How did Rwanda transition from loosing an estimated 80,000 citizens during the 1994 genocide to reducing its child mortality rate by 50% and expanding its average life expectancy by 10 years? And house hospitals that look like this! (Thanks to Partners in Health.)
The answer is complicated, but mostly attributed to its strong resolve to invest in a quality, accessible health care system.
After years of global health campaigns targeted at specific diseases, some experts are advocating to improving population health through systems, which are better equipped to prevent and treat specific health needs. Those for this shift have cited stunted progress towards achieving specific Millennium Development Goals, such as MDG 4, 5 and 6 (reduce child and maternal mortality rates and treat and prevent the number of HIV/AIDS patients, respectively). The skeptics are mostly cautious because investing in health systems can be expansive, expensive and require intensive management, with difficult to define results.
The case of Rwanda provides strong proof that it is worth every brick, penny, and health worker.
When forced to rebuild after the genocide, the Rwandan government knew it needed a health system equipped to tackle the interconnected issues of poverty and health. Its goal was to promote access to quality health care by eliminating financial barriers that blocked a majority of the country from receiving vital services. The government took responsibility for the project and created the Rwanda Vision 2020 plan as its blueprint. At its crux is the idea that: “Rwanda’s ongoing development will have, at its core, the Nation’s principal asset – its people.”
This massive undertaking came at no small expense. The country had lost much of its health facilities and workers, and a good portion of the health-related aid resources seeping into the country were directed towards HIV/AIDS. What could be done? Rwanda thought outside the box and integrated these ‘vertical’ program funds into constructing its health system. In doing so, they were able to treat 100,000 patients with HIV, an increase of 99,130 from 2002. Rwanda is on track to meet MDG #6 (as well as the others).
That’s just the start of it! Rwanda’s health insurance plan – Mutuelles de santé – is made affordable to all of its citizens to ensure that heath facilities are not too expensive to be useful. For the 25% of those who cannot afford the small fee, healthcare is provided free of charge. With more people able to access health services for the first time, a corps of community health workers was trained to fill in the gaps where there are no doctors or nurses. Rwandans are now able to seek help for a wide range of ailments that improve their overall quality of life, while the government is still able to reach international benchmarks for development and health progress.
Rwanda proves that building and strengthening a health care system is an investment whose immediate, impressive benefits are just the start. I look forward to watching more grow in years to come.
 Reich, MR, Takemi, K, Roberts, MJ, Hsiao, WC. (2008) “Global action on health systems: a proposal for the Toyako G8 summit.” Lancet 371: 865-869.
 Rwanda Vision 2020. Found: http://www.minecofin.gov.rw/fileadmin/General/Vision_2020/Vision-2020.pdf