Rwanda’s Health Care System: A Lesson For the World

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Far from the genocide-stricken and poverty and disease-ridden country, Rwanda has emerged as the only country in sub-Saharan Africa that is on track to meet most of the Millennium Development Goals. Here is a lesson for the world.

Rwanda, where life expectancy has doubled, offers a cost-efficient healthcare system for its entire population. And the results have been stunning.

The last 10 years: Deaths from HIV, TB, and Malaria have dropped by 80% each and maternal mortality rate has decreased by 60%. Annual deaths of children have dropped by 63% and, coupled with a 35% increase in population and control of diseases, have led to a marked rise in economic growth. Per person GDP increased to $580 while millions of people stepped out of poverty.

Compare this scene with Rwanda’s recent past. Here is a lesson for the world.

Post-Genocide in 1994: At least 1 in 4 children died before turning five years old, infectious diseases ran amok, healthcare facilities were dysfunctional, life expectancy was only 30 years, economic growth stagnated as healthy workers were few in number, and poverty and confusion defined the socio-economic-political scenario.

How did Rwanda achieve such improvement?

While some experts believe that Western financial aid in the aftermath of the genocide helped Rwanda achieve its present state of development, it is well-known now that Rwanda received the least health aid among all sub-Saharan African countries because most wealthy countries considered Rwanda a “lost cause.”

Rwanda achieves its development by spending very little – $55 per person per year in healthcare and public health – but using  it very effectively. Here is a lesson for the world.

Centralized planning adopted by the Rwandan government has played a key role in identifying health as a crucial element of the country’s development. They framed a plan ‘Vision 2020’ in order to become a middle-income country. The government has also notified that  ministries will work with cross-cutting issues, such as HIV and cardio-vascular diseases, because all are inter-linked in the progress of the country.

Similarly, the government has specific plans for development and organizes foreign aid accordingly and does not allow aid agencies whose missions do not coincide with the ‘Vision 2020’ plan.

According to the Minister of Health, Dr. Agnes Binagwao, improvement must be sustainable. So, in addition to building clinics and hospitals, 45,000 community healthcare workers were trained to provide home-care and psychosocial support to HIV patients. Primary care is crucial and additional community care from trained personnel sustains improvements in health. Retention of HIV patients in care has been 92% in Rwanda, in sharp contrast to 50% in USA. Here is a lesson for the world.

Rwanda provides universal health insurance in order to provide adequate health care to everyone. The community-based health insurance company, Mutuelles de santé, has ensured that out-of-pocket expenses decrease and more people can be treated without being pushed into poverty owing to high medical bills.

Rwanda’s health policies are based on available health data. Chair of the Department of Global Health and Social Medicine at Harvard Medical School and co-founder of Partners In Health, Dr. Paul Farmer, says the Government of Rwanda uses a ‘burden and gap analysis’ in order to 1) identify those problems that cause maximum ill health and then to 2) identify those cases where the most cost-effective intervention can be achieved to fill the gap.  Here is a lesson for the world.

Rwanda centralizes scientific research in its policy framing. Thus, it successfully addresses upcoming challenges and ensures efficiency of proposed plans and programs.

Dr. Farmer believes that there are lessons for the whole world, including the USA, to learn from Rwanda. Through central planning, accessible healthcare, result-based policy framing, and community health-care, Rwanda has been able to uplift a society from the doldrums of genocide onto the path of sustainable health and economic development.

Dr. Farmer rightly asserts that Rwanda has demonstrated that it is indeed possible to break out of the cycle of poverty and disease. Here is a lesson for the world.

– Mantra Roy

Source: The Atlantic
Photo: CWH Central

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