Health

2017

The crude mortality rate is 0.2/1000/month while under-5 mortality rate remains at 0.3/1000 / month - remaining above UNHCR standards as of September 2016. Infectious diseases are the leading causes of morbidity where respiratory tract infections alone accounts for 54 per cent of the total under-5 morbidity and 40 per cent of overall morbidity. Diarrheal diseases accounts for 9 per cent of the under-5 morbidity and 4 per cent of the overall. Malaria re-emerged as a public health threat in some of the Congolese refugee camps where the overall crude morbidity of Malaria represented 3 per cent of the total morbidity. Nyabiheke was the worst affected Congolese refugee camp. 
 
Due to continuous partial response attributed to low financial resources, the infectious disease burden has remained high in Congolese refugee camps as well as in the Mahama refugee camp. The total number of primary health care level consultations at all refugee camps in Rwanda remained at 227,072 for the period of January to August 2016, with a health facility utilization rate of 2.7 visits per refugee per year (within UNHCR standards).  All camp health centers were operational and staffed with minimal staffing needs thus the maximum capacity remained limited. The total number of primary health care level consultations increased by 8 per cent during 2015, which resulted in increased requirements for resources. The mentioned minimal staffing level had been a challenge in maintaining the quality of the services.  The number of staff in certain staffing categories remained much lower compared to refugee population. Some camp health facilities did not meet the minimal standards of health centres due to lack of funding, staffing, logistics and infrastructure.  The proportions of secondary referrals dropped from 6.9/1000 population in 2014 to 4.7/1000 in 2015.
 
However, with the Burundian emergency and the establishment of Mahama refugee camp the referral rate rose up to 6.9/1000/year again in 2016. The rise is due to higher morbidity burden within the emergency refugee program and the low response capacity of Mahama refugee health care facilities associated with lack of funding. Major causes of morbidity of in-camp population were exacerbated by congested living conditions and suboptimal WASH conditions.
 
A systematic community level prevention and promotion programs are in place in all camps, but in a limited scale due to finite resources and limited staffing.  Health education has been provided at the health centres during consultations in addition to the community level programs, focusing on the use of treated bed nets, the importance of growth monitoring, the use of safe water and prevention of diarrhoea, and the importance of vitamin A and deworming of children below 5 years. The availability and access to essential medicine was ensured through international procurement. Health services suffer high staff turnover, necessitating frequent new recruitments and thus regular on-the-job training. Due to limited staffing capacity the non-communicable disease response still remains suboptimal. Mental health issues are not understood and thus not correctly addressed.  Comprehensive community and institutional level preventive and primary health care is to be reinforced and continued in 2017. Access to primary health care is to be maintained at 100 per cent in all refugee camps. Adequate staffing and upgrading of the health posts to health centers in Mugombwa and Kigeme is to be completed. Reproductive health interventions will focus on providing safe motherhood, increasing family planning acceptance and improving antenatal and postnatal coverage. An objective and transparent referral mechanism will be in place providing referral support to all the refugee patients who need secondary and tertiary level of care. All camp health centres will be provided with necessary medicine and medical supplies with a 25 per cent buffer stock.