Child survival & development
Rwanda has made more improvements in child survival than any other country in the Eastern and Southern African region
UNICEF’s Child Survival & Development Programme supports the Government of Rwanda’s efforts across multiple sectors, including maternal, newborn and child health; nutrition; HIV and AIDS; and water, sanitation and hygiene (WASH). Rwanda has one of the best health systems in the region, with more than one health centre per sector and 45,000 community health workers (CHWs) focusing on the health of children under 5 years of age. This has led to a sharp reduction in under-five mortality over the past decade: according to the Rwanda Demographic and Health Survey 2014-15 (2014-15 RDHS), the rate fell from 103 deaths per 1,000 live births in 2005 to 50 deaths per 1,000 live births in 2015. The overall reduction in child mortality is primarily attributable to gains in the post-neonatal period, while neonatal mortality has declined only modestly and constitutes an unfinished agenda.
Just as importantly, maternal mortality has also been significantly reduced, from 1,500 deaths per 100,000 live births in 2000 to 210 deaths per 100,000 live births in 2015. This is largely due to the fact that 91 per cent of deliveries now take place in health facilities, and that the Government of Rwanda has improved access to health services for the poor and other vulnerable groups through the community Mutuelle de Santé medical insurance system, which covers 90 per cent of the population. In spite of this notable progress, the current mortality rates are still high compared to countries in other regions of the world.
I do volunteer work because it’s the way I can benefit my society.” - Esther, Community Health Worker from Musanze district
In terms of the nutritional status of Rwandan children, 87 per cent of infants under 6 months of age are exclusively breastfed, which is quite high compared to other countries in the region. Only 18 per cent of children between 6 and 23 months receive the minimum acceptable diet necessary to ensure healthy growth, however, and 37 per cent of children suffer some degree of anaemia. Inadequate nutrition among pregnant women also results in a higher-than-average rate of babies born with low birth weight; this contributes to Rwanda’s neonatal mortality rate, which stands at 20 deaths per 1,000 live births.
As a long-term consequence of poor nutritional practices, stunting, or low height-for-age due to chronic malnutrition, remains a challenge: 38 per cent of children under the age of 5 are stunted, with the heaviest burden found in rural areas, where the stunting prevalence is 41 per cent, as opposed to 24 per cent in urban areas (2014-15 RDHS).
The Government of Rwanda has committed to achieving the elimination of mother-to-child transmission of HIV, with a target of reducing the rate of transmission to 2 per cent by 2015. That target has been met, and the present rate of mother-to-child transmission of HIV is 1.8 per cent at 18 months of age (National HIV Annual Report 2013–2014, Ministry of Health Rwanda), compared to 6.9 per cent in 2009. Among especially vulnerable populations, however, such as female sex workers, the mother-to-child transmission rate is 7.7 per cent at 18 months, which indicates a greater need to focus on key populations. While the overall rate of new HIV infections is declining in Rwanda, the increasing numbers of new infections among adolescents is an area of particular concern–especially since comprehensive knowledge of HIV is relatively low among people between the ages of 15 and 24 (2014–2015 RDHS)–which requires further knowledge and action to prevent an epidemic within this age group. In addition, only 55 per cent of females and 42 percent of males between the ages of 15 and 19 have ever been tested and received results for HIV, compared to 82 per cent of females and 77.6 per cent of males within the broader age group of 15 to 49 years (2014-15 RDHS). Furthermore, only 35 per cent of girls and 33 per cent of boys between the ages of 15 and 19 in need of antiretroviral treatment are receiving it, compared to 79 per cent of people aged 15 years and above, all of which highlight the need for a greater focus on adolescents.
Recognizing the key role that WASH plays in the promotion and protection of public health, socio-economic development and gender empowerment, the Government of Rwanda has committed itself to a target of 100 per cent water and sanitation coverage by 2017/2018, as outlined in the Second Economic Development and Poverty Reduction Strategy. According to the 2014-15 RDHS, 73 per cent of households have access to an improved source of drinking water, while 54 per cent of households have access to an improved, unshared toilet facility. There are also large disparities based on both geography and wealth: access to an improved drinking water source in rural areas is 69 per cent, for example, while in urban areas it is 91 per cent. Similar disparities exist between the poorest and wealthiest Rwandans.
Strikingly, only 12 per cent of the households were observed to have a place for handwashing, and only 4 per cent of households were observed to have a place for handwashing with soap and water. Poor hygiene practices and the lack of appropriate services likely contributes to both the high incidence of WASH-related diseases and the high prevalence of stunting among children under 5 years of age.