.Comm.


3

Mme Claudine UMULISA

License


4.

Miss Veneranda INGABIRE

OSSREA member


5.

Miss SOFIA

OSSREA member


6.

Miss OLIVE

OSSREA member


7

Miss ALICE

OSSREA member


8.

Mr BUGINGO

OSSREA member


9

Mr Dennis MIGAMBI

OSSREA member


10

Ms CHRISTINE

OSSREA member


11

Mr Freddy UWISANGA

OSSREA member


12

Miss MUDENGE

OSSREA member


13

Miss LOLIOSE

OSSREA member


14.

Miss KURUJYEJURU

OSSREA member


15.

Mr NEMEYE

OSSREA member


16.

Mr Eugene NDAHIRO

OSSREA member


4.6.4.ITINERARY TEAM LEADER

Associates

31st October to st

TEAM 1

Cyangugu

Mr P.Claver RUTAYISIRE

V TEAM 2

Gatare

Richard

2nd

to

4th

1 November

2005

Kamembe

Shagasha

November

Ingabire Mr Bernard RUTIKANGA

Mugunga

Cyato

Cyiya

Sofia TEAM 3

Gisenyi V

Mme M. Therese KAMPIRE

Karangwa

Gisenyi

Byahi

Rubona

Sovu

Kibungo

Rubona(K)

Zaza

Nyange

Nyarugenge

Biryogo

Butamwa

Nyarubande

Liliose Doris TEAM 4

Nyagisagar

Mr Gerard NYABUTSITSI

a TEAM 5

Kibungo V

Bugingo Olive

Mr P.Claver MUTAMBUKA

Jowelia Umulisa

TEAM 6

Mirenge

Mr Joseph HAHIRWA

Ngarambe Kurujyejuru

TEAM 7

Nyarugeng

Miss Susan MUTONI

e

Migambi Christine Ndahiro

TEAM 8

Butamwa

Mrs Therese MUSABE

Alice Freddy Nemeye


127

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