Connecting Clinical Care & Socioeconomic Development

Connecting Clinical Care & Socioeconomic Development

Rwanda
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$10,000 - $50,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

The Ihangane Project believes that sustainable improvements in health occur through home-grown solutions that are initiated by an invested community, supported through empowerment models of integrated program development, & maintained over time through quality improvement activities & targeted projects that address socioeconomic challenges to long term success of the intervention. In this particular program, TIP works with a variety of Rwandan stakeholders to leverage existing resources that address malnutrition & minimize the risk of HIV transmission through breastfeeding. In addition to developing clinical interventions, TIP is working with the Ruli community to address the challenges of local food security that threaten the long term success of the clinical program.

About Project

Solution: What is the proposed solution? Please be specific!

Our model guides the community through a process of infrastructure analysis & program development in a way that fosters empowerment and provides needed technical support. TIP begins with a core clinical need that, when addressed, will improve the ability to successfully implement best practices consistent with Rwandan Ministry of Health Protocols. We consider the socioeconomic factors that influence the potential success or failure of the clinical intervention & search for the means to address these issues in the larger community context. Most importantly, we take a community-based approach that begins by thoroughly understanding the existing infrastructure & by reaching out to stakeholders to understand their needs. Monitoring & evaluation is encouraged as a tool to appreciate the impact of their work & to recognize areas that are in need of improvement. In this particular program, TIP works with clinicians, Community Nutrition Workers, & program participants to identify the challenges to both short & long term nutrition needs & to develop sustainable solutions. Our approach is innovative because our core values are rooted in community-based development. Not only do we believe that this approach fosters invested participation, but it also provides a knowledge base that can be built upon in future endeavors. This will gradually minimize the community's dependency upon external resources. In addition, our series of short and long view approaches address sustainability of a clinical program by tackling the barriers to long term success such as local food insecurity.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

The medical community of Ruli District Hospital and the Ihangane Project have worked together to develop three specific goals for a comprehensive nutrition program. These goals include: i. The creation of a cost-effective clinical program that prevents both malnutrition and HIV amongst HIV-exposed infants through the provision of nutritional supplements, appropriate medical care, and clinical monitoring until 24 months of age ii. Long term success by strengthening the existing infrastructure that responds to malnutrition in the community, improving home and community-based food security, and securing a reliable source of nutritional supplements for vulnerable families. iii. The development of a culture of quality-driven, collaborative, empowering and integrated approaches to individual and community health. With these goals as our focus, our team has developed a concrete set of interventions and realistic measurable outcome objectives to meet these needs.
About You
Organization:
The Ihangane Project
About You
About Your Organization
Organization Name

The Ihangane Project

Organization Phone
Organization Address
Organization Country
Country where this project is creating social impact

, XX

How long has your organization been operating?

1‐5 years

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Innovation
What stage is your project in?

Operating for 1‐5 years

Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.

Ruli District Hospital functions as the hub of clinical care in the southern half of Gakenke District in the Northern Province of Rwanda. Its catchment area serves 7 health centers and 3 health posts, and it is the referral hospital for several health centers in the Rulindo, and Muhaga districts. Its reach encompasses a total population of approximately 200,000 rural-dwelling individuals.

As in the majority of countries globally, HIV prevalence of women in Rwanda is 3.6 percent. This is significantly higher than in men (2.3 percent). Eighty three percent of Rwandan people live in rural areas. Given the high population density in Rwanda and the relative ease of movement within this small country, rural communities are also at increased risk of HIV infection due to frequent contact with people in urban areas. In the Ruli District Hospital catchment area, situated 95 km north of Rwanda’s capital city of Kigali, approximately 4% of pregnant women are found to be HIV positive every year. This may be a low estimate, since The Ihangane Project’s anecdotal experience has been that the prevalence of HIV in Ruli may be higher than the statistics imply. Increased access to HIV testing through the recent initiation of solar electricity at rural health centers may provide more accurate estimates in the near future. In recent years, between 240 and 400 mothers and infants in this rural community participate in the prevention of mother-to-child transmission of HIV (PMTCT) programs due to maternal HIV infection on an annual basis.

Based on data compiled from Community Health Worker surveys of the Ruli catchment area, 16.7% of children under five years of age suffer from severe malnutrition. Although this proportion is disconcerting on its own, an additional 59.5% of children under five were found to be borderline malnourished, and so were at significant risk of suffering from malnutrition in the future. A prospective cohort study of children admitted to Ruli District Hospital from January 2008 to June 2009 demonstrated that 57% of hospitalized children suffer from chronic malnutrition.

In collaboration with clinical staff at Ruli District Hospital, the Ihangane Project initiated a pilot infant nutrition project in November 2009 intended to address the twin concerns of HIV and malnutrition and to support the delivery of Rwandan Ministry of Health protocols for Prevention of Mother To Child Transmission (PMTCT) of HIV. This pilot project, which responded to clinical trials indicating that the highest risk of long-term complications from malnutrition occur between 6 and 24 months of age, was designed to explore the challenges, constraints, benefits, and opportunities associated with infant feeding in the context of HIV and malnutrition in rural settings. Findings of this small pilot initiative, which involved assessments, interviews, and monitoring of seven mother-infant pairs, informed the design of the Ihangane Project’s Infant Nutrition Project.

In September 2010, TIP’s Infant Nutrition Project was expanded to include all HIV-exposed infants between the ages of 6 and 24 months presenting at the Ruli District Hospital. Because of the high rate of death due to malnutrition amongst the infants whose mothers have died from any cause, the program has also been extended to any infant with malnutrition due to maternal death. In November of 2010, Rwandan Ministry of Health protocols shifted to support extended breastfeeding in situations where the mother is taking HIV medications. In light of this change, the team reassessed the priorities for nutritional supplementation and shifted some resources towards providing nutritional support to breastfeeding mothers.

The Ihangane Project has been working closely with the communities within the catchment area of Ruli District Hospital for the past 5 years. We focus on building strong relationships between ourselves and a wide variety of stakeholders within the community. We make every effort to partner each American intern with a Rwandan counterpart to foster the transfer of knowledge. Through our collaboration with Dr. Ngirabega, a local Rwandan physician who recently obtained his PhD in Nutrition through his work with community-based nutrition outreach, we have an intimate knowledge of the challenges faced in this region.

Share the story of the founder and what inspired the founder to start this project

Dr. Leonard was the first physician to volunteer for the Clinton HIV/AIDS Initiative's clinical mentoring program in Rwanda. Since 2006, she continued to work as an educator and consultant to the health care providers in Ruli, Rwanda. Inspired by the dedication of the Ruli community to find solutions to their local dilemmas, as well as her observation that sustainable change must involve the engagement of all stakeholders, she founded The Ihangane Project in 2008.

Ihangane means ‘to be patient’ in Kinyarwanda, the native language of Rwanda. The Ihangane Project’s goal is to mobilize local communities to cultivate their own innovative solutions to their local health needs. Our belief is that true healing can only be promoted when the whole person is considered. For this reason, we encourage integrated approaches, whether we are focusing on an individual or a health system. We promote the integration of monitoring & evaluation into each project as a way of appreciating the positive impact of the intervention and identifying areas in need of improvement.

We have been struck by the importance of sustainability in program development, especially in poor communities. That said, income generation is only one requirement. Empowerment, training, and efficiency are also equally as important, and often neglected, qualities in a sustainable intervention. Wendy and her team are hopeful that the Ihangane Project can be a model for how to incorporate all of these essential components into sustainable development and foster good health for all.

Social Impact
Please describe how your project has been successful and how that success is measured

Measuring impact is an important component of The Ihangane Project’s model for success. We emphasize the importance of building a system of monitoring and evaluation into each program. For this reason, we have set three main goals for the overall proposal that includes associated outcome objectives and timelines for completion. In addition, we have worked with the Ruli HIV Medical Team to implement a system of Monitoring & Evaluation into the clinical aspects of the program. This entire process has been guided by the direct involvement of representatives of all program stakeholders in Ruli, Rwanda.

In September 2010, TIP’s Infant Nutrition for HIV-Exposed Infants Pilot Project was successfully expanded to include all HIV-exposed infants between the ages of 6 and 24 months presenting at the Ruli District Hospital. Because of the high rate of death due to malnutrition amongst the infants whose mothers have died from any cause, the program has also been extended to any infant with malnutrition due to maternal death. Recent data shows that only 2 of the 41 children enrolled showed any evidence of under-nutrition, which is 7 times less than the average rate of malnutrition in this community. Because of the frequent nature of the nutritional assessments, these two children were quickly identified and referred to the malnutrition team for more concentrated support.

In 2010, the team developed a standard Infant Nutritional Assessment data sheet that would be completed for every program participant on a monthly basis. When the program expanded to include all eligible families at Ruli Health Center, the handwritten form was found to be cumbersome and less effective because of the labor-intense data entry into Excel spreadsheets. We are now in the process of developing an electronic version of the Infant Nutritional Assessment form. This will allow the medical staff to more easily follow the individual families over time, and also provide a simpler way to collect and review aggregate data. The team can more easily identify areas of strengths or weaknesses in the program, adjust the program according to this data, and then evaluate the impact of the changes.

To foster cross-training in both HIV and malnutrition, The Ihangane Project is developing a pocket guide that provides straightforward information regarding protocols for prenatal care, PMTCT, management of HIV-exposed infants, and the diagnosis/treatment of various forms of malnutrition. This guide will be distributed to all physicians, nurses, and health center staff to provide easy point-of-care access to most recent Ministry of Health protocols. It also provides commonly used formulas and charts to improve proper medication dosages for children. Because many nurses specialize in one particular area such as HIV or Malnutrition, these guides will begin to develop a bridge between disciplines and assist them in considering the entire spectrum of Maternal & Child health. In addition, decentralized health care has placed more responsibilities upon the nursing staff, while decreasing physicians’ involvement with outpatient medical care. The physicians find themselves faced with managing complex cases in the hospital without extensive outpatient experience in either HIV or malnutrition. These guides will provide direct access to information that saves time and promotes standard of care treatment for mothers and young children.

In May of 2011, a draft version of the Pregnant Women & Children Pocket Guide: HIV Prevention & Treatment was field tested with Rwandan physicians and nurses at Ruli District Hospital. Participants were universally were excited about the concept of this guide, and offered their feedback regarding additional information they would like included. A final version has been developed, and should be available for distribution in September of 2011.

One major challenge to food security is lack of access to farming inputs and farmable land. The Ministry of Health has advised all district-based malnutrition programs to organize families with children under 5 into farming groups. This would allow these families to share land, as well as seeds and other farming tools. Although excellent in concept, this has been difficult to implement due to lack of local resources. The Ihangane Project will work in collaboration with a hospital-based agronomist and Rwanda Economic Development Initiative (REDI) to create the most effective means of organizing these families to provide them with land, seeds, appropriate soil, and adequate knowledge in organic farming techniques. By taking this community-wide approach, HIV + families would be integrated into these farming cooperatives without being identified as HIV+. These farming cooperatives will provide access to a variety of nutritious foods, as well as income generation.

The NHI Program utilizes fortified sosoma as a staple nutritional supplement to prevent malnutrition amongst HIV-exposed infants. To improve long term sustainability of this aspect of the program, Ihangane Project would like to develop a mechanism for local fortified sosoma production. With the assistance of a 2010 William Davidson Institute Global Impact (WDI) fellow, TIP and the Ruli community developed several potential business models for local production of sosoma. For any model to be successful, local cultivation of soya, sorghum, and maize (components of SoSoMa) must be increased. Our goal is to encourage the farming cooperatives to cultivate these grains in enough quantity to produce sufficient sosoma supply for the hospital. The cooperatives would provide these grains in exchange for land provision and the initial start-up costs of the cooperatives.

In May of 2011, a large focus group was held with HIV+ families who receive their health care at Nyange Health Center. This community meeting led to a training session in sustainable agriculture that was conducted by WDI Intern Sean Morris. After this training session, the Nyange PLWHA Association presented Sean with a proposal for the development of a farming cooperative. He is working with this group to develop a list of expectations and a business plan that will include donation of soya and maize to the hospital in exchange for the start-up costs of this farming initiative. Once this agreement has been established, the Nyange PLWHA Association farming cooperative will serve as a pilot project for future health center based farming cooperatives.

With the assistance of WDI fellow Sean Morris and National University of Rwanda biostatistics student Huriro Uwacu Theophila, The Ihangane Project is working to better understanding the existing Community-Based Nutrition Program (CBNP) and identify areas of need through a system of comprehensive community-based surveys. The team has developed and conducted surveys for 100 community nutrition workers (CNWs) to assess a wide variety of parameters, including nutrition knowledge, job satisfaction and areas in need of improvement. A second survey, developed for CBNP participants, assesses topics such as satisfaction with the program, household resources, family size, family income and nutrition knowledge. These surveys have been widely distributed and collected throughout the catchment area of Ruli District Hospital, and the information gathered will guide our decisions regarding cost-effective interventions. In addition, this information will serve as baseline data by which we will measure the impact of our future interventions. Sean and Theo plan to present their findings and recommendations to the Ruli District Hospital Nutrition team managers in early August 2011. Based upon their feedback, TIP will work with the team to identify the next steps in implementation of these recommendations.

Preliminary review of this data shows that the program is in need of a standard nutrition education curriculum, as well as a system for ongoing education of the CNWs. There is a lack of access to practical teaching gardens, and many families lack access to land, soil, or seeds that are needed to develop kitchen gardens. Many of these issues can be addressed in a simple, cost-effective manner, and all stakeholders agree that a hospital-based agronomist would easily facilitate any interventions that are recommended. Once the appropriate interventions are identified and implemented, HIV+ families from our NHI Program will be integrated into this system to receive the benefits of appropriate nutrition education, household nutrition assessments, and training for the development of kitchen gardens.

How many people have been impacted by your project?

101-1,000

How many people could be impacted by your project in the next three years?

1,001-10,000

Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact

We will strengthen the Community Based Nutrition Program, promote integration of HIV-affected families into the CBNP, & strengthen the clinical M & E system.

Task 1

Utilize CNW/Participant surveys to identify key interventions that will strengthen the CBNP & begin implementation of these interventions.

Task 2

Support the development of a PLWHA Association farming cooperative in Nyange that will incorporate training in sustainable agriculture & nutrition. This Coop will provide soya & maize to the hospital.

Task 3

Identify partner to develop an electronic form & then train the HIV nursing team to track both individual & aggregate data on HIV-exposed infants/mothers who participate in the clinical program.

Identify your 12-month impact milestone

Expansion of clinical intervention to all 7 health centers, strengthen stakeholder engagement, & network of farm coops to provide grains for local sosoma production & variety of nutritious crops.

Task 1

Development of Policies & Procedures Manual for clinical intervention that guides health centers in the expansion of the program.

Task 2

Establishment of Rwandan-based Steering Committee that reviews data, identifies areas of need, and makes programming recommendations.

Task 3

Expand from pilot farming coop @ Nyange to create cooperatives at all 7 health center sites

How will your project evolve over the next three years?

We expect to meet the following objectives in the next 3 years:
*Well-run clinic and community-based program run by Rwandan staff using strong culture of mentoring, communication, & data collection.
*A network of well-managed farming cooperatives providing high quality food to district population
*Peer-led nutrition intervention for HIV-exposed families
*Active community-based steering committee that makes recommendations based upon data & stakeholder input
*Effective & sustainable Nutrition intervention that includes exit strategy for families
*Clinical nutrition intervention model @ all 7-8 health centers with integrated QI programs
*Local sosoma production that meets the need for district food supplementation
*Elimination of mother to child transmission of HIV

Sustainability
What barriers might hinder the success of your project and how do you plan to overcome them?

This proposal is unique because long term sustainability is built into its design. The program provides short term access to nutritional supplements to prevent malnutrition in a high risk population while also providing a variety of tools for long term food security. We have identified four main areas that we must address to ensure the long term success of our program. These areas include long term food security for program participants once they graduate from the clinical program, appropriate skills/knowledge transfer as tasks shift to lesser trained medical personnel, program cost-effectiveness, and continued community engagement. Because the Ihangane Project works within the infrastructure created by Rwandan Ministry of Health protocols for HIV and Malnutrition, we are able to leverage existing resources to build a cost-effective and sustainable program.

The Ihangane Project initially planned to address the challenges of food security amongst our Nutrition for HIV-Exposed Infants Program participants through the performance of household nutrition assessments and the development of household kitchen gardens for all program participants. We found that a similar initiative was already in existence through Ruli District Hospital’s Community-Based Nutrition Program (CBNP). Ihangane Project is working with the CBNP to learn what is currently being done, where the gaps are, how the program can become more successful, and how we may integrate these approaches into the Nutrition for HIV-Exposed Infants (NHI) Program for primary prevention of malnutrition amongst HIV affected families. Ideally, food security will increase to a level in which many HIV+ families will no longer require nutritional supplementation. Despite this, there will certainly always be some vulnerable families who will rely on the hospital for external nutritional support. Within five years, however, the hospital-based program will be able to sustain itself through the local production of fortified sosoma.

The NHI Program utilizes fortified sosoma as a staple nutritional supplement to prevent malnutrition amongst HIV-exposed infants. To improve long term sustainability of this aspect of the program, Ihangane Project would like to develop a mechanism for local fortified sosoma production. With the assistance of a William Davidson Institute Global Impact fellow, TIP and the Ruli community developed several potential business models for local production of sosoma. For any model to be successful, local cultivation of soya, sorghum, and maize (components of SoSoMa) must be increased. Our goal is to encourage farming cooperatives to cultivate these grains in enough quantity to produce sufficient sosoma supply for the hospital. The cooperatives would provide these grains in exchange for land provision and the initial start-up costs of the cooperatives. Through this process, the NHI Program will have a sustainable source of fortified sosoma to serve its needs and the hospital will also be better equipped to provide nutritional support for a wider array of vulnerable families.

To foster cross-training in both HIV and malnutrition, The Ihangane Project is developing a pocket guide that provides straightforward information regarding protocols for prenatal care, PMTCT, management of HIV-exposed infants, and the diagnosis/treatment of various forms of malnutrition. This guide will be distributed to all physicians, nurses, and health center staff to provide easy point-of-care access to most recent Ministry of Health protocols. It also provides commonly used formulas and charts to improve proper medication dosages for children. Similar pocket guides will eventually be developed for volunteer Community Nutrition Workers. These guides will be in Kinyarwanda, and reflect the most important aspects of community-based malnutrition management. In addition, a standard nutrition curriculum will be developed and shared with the network of CNWs though a series of training opportunities.

To encourage ongoing stakeholder involvement and commitment to these program initiatives, the community plans to establish a steering committee. This committee will be comprised of physicians, nurses from both HIV and Malnutrition teams, HIV+ and HIV- program participants, an agronomist, and a member of the local business community. They will review and assess quality measures, decide upon quality improvement activities, and direct ongoing program development.

Because we believe that economic development is key to HIV prevention and to longevity for those who are living with HIV, The Ihangane Project works with two women’s artisan associations to strengthen their business practices and increase their access to a variety of markets. Many of these women are HIV+ or at high risk due to extreme poverty. One of these groups extended invitations to the women in the NHI program to join their association. Women who are interested are trained at no cost. Once their skills meet the expectations of the group, they share all of the profits with the other women in the association. This allows the women in the NHI program access to income and social support that can decrease their families’ risk of malnutrition once they exit the nutrition program.

In the future, we hope to create the Economic Development Center for the Promotion of Healthy Families. This will be a central site that families can be referred to by medical providers for job and financial management training, farming techniques, English classes, income-generating projects, microloans and social support. This would further promote long term food security through economic development.

The Ihangane Project’s initiatives reflect the community’s input, maximize local resources, and both champion and further develop indigenous leadership, knowledge, and capacity. All of these factors help to strengthen the likelihood of long term success.

Tell us about your partnerships

Because our area of expertise lies with our medical knowledge and our ability to build relationships within communities, The Ihangane Project forms strategic alliances with organizations that provide technical expertise for the non-medical aspects of the programs. We strive to partner with Rwandan experts because they understand the particular opportunities and challenges within their country. Our goal is also to cultivate local Rwandan talent and resources.

Our most important partnerships lie within the communities served by Ruli District Hospital. We are collaborating with community leaders in health, business, and agriculture, in addition to recipients of medical care.

To better guide these communities in the development of farming cooperatives, we will partner with Rwanda Economic Development Initiative. This organization, led by Christine Condo, has expertise in the cooperative management, good governance, and women-led business development.

We work within the Rwanda Ministry of Health guidelines for HIV and Nutrition, and partner with them to strengthen rural communities' ability to implement these protocols. Once we have developed a scalable solution, we offer our experience to other rural communities. We hope to offer our pocket guides to the Ministry of Health once they have been more thoroughly field tested.

Because we are very interested in a cost-effective and time-efficient method of clinical data collection, we are considering a partnership with Dimagi. This is a for-profit firm that provides training for an open source mobile phone software system called CommCare. We would like to use this system to collect individual and aggregate data for the clinical program for HIV-exposed infants, and eventually connect all Community Health Workers, health centers and Ruli District Hospital to this electronic network that can improve communication, data collection, and care efficiency. Once this system has been established in the catchment area of Ruli District Hospital, the system can be implemented in other district hospital catchment areas through a train-the-trainer method. Since the software itself is free, this will be an extremely cost-effective way to develop a nation-wide electronic medical record that is integrated through mobile phone technology.

We are also hoping to partner with Catapult Design to assess potential clean water interventions. Because clean water is crucial for the success of any nutrition intervention, Catapult Design would perform assessments at each community health center to determine current practices and recommend potential solutions. This broad array of specialty partnerships creates a robust program that addresses a wide variety of potential challenges.

Explain your selections

The Ihangane Project has developed organically through a network of staunch supporters, volunteers, and small donations. In 2010, we partnered with UCLA HIV Care Clinic to install solar electrical systems at 5 health facilities in the Ruli District Hospital catchment area. The funding for this program came from a partnership between UCLA and an anonymous foundation.

How do you plan to strengthen your project in the next three years?

To strengthen our program over the next three years, we hope to increase our presence in Rwanda. Currently, we operate through a network of volunteers and graduate level interns who travel to Rwanda for discrete periods of time. We find that progress happens much more effectively when we have someone on the ground. Our goal is to have the funds to hire a full time in-country Ihangane project coordinator by January of 2013. We also anticipate that the development of a steering committee comprised of all stakeholders will further strengthen the program. In addition, we will continue to research the most effective business models for the development of local production of fortified sosoma.

Challenges
Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.

PRIMARY

Limited access to preventative tools or resources

SECONDARY

Health behavior change

TERTIARY

Limited human capital (trained physicians, nurses, etc.)

Please describe how your innovation specifically tackles the barriers listed above.

Our innovative approach provides access to nutritional supplements to prevent malnutrition and HIV in a high risk population, while also providing a variety of tools for long term food security. The opportunity for prevention of malnutrition also provides incentive for these families to consistently participate in their health care. In addition, we take an empowerment approach that includes the ongoing engagement of program participants in the decision-making process. Empowerment is often the most important tool in health behavior change. Improving access to knowledge tools and updated Ministry of Health protocols through simple pocket guides and standardized nutrition & sustainable agriculture curricula improves the human capacity at all levels of medical care.

How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.

PRIMARY

Enhanced existing impact through addition of complementary services

SECONDARY

Influenced other organizations and institutions through the spread of best practices

TERTIARY

Repurposed your model for other sectors/development needs

Please describe which of your growth activities are current or planned for the immediate future.

Our program strengthens the effectiveness of existing infrastructure for the prevention and early intervention of both HIV & malnutrition amongst high risk families. The Ruli District Hospital medical community can now implement gold standard Ministry of Health protocols more effectively, & these methods can be scaled to other communities. We plan to share our experiences & to offer any resources that we develop to other Rwandan communities. In fact, we are hopeful that our model can be scaled to all other district hospitals. In addition, we are working with our Monitoring & Evaluation specialist to develop a simple guide that outlines the general processes to develop logic models, strategic plans, goals & measurable outcomes that can be utilized in a community-based development setting.

Do you collaborate with any of the following: (Check all that apply)

Government, Technology providers, NGOs/Nonprofits, For profit companies, Academia/universities.

If yes, how have these collaborations helped your innovation to succeed?

Our partnerships with the University of Michigan, Ross School of Business & the WDI Global Impact Fellowship program have vastly broadened our understanding of the complexities of emerging markets. This collaboration has guided our thinking in terms of business models, consumer satisfaction, system efficiencies, communication, & other essential aspects in the sustainable development of health systems.

Partners in Health provided us with their thoughts & experiences at the onset of this project. The medical director at Rwinkwavu Hospital provided us with documents, work flow, & lessons learned. This information has been invaluable in framing our work.

We look forward to partnering with the Ministry of Health in Rwanda, Dimagi & Catapult Design on specific aspects of the program.