Following the Financial Flow in Rural Rwanda
When Chunling Lu, PhD, arrived in the Kayonza district of Rwanda on the morning of June 15, 2011, she immediately set to work. By noon, she had secured a translator and driver, and was interviewing two recent graduates of the local university for positions on her team. By 3 p.m., she had hired them, and was training them to work in the field to collect financial data from health facilities in rural settings.
“We had so much to do, and we were very lucky to have an effective local team who implemented data collection – they picked things up so fast.” recalled Lu, a researcher in the BWH Department of Medicine.
Lu is a health economist, which means that her work brings her into contact with immunologists, anthropologists, statisticians and physicians at BWH, and also takes her to rural settings like Rwanda, where her team tracked the flow of money, goods and services in two rural districts as a part of the Rwanda Population Health Implementation and Training Partnership, a program for strengthening health systems in the two rural districts. Lu’s base was at a site run by Partners In Health (PIH), and with PIH’s support, she was able to assemble her team and get her project underway.
Rural health facilities in Rwanda serve approximately 85 percent of the country’s total population but lack effective health financial information systems to know how much support has been received each year and on what it has been spent. Based on field experiences in the two rural districts, Lu’s team recently completed a case study on developing a method for effectively tracking health facility finance that could have implications for health facilities in other low-income countries, including those in West Africa receiving aid to fight Ebola. In December, the team published a paper in PLOS Medicine describing a “five-step” procedure that they hope will be useful in strengthening finance tracking in these settings.
“As my colleagues have advocated, we need to take this crisis [of the Ebola epidemic in West Africa] as an opportunity to address a fundamental issue: health system strengthening,” Lu said. “Building an effective health financial tracking system is essential for informed budgeting, planning, monitoring and evaluation. After we completed analysis on collected financial data, we returned the results to health centers, and they found it to be very useful.”
The five-step procedure developed by Lu’s team has been recommended to the Rwandan Ministry of health and will be integrated into the Rwandan national health information system to strengthen its capacity for tracking financial data in health facilities.
Lu, originally trained as an economist, works alongside colleagues with expertise in different areas of medicine and public health in BWH’s Division of Global Health Equity and as an assistant professor in the Department of Global Health and Social Medicine at Harvard Medical School.
“It’s a dynamic and diverse group of people,” said Lu. “I have the opportunity to talk to medical doctors all the time. It’s a privilege.”