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Instruments and structures of development cooperationconcluded

Rwandan-German Development Cooperation in the Health Sector

The German Federal Government supported the health sector in Rwanda from 1980 to 2012. At the end of this cooperation between the two countries, DEval investigated the impact that the cooperation had achieved during this period and the conclusions that can be drawn for cooperation with other countries in the area of health care. The evaluation was completed in 2014.

In keeping with international agreements such as the “Paris Declaration on Aid Effectiveness” adopted in 2005 and the “Accra Agenda for Action” adopted in 2008, Rwanda has committed itself to improving the division of labour between donors. One intervention entailed limiting the cooperation with partner countries to three priority sectors in each case. At the request of Rwanda, the German Federal Government thus decided to end its involvement in the Rwandan health sector.

The end of the cooperation provided a good opportunity to take stock and assess the various development cooperation programmes and instruments that the countries used during the 30 years of cooperation. For this purpose, the cooperation period was divided into three phases, based not only on historical circumstances in the country but also on the form of German development cooperation: (1) the period between 1980 and the genocide of 1994, (2) the post-conflict period and subsequent years of reconstruction up to around 2003 and (3) the period from 2004 to 2012. The core component of the evaluation was the last phase.

Results and Recommendations

The state of health of the Rwandan population improved substantially during the last decade that was examined – an improvement to which German development cooperation made a significant contribution.

The combination of financial and technical cooperation tools used and the approach of intervening at both district and national level had a positive effect. However, there continues to be great inequality in terms of the provision of health care, which Rwanda urgently needs to resolve. This applies above all to women, poor people and the rural population.

The aim was to reach as many people as possible through health services and improve the quality of those services. German development cooperation thus concentrated primarily on strengthening the country’s health care systems.

In this way, it provided an important counterbalance to the programmes of other donors, which were primarily committed to preventing and combating individual illnesses such as malaria, tuberculosis or HIV/AIDS.

In future health care interventions in comparable country contexts, development cooperation should pay increased attention to deploying key individuals in communities.

Doing so would intensify the multiplier effect. It would also make it possible to tap potential synergy effects between the private and public sectors. Moreover, Germany should provide greater support for the partner countries in medical training. In return, the partner country concerned must endeavour to provide sufficient funding for training.


The evaluation was completed in 2014. This is a summary of the results and recommendations; you can find the complete results and recommendations in the report.

Objectives of the Evaluation

In terms of specific objectives, the evaluation aimed to explore the following issues:

  • the development of Rwandan-German cooperation in the health sector;
  • the relevance, effectiveness, efficiency, impact, sustainability, coherence, coordination, complementarity and harmonisation of Rwandan-German cooperation in the health sector;
  • successful and less successful development cooperation modalities and tools as well as how they interact and adapt to changing circumstances both within the sector and with respect to socio-economic and political developments;
  • the strategy based on the progressive withdrawal of German development cooperation from the health sector.


In 2010, the German Federal Government agreed to the request of the Rwandan government to discontinue its support to the Rwandan health sector by the end of 2012. The amicable decision accommodates the Rwandan Government’s commitment to improve the division of labour between donors in accordance with the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action.

This historic moment provided a unique opportunity to assess the 30 years of cooperation in the health sector by means of a summative evaluation. DEval conducted the evaluation between July 2012 and October 2013.

In line with the phases of Rwanda’s history and the milestones in German and international development policy, the evaluation divided the period since 1980 into three periods: (1) the period between 1980 and the genocide of 1994, (2) the post-conflict period and subsequent years of reconstruction up to around 2003 and (3) the period up to 2012, which was characterised by the integration of the Rwandan-German health care programme into the Rwandan Sector-Wide Approach (SWAp) including sectoral budget support.

An analysis of the key social, political and economic trends examined the entire period since 1980 and provided the backdrop for a critical revision of Rwandan-German cooperation since 1980. This context analysis also included an overview of changes in the health sector and the development of the health of the Rwandan population.

The evaluation looked primarily at the phase between 2003 and 2012. First, the extensive documentation of more recent development projects in comparison to the early phase allowed a more precise analysis. Second, the strategic change in Rwandan-German cooperation since 2003 provided an interesting additional object of investigation.


The evaluation applied the following methods: (1) literature and document research, (2) a standardised online survey among former development workers, (3) interviews with various groups of key stakeholders, (4) a statistical data analysis of the most recent Demographic and Health Survey (DHS) in Rwanda and (5) a comparative case study of the health care systems in four selected districts, using focus group discussions and qualitative interviews.



Portrait von Dr. Martin Noltze
© DEval

Dr Martin Noltze

Senior Evaluator - Team Leader

Phone: +49 (0)228 336907-934

E-mail: martin.noltze@DEval.org

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