Empowering Leaders in Rwanda to Deliver on National Health Priorities
Between 2018 and 2024, Rwanda’s Ministry of Health implemented the Fourth Health Sector Strategic Plan (HHSP4), prioritizing improved access to quality of public health services for all citizens as a key objective.
Despite Rwanda’s progress in strengthening its health system, leaders across the sector faced challenges turning national priorities into consistent, measurable results. Inconsistent coordination processes and limited use of data to target delivery efforts were stalling progress on critical goals like improving availability of essential medicines and improving Human Resources for Health (HRH) distribution at district hospitals.
The Ministry of Health recognized that addressing these gaps required a focused investment in supporting leaders and fostering a stronger culture of delivery to drive long-term impact.
In early 2022, DA began by working side by side with Rwanda’s Ministry of Health to understand the system from within, gaining a clear view into the delivery challenges and opportunities leaders and teams faced. By spending time within the Ministry and collaborating directly with leaders, DA was able to ground its support in the real rhythms, challenges, and opportunities of Rwanda’s health system.
At the outset, DA conducted a comprehensive capacity review to better understand how Rwanda’s health system was functioning and where additional support could strengthen delivery. This diagnostic drew on interviews with 20 senior leaders, a survey with 43 leaders across the sector, and a review of 21 strategic documents. The assessment highlighted strong foundations in shared aspirations, understanding of delivery issues, planning, communication, and partnerships, while also revealing gaps in data usage, the effectiveness of routines, proactive problem-solving, and consistent planning and implementation. These insights shaped a targeted leadership development program tailored to the Ministry’s day-to-day realities and laid the groundwork for the implementation support that followed.
Once the leadership development program was designed, DA worked closely with the Ministry to bring it to life through a blend of structured learning and hands-on delivery support. Three leadership retreats anchored the experience, bringing senior leaders together to align on the five national health priorities and chart the path from planning to implementation. These retreats were complemented by seven rounds of monthly coaching for 42 senior leaders, offering space for reflection and practical problem-solving rooted in the real delivery challenges they were facing. Mid-level managers also participated in two knowledge-sharing sessions, which created a collaborative learning platform for exchanging experiences and deepening understanding of delivery practices across the sector.
Alongside the structured learning, DA worked shoulder to shoulder with Ministry teams to help translate new skills into day-to-day action. This hands-on delivery support focused on the five selected priorities and included root cause analyses to diagnose problems, prioritization of interventions, development of delivery plans, and the establishment of clear routines to follow through on implementation. By working directly with teams as they tackled live challenges, DA helped embed delivery practices into the fabric of how work happened across the Ministry.
To sustain momentum and support long-term accountability, DA also helped establish a ministerial priority tracking team, chaired by the Office of the Minister of State. This team now plays a central role in monitoring progress on sector-wide priorities, addressing bottlenecks quickly, and ensuring leaders have the information and support they need to fast-track delivery. Together, these efforts created a stronger, more connected delivery system capable of driving Rwanda’s health priorities forward.
- Strengthened the culture of delivery: The structured learning program resulted in tangible shifts in how leaders set priorities, track progress, and collaborate across the Ministry.
- Accelerated progress on two national priorities: Strong ministerial leadership led to notable advances in reducing medicine stockouts and institutional maternal mortality.
- Rwanda’s Ministry of Health adopted delivery tools and practices: DA tools and frameworks were adopted across institutions, with leaders requesting the establishment of a dedicated delivery unit within the Ministry of Health.
- Improved coordination and decision-making: A sector-wide coordination and tracking team was formed and trained to strengthen reporting, problem solving, and evidence-based decision-making across leadership.
- Built lasting delivery capacity within the Ministry: The work left behind stronger institutional foundations, clearer delivery practices, and a growing community of health leaders equipped to sustain and scale results.
