Rwanda has made tremendous strides in improving the health and well-being of its citizens over the past decade and attained health Millennium Development Goals ahead of schedule. To sustain these impressive gains and go further, the government of Rwanda (GOR), its development partners (DPs), and key stakeholders recognize the urgent need to have a well-capacitated and sustainable health system (HS). Through the five-year, $294 million Strengthening Capacity of the Health Sector to Deliver Quality Health Services (SCHS) Project, USAID/Rwanda is strengthening the Rwandan HS to deliver affordable, responsive, high-quality health services. The purpose of this evaluation is to better understand the effectiveness of the SCHS project activities toward the expected results, and provide specific learning and evidence for design, planning, implementation, and management decisions by the SCHS team going forward. The evaluation team used a mixed evaluation methodology combining review and analysis of quantitative data and application of qualitative techniques. The mixed methodology approach involved the systematic integration of different kinds of data, using different methods. The design of SCHS is well aligned with GOR and USAID strategic priorities, and has so far facilitated USAID support to strengthen the capacity of the Rwandan health sector to deliver high-quality health services, with some gaps and challenges remaining in specific areas, including inadequate coordination and collaboration among IPs in specific program activities, hindering overall efficiency. While some gaps and challenges remain, DELIVER/SCMS made critical contributions in significantly improving SCM systems in Rwanda. RHSSA has played a critical role in supporting and strengthening GOR capacity in HF, including domestic resource generation and effective mobilization. However some challenges remain. SCHS activities, particularly RHSSA, have meaningfully contributed to building leadership and governance capacity in health at central and decentralized levels; however, some gaps and challenges remain. so far, SCHS and its activities (RHSSA, AIRS, and DELIVER/SCMS) have targeted well most of the “important” and “changeable” factors that help contribute to the GOR’s capacity to sustain a strong system. To successfully realize the recommendations made, SCHS and its activities will have to focus on “important” and “changeable” factors of sustainability specific to each recommendation.
MIDTERM PERFORMANCE EVALUATION OF THE USAID/RWANDA STRENGTHENING THE CAPACITY OF THE HEALTH SECTOR TO DELIVER QUALITY HEALTH SERVICES (SCHS) PROJECT