Cécile is talking to Séraphine about her medicine. Séraphine is HIV positive. She lost her husband to the virus and is now bringing up their six kids in Bungwe, a village high in the hills of northern Rwanda.
A senior nurse at Bungwe Health Center, Cécile used to have to wait for a doctor to come to start people on antiretroviral therapy and conduct more complex medical evaluations—and those visits are only once a week. But now she can handle it by herself. She’s had the training courtesy of the Ministry of Health.
It’s just one of the changes since the center became an AIDSRelief site in 2005. Catholic Relief Services leads the consortium that runs the AIDSRelief program, which is funded by the President’s Emergency Plan for AIDS Relief.
“A lot has changed, I’ve learned a lot with the AIDSRelief program,” says Cécile. “It’s helped so much with patient care, with medication, counseling. They’ve trained us, mentored us—really helped us to work as a team. Treating HIV and AIDS is a multidisciplinary affair. None of us can work alone.”
What’s really stuck in Cécile’s mind from this morning’s consultation, though, is Séraphine’s boy, 12-year-old Jean-Claude. Cécile had to break some life-changing news to the child today. Like his mom, he is HIV positive. But Jean-Claude didn’t cry when he heard the news. He kept a bright smile on his face. He’s accustomed to coming to the health center with his mom to make sure she’s okay.
‘It No Longer Means Death’
Cécile has been counseling kids like Jean-Claude who may have been exposed to HIV during their mother’s pregnancy, delivery or breastfeeding. “Before, when you spoke to someone about HIV, it meant death,” Cécile says.“But, now, it no longer means death. We’ve been helped to treat patients as a human being like any other, not like someone who’s going to die.” Jean-Claude told her this morning that he wants to become a doctor.
Throughout Rwanda, AIDSRelief has drawn on three pillars to strengthen existing local health systems. It has looked at the financial side of things—how funding grants are managed. It has shown how the use of data can be vital in tailoring and improving treatment and the overall program. And AIDSRelief has invested in establishing and maintaining high-quality HIV care and treatment services. All of this is against a backdrop of involving the community in care and treatment, such as regular home visits, which help ensure good follow-up.
Nearly 12,000 people receive HIV care and treatment, and almost 7,000 of those undergo antiretroviral therapy The program has achieved outstanding clinical results in remote areas of the country: Only 2 percent of people fail to return for follow-up appointments, and 91 percent of people surveyed who are receiving antiretroviral therapy have a such a low level of the virus in their bloodstream that it’s undetectable.
Over the past few years, though, PEPFAR’s focus has shifted from an external emergency response to an increasing emphasis on strengthening health systems and building a sustainable response owned by each host country.
So, for the past 2 years , AIDSRelief has been accompanying Rwanda’s Ministry of Health, with its district hospitals and health centers, so that it could eventually take the driver’s seat. That transition is now complete. It’s the first time a host government has fully taken over a PEPFAR-funded HIV treatment program.
Alphonse Kayiranga is a nurse educator with the University of Maryland School of Medicine’s Institute of Human Virology, a member of the AIDSRelief consortium. “We’ve tried to do our best to prepare the different health centers and hospitals for transition,” says Alphonse. “We’ve tried to strengthen capacity and share our knowledge. I feel they’re well prepared. There’s also been work with central government to strengthen the national system. I’m confident that it’ll go well.”
For Leia Isanhart Balima, chief of party for CRS-Rwanda AIDSRelief, and her team, the transition has had an interesting twist. “It’s not every day in development that you get to work yourself out of a job,” she says. “It’s been really special to work with the team and watch the way they’ve grown and to watch the sites take ownership of the program and the government really taking on responsibility.”
She adds, “It’s neat to be able to let go and say we’ve put the basic building blocks in place for them, and now they can go on from here”.
Helen Blakesley is CRS’ regional information officer for West and Central Africa. She is based in Dakar, Senegal.
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