Pathway 2 - Health

• OVC of 0-5 years old. Health at young age strongly influences children’s development at later age. Pregnant women are targeted to ensure good health of the child at birth.
• Adolescent OVC. They specifically need access to SRH knowledge and services. OVC are generally more at risk of unwanted pregnancies and being infected by STIs. Specific attention is needed for young mothers.
• Children without adult support. These children often have psychosocial needs and lack the presence of an adult who explains them issues on hygiene, SRH, prevention of illnesses, etc. or accompanies them to access health services if necessary.
• Children from historically marginalized groups. They live in conditions that expose them to health problems and often lack sufficient knowledge on SRH (also among parents). Their access to health services is limited due to poverty and low awareness.

• The Ministry of Health, who is the main actor responsible for the health sector in Rwanda, and manages multiple laws and policies affecting the health situation of OVC.
• The Ministry of Gender and Family Promotion, supporting OVC development and a main partner for the scale-up of the Child Mentorship Model
• UNICEF, who gives financial and technical support to the Ministry of Health. UNICEF is also a member of the advisory council for Kuraneza project on ECD.
• ARCT-Ruhuka is specialized in the psychosocial domain, which is an area where CARE does not have sufficient in-house expertise.

CARE Rwanda’s work on this pathway is informed by the Government of Rwanda’s policy context. Of specific importance to this pathway are:

• The Minimum Package of Services for OVC (MIGEPROF, 2009) offers a guide for service provision to OVC, including a number of health related services.
• The National Community Health Policy (MINISANTE, 2008) envisions the provision of holistic health care services for all, embracing the values of equity in services distribution and solidarity with the disadvantaged as they seek health care.
• The Integrated Child Rights Policy (MIGEPROF, 2011) specifies the GoR’s commitments to ensure children’s access to health care.
• The Health Sector Strategic Plan (MINISANTE, 2009) operationalizes the EDPRS in the health sector. Of special interest is its sub-strategy on child and maternal health.
• The National Strategic Plan on HIV/Aids (MINISANTE, 2009) aims to make HIV prevention, treatment, care and support accessible for all Rwandans.
• The Reproductive Health Policy (MINISANTE, 2003) includes six priorities: safe mother & child health, family planning, prevention & treatment of STIs, adolescent reproductive health, prevention & management of sexual violence, and social change to increase women’s decision making power.
• The National Policy Against Gender-Based Violence (MIGEPROF, 2011) shows how the GoR is engaged in prevention, response and evidence building of GBV.
• The Health Insurance Policy (MINISANTE, 2010) allows all Rwandans in to be included in a community based health insurance scheme.

In order to achieve change in the health situation of OVC, CARE Rwanda contributes to awareness raising on maternal and child health, illness prevention, hygiene, immunization, nutrition, and SRH, facilitate access to health services for OVC, and use (community) advocacy for improved service quality. Where we see that direct technical support to health facilities is needed, we work together with others who are better placed to provide this support. This pathway works in close cooperation with pathway 3 that focuses on food and nutrition.

A combination of well-tested models and innovative approaches is used to achieve change, including the following:

• ECD. Holistic care for children at this age, crucial for their development, is ensured by integrating the 5x5 model. This model identifies 5 intervention areas that any ECD program should address (child development, health, food & nutrition, economic security and child rights & protection) and 5 levels it should work at to be effective and sustainable (the individual child, the family or caregiver, the childcare setting, the community and the national policy environment).
• Child Mentorship Model. The Child Mentorship Model provides OVC with an adult mentor to help them in multiple areas in their lives. The participating children choose adults they trust to serve as their volunteer mentor.
• Awareness raising on SRH and access to SRH health services. Apart from the attention given to SRH in the Child Mentorship Model, CARE Rwanda promotes awareness raising on SRH through peer educators (e.g. working with youth clubs or girls clubs, or by using World Vision’s life skills model).
• Community Scorecards. It is an approach that facilitates dialogue between citizens and service providers. It allows citizens to monitor and give feedback on the quality of a certain service provided.
• Advocacy. Through its experience from the above interventions, CARE Rwanda collects evidence on the accessibility of health services for OVC. 

The following indicators are used to measure impact at the level of this pathway:

• % of OVC receiving health components of minimum package of services for OVC
• % sexually active adolescent women 15-19 year who use a modern family planning method
• % OVC reporting an improvement in their psychosocial wellbeing

• Volunteer mentors so far have contributed to the physical and psychosocial health of the OVC under their care. The fact that the OVC do no longer feel left isolated and without help has already a great impact on their health status.
• Testimonies from parents, local leaders, community health workers and partner organizations, collected in qualitative assessments as part of Kuraneza project indicate that the ECD model has a positive influence on children’s health situation.

The following ongoing or recently closed projects contribute to this pathway:

• Kuraneza (Kinyarwanda for ‘good growth’)
• ECDRE (ECD in emergency response)
• NISU (Nkundabana Initiative ScaleUp)
• KGAS (Keeping Girls at School)
• COSMO (Community Support and Mentoring for Orphans and Vulnerable Children)
• NIPS (Nkundabana Initiative for Psychosocial Support)

CARE Rwanda is committed to learning, to continuously improve the relevance and quality of its work. In relation to health, it poses itself the following questions:

1. To what extent does an integrated child survival ECD model enhance the outcomes of a community health strategy?
2. How to strengthen OVC access to psychosocial support, both through mentors as well as through the formal health sector?
3. To what extent are the current ECD and Child Mentorship Models including and tackling the specific issues of historically marginalized and disabled children?
4. What are the current barriers that OVC face in accessing and using formal health services?
5. What role does traditional medicine and common practices based on these play in the health of children?