USAID/Rwanda's new Integrated Health Service Delivery (IHSD) Project is a five year project that aims to increase the use of facility and community-based family health (FH) services. For the purpose of this activity, "family health" includes an integrated package of services related to family planning and reproductive health (FP/RH), HIV/AIDS, maternal, neonatal, and child health (MNCH), malaria, nutrition, and safe water and hygiene. "Integration" means the organization, coordination and management of multiple activities and resources to ensure the delivery of more efficient and coherent services in relation to costs, outputs, impacts and use.

The IHSD Project builds upon more than ten years of USAID support to the Government of Rwanda (GOR) and to non-governmental organizations (NGOs), community-based organizations (CBOs), and the private sector in several areas of FH. The IHSD Project will emphasize the integrated provision of the following core services: • Voluntary FP services that enable delaying, spacing and limiting of births • Maternal and neonatal services, including safe delivery, newborn care, and management of complications related to pregnancy • Child survival interventions, including breastfeeding, integrated management of neonatal and child illnesses (IMNCI), community case management (CCM), and immunization The IHSD will also integrate the following interventions with the core services: • Malaria prevention and treatment • HIV/AIDS primary and secondary prevention (emphasizing prevention with positives [PwP]), and referral for testing, treatment, care and support • Nutrition • Safe water, sanitation, and hygiene

The integrated health service delivery project (IHSDP) will improve the use of HIV/AIDS preventive and treatment services at all entry points (e.g., FP, ANC, delivery, postnatal visit, immunization, sick child) along the continuum of MNCH care at both facility and community levels. The focus will be on the use of theory-based health promotion strategies, such as information, education and communication (IEC) and BCC, by all levels of providers--from doctors to CHWs--to promote prevention and referral for testing, treatment, care and support.

This is a new activity and the RFA is underway.

Pediatric HIV Care

The Family Health Project (FHP) is a new USAID/Rwanda's five year Award that aims to increase the use of facility and community-based family health services. For the purpose of this activity, "Family Health" includes an integrated package of services related to family planning and reproductive health, HIV/AIDS, maternal, neonatal and child health, malaria prevention and management. This award will support multiple activities and resources to ensure the delivery of more efficient and coherent services aimed at improving use of services and measurable outcomes in an efficient way. The FHP builds upon more than fifteen years of USAID' support to the Government of Rwanda, non-governmental organizations, community-based organizations and the private sector in several areas of FH.

The FHP will support pediatric care through the implementation of the national IMCI guidelines that include early infant diagnosis (EID) of HIV, counseling and referral to appropriate services for initiation of treatment and follow -up. Through BCC, counseling and referral, the FHP will also link PMTCT services to MCH services, and to the extent possible promote collocation of integrated services to reduce loss to follow-up of exposed children and children on ART. The FHP will also strengthen referral of newly

diagnosed children and their enrollment into care program. The FHP will provide LLINs to pregnant mothers and all HIV-positive children, in order to reduce HIV/Malaria co morbidity.

At community level the FHP will work closely with CHWs to strengthen the link between facilities and the community; promote case management of diarrhea, fever and pneumonia and track referral and follow up of HIV-positive children in their catchment areas.

The IHSD Project will primarily strengthen management and referral systems between facilities and

communities, as well as within communities. At the community level and between communities and

facilities, this project will initiate and/or reinforce:

• Supervision of CHWs by health center nurses

• Maintenance of CHW kits

• Referral systems, including emergency transport systems

• Accurate record keeping and reporting

Ensuring secure resupply along with a strengthened record/reporting system is essential for CHWs to

have the supplies they require and the skills to track distribution to clients. Supply management at facility

and community levels requires clear policies, plans and resources, and the use of data for monitoring and

decision making. It may also require interventions to promote accountability and sound management of

public goods.

The Integrated Health Service Delivery Project (IHSD) overall goal is to focus on strengthening service

provision, and/or building capacity of service providers in the context of the purchase/provider. The

specific focus will be on integration, decentralization and quality service with a technical emphasis on

HIV/AIDS, malaria and other infectious diseases, FP/RH, MCH, neonatal and child health, nutrition and

water and sanitation. Specific to HIV prevention, under HVAB, the IHSDP will use theory-based health

promotion strategies to promote sexual prevention using AB messages to promote family prevention (i.e.,

a multi-generational approach) by a cadre of providers, from doctors to community health workers.

Proven approach will also be used to refer clients from all entry points for testing, treatment, care and

support. Services such as family planning, antenatal and postnatal care visits, immunization, sick child

points will be used to promote prevention with AB. Services will be provided in at least 12 to 15 of the 30

districts in Rwanda. Specific mechanisms to promote quality assurance include training to strengthen

clinical supervision, commodity management and data use, and a monitoring and evaluation plan will be

established by a TBD partner.

The Integrated Health Service Delivery Project's (IHSD) overall goal is to focus on strengthening service provision, and/or building capacity of service providers in the context of the purchase/provider. The specific focus will be on integration, decentralization and quality service with a technical emphasis on HIV/AIDS, malaria and other infectious diseases, FP/RH, MCH, neonatal and child health, nutrition and water and sanitation.

The IHDS will use entry point such as family planning services, antenatal and post natal care visits, immunization, and sick child visits to promote other sexual prevention using proven and innovative IEC and BBC strategies at all levels targeting families and by a cadre of providers, from doctors to CHWs. Services will be provided in at least 12 to 15 of the 30 districts in Rwanda. Specific mechanisms to promote quality assurance include training to strengthen clinical supervision, commodity management and data use. A monitoring and evaluation plan will be established by a TBD partner.

The IHSD project will improve the use of HIV/AIDS preventive and treatment services at all entry points

at both facilities and community levels. Information, education and communication (IEC) and behavior

change communication (BCC) will be used during family planning, antenatal and postnatal care visits, to

promote the use of services to prevent mother to child transmission of HIV as well as to refer pregnant

women for testing, treatment, care and support.