Integrated Health Care


Gervais Twaherere stands with a potential vasectomy candidate and Charles Nkrunziza outside Mukono Health Center in Gicumbi, Rwanda


Greg Branch

GICUMBI, Rwanda - Nestled on a hillside, between tea and banana plantations, near an unexpected forest of silver dollar eucalyptus trees, lies the Mukono Health Center.

Staffed with volunteer community health workers, all of whom are trained and supervised by dedicated medical professionals, the health center is seen as an important example of community-based and holistic care for Rwanda.

Mukono provides ‘integrated’ health services — for everything including HIV/AIDS, malaria, maternal and child health care, family planning and reproductive health— and boasts 136 community health providers serving a population of about 18,200 in 4 rural villages in the Gicumbi district. They also offer home visits for those unable to make regular trips to the health center.

The restructuring of the Mukono Health Center is a part of an five year agreement, totaling $27.8 million*, between the United States Agency for International Development (USAID) and implementing partner IntraHealth to integrate health services and strengthen health systems in 46 different hospitals, health centers and prisons. The Mukono Health Center was allocated $46,914 in 2011 which has gone to enhancing the quality of services by training providers, upgrading facilities and equipment, and conducting public awareness programs.

On July 11, 2011, Mukono began offering vasectomies as an option for family planning. Three procedures have been performed. Charles Nkrunziza and Gervais Twaherere, two middle-aged farmers, were the first to have the procedure. They were both eager to discuss their decision to curb the size of their families.

While getting a vasectomy can be a difficult choice for most men, it is particularly shunned in sub-Saharan Africa. When asked why he chose that method of birth control, Twaherere had a surprisingly easy answer, “I have had the number of children that I desire, I don’t want to have more, so we needed to stop having children.”

After their procedures, Nkrunziza and Twaherere joined the community staff at Mukono and helped counsel other men regarding vasectomies. Now 20 more men await the procedure.

The Mukono Health Center is a part of 'Vision 2020', an aggressive move by President Paul Kagame's government’s, to reduce aid dependency, transform the country into a knowledge-based economy and create a productive middle class. Developed about 12 years ago, the government says Rwanda's healthcare is at the center of ‘Vision 2020.’ 

*An earlier version of this post incorrently stated that the total funding for the Mukono Health Center was $27.8 million.