Félix Sayinzoga|Leon Bijlmakers
Drivers of improved health sector performance in Rwanda: a qualitative view from within
Ministry of Health|Radboud University Nijmegen|Radboud University Medical Center|Radboud Institute for Molecular Life Sciences
rwanda achieved great improvements several key health indicators including maternal mortality health outcomes raises question made possible makes rwanda uniquewe describe results webbased survey among district health managers rwanda gave personal opinions factors drive performance health sector particular determine maternal health service coverage outcomes questionnaire covered six health systems building blocks make framework health systems analysis two additional clusters factors directly covered framework community health determinants beyond health sectorcommunity health workers health insurance come factors considered contributed rwandas remarkable achievements past decade results also indicate importance health system features managerial skills culture continuous monitoring key indicators addition factors beyond health sector per se widespread determination people increase performance achieve targets determination appears multilevelled influenced intrinsic extrinsic motivationit comprehensiveness combination interventions drive performance rwanda rather single health systems strengthening intervention set interventions target specific disease need policy makers scholars acknowledge complexity health systems fact dynamic influenced societys fabric including overall culture performance management public sector rwandas robust model difficult replicate fasttracking elsewhere world interventions form part success require holistic approach