The United States has praised the government of Rwanda for its tremendous strides in improving the lives of Rwandans by increasing the rate of life expectancy for its citizens and reducing the maternal mortality.
Speaking at the Africa Health Forum in Washington DC on Friday, the US Deputy Secretary of State William J. Burns said that the country is on track to meet many of the Millenium Development goals despite challenges the country faced after the 1994 Genocide against Tutsi.
In his key note address, the Deputy Secretary of state said that: “Rwanda, a country devastated by genocide less than two decades ago, is today on track to meet many of the Millennium Development Goals – life expectancy has doubled, maternal mortality and annual child deaths more than halved, and deaths from HIV, TB, and malaria have dropped by 80percent.”
The US diplomat went on to thank the current African leadership for the dramatic transformation of the continent.
“We gather here today amidst a dramatic transformation of the African continent from a region once defined largely by its problems, to a region defined increasingly by its possibilities… from a region afflicted by conflict, crisis, and impoverishment to a region known more and more for its economic growth, expanding democratic governance, and enhanced health and human development,” said William J. Burns.
He emphasized that as the continent evolves, and as governments take on greater leadership and responsibility for their own future, the nature of assistance and cooperation from the international community should evolve as well – from a donor-recipient relationship to more of a partnership.
“This partnership – based on principles of country ownership, shared responsibility, and mutual respect – allows donors and partner countries to better meet the needs of the country’s population. Where transparency, good governance, and accountability are enshrined in law and in practice – our joint investments will yield more effective, more efficient, and ultimately more sustainable outcomes.
This is why sustainability and shared responsibility are two foundational principles of President Obama’s Policy Directive on Global Development and our global health diplomacy strategy.”
The US Deputy secretary of State told delegates that United States commitment to global health is strong, citing President Obama’s budget request for a $1.65 billion contribution to the Global Fund in fiscal year 2014 as US’s historically high level of support.
The Forum was attended by Ministers and representatives of Ministries of Finance and Health over two dozen African countries.
Rwanda is globally hailed for presenting a unique case in development and in the progress towards attaining the MDGs.
Several HIV/AIDS awareness campaigns by the government and other stakeholders have recorded significant improvement in the reduction of new HIV infections in the country.
Dr Sabin Nsanzimana, the Coordinator of HIV and Sexually Transmitted Infections (STIs) Care and Treatment Department at Rwanda Biomedical Centre, who disclosed this at a meeting in Kigali on Wednesday, said the campaigns have been effective that the rate of new infections has gone down compared to the previous years meaning that more Rwandans are aware of the dangers of HIV/Aids.
“The rate of new infections was at 25,000 people every year in Rwanda five years ago, but now it has gone down. We have laid a number of strategies to increase awareness and other protective measures against new HIV infections so we are positive that this rate will go down further,” Dr Nsanzimana said. Every hour, two people get infected with HIV in Rwanda, according to Dr Nsanzimana. This is equivalent to 15,000 new HIV Infections every year, according to the doctor, who called upon those already infected to adhere to the instructions of their anti-retroviral treatment.
Functional HIV cure:
An infant was reportedly cured of HIV as announced recently at the Conference on Retroviruses and Opportunistic Infections in Atlanta, while French researchers published in the journal PLOS Pathogens that they had been studying 14 people that have been “functionally cured” of HIV.
But Professor Andrew Zolopa, from Stanford University School of Medicine, said those people who got cured had started on their ARVs at least a month after infection and so they started treatment early enough.
When Agnes Binagwaho began her career as a doctor in the slums of Kigali, Rwanda, in 1996, she worked in one of the most precarious health environments in the world.
“We could do nothing for them,” she remembers. “We didn’t have drugs even for ordinary diseases.”
19 years later, however, Rwanda is on pace to become the only country in sub-Saharan Africa to meet all of its health-related Millennium Development Goals, and the tiny pocket of Central Africa has posted some of the world’s most staggering health gains in the past decade, outpacing nations that spend far more per capita on healthcare.
And Dr. Binagwaho, who once stuffed her suitcases full of basic medicinal supplies to take home to Kigali whenever she traveled abroad, is now leading that charge as minister of health.
In an article published earlier this year in the British Medical Journal (BMI), a team of doctors and researchers working in Rwanda laid out the country’s swift rise.
Between 1994 and 2012, they wrote, the country’s life expectancy climbed from 28 years to 56 and the percentage of the population living in poverty dropped from 77.8 percent to 44.9 percent.
In the past decade, deaths from HIV have fallen 78 percent – the single largest decline in the world during that time frame – while tuberculosis mortality has dropped 77 percent, the most significant decrease in Africa.
Of course, the starting point in Rwanda’s climb was a harrowing one: In 1994, between 500,000 and 1 million people — up to 20 percent of its total population — were killed in an ethnic genocide, and some 2 million more fled. Many doctors were among the dead and exiled, and the country, including its healthcare system, was left in tatters.
That year, less than a quarter of Rwandan children received immunizations and more than 1 in 4 children were dead by their fifth birthday.
But in the years that followed, Rwanda became the darling of the international development community, a case study for how a country could use a trans-formative post-conflict period to effectively rebuild its core institutions.
As aid poured in, Rwanda’s new government channeled it into a wide variety of social programs, including healthcare. It rolled out a system of universal health insurance, doled out vaccinations and mosquito nets, and put nearly every AIDS patient on antiretrovirals.
And it did all of this in a place that still faces what the BMI article called “one of the greatest shortages of human resources for health in the world.”
Indeed, the country of 11 million has only 625 doctors in its public hospitals nationwide. But there are also now more than 45,000 “community health workers,” trained to treat basic health issues and help ensure adherence to drug regimens in rural areas far from hospitals and clinics.
As a result of these efforts, the probability that a child will die before the age of five has fallen by 70 percent and is now half the regional average. Some 108,000 people now receive antiretroviral treatment for AIDS – a figure approaching universal access.
But as the healthcare system has lurched forward, it has also come under attack for its heavy reliance on foreign aid: Nearly half of the government’s health budget comes from external funders.
Unlike many other countries, however, Rwanda has used these cash infusions to build institutions, not merely fund programs, says Peter Drobac, the Rwanda director for Partners in Health, a public health nonprofit, and one of the authors of the BMI paper.
Indeed, Rwanda spends no more on health than many of its neighbors, ranking 22nd among 49 sub-Saharan African countries in per capita health spending. That comes to about $55.50 per person each year, which Drobac says is a “tremendous value for money.”
But Rwanda’s government has ambitiously called for the country to be aid-free by 2020, an undertaking that would require a massive pivot away from its current healthcare funding model. In reality, that goal may be decades off, but in the meantime, officials have built the scaffolding for a sturdy healthcare system, Drobac says.
“The lesson we have learned is that you cannot solve every [health] problem at once,” Binagwaho says. “So you do the best with what you have, and you don’t leave anyone out.”
Twenty five low- and middle-income countries, including Rwanda, have managed to halve their rate of new HIV infections since 2001, UNAIDS said in its annual report on the state of the global pandemic.
The UN body’s World AIDS Day Report 2012 shows that in the last ten years, the landscape of national HIV epidemics has changed dramatically, for the better in most countries, especially in sub-Saharan Africa.
Countries are making historic gains towards ending the AIDS epidemic: 700,000 fewer new HIV infections across the world in 2011 than in 2001, it says.
Rwanda, Gabon, and Togo, are some of the countries which achieved significant declines of more than 50%, according to the report.
“We are moving from despair to hope,” Michel Sidibe, the Executive Director of UNAIDS, said in Geneva, pointing out that around half of all reductions in new HIV infections in the past two years had been among children.
“It is becoming evident that achieving zero new HIV infections in children is possible,” he said.
Globally, new HIV infections fell to 2.5 million last year from 2.6 million in 2010 and represented a 20-percent drop from 2001, according to UNAIDS.
“The pace of progress is quickening. What used to take a decade is now being achieved in 24 months,” Sidibe said.
Particular progress had been made in bringing down the number of children newly infected with HIV.
Last year, 330,000 children worldwide were infected with the virus that causes AIDS, down from 370,000 in 2010, and 43 percent fewer than in 2003.
And in sub-Saharan Africa — a region that is today home to 90 percent of the world’s infected youngsters — the number of children newly infected with the virus dropped by 24 percent between 2009 and 2011 alone.
Sub-Saharan Africa has cut the number of people dying of AIDS-related causes by 32% between 2005 and 2011.
In 2011, 1.7 million people died from AIDS-related causes worldwide — down 24 percent from 2005 and nearly six percent below the 2010 level, according to the report released ahead of this year’s World AIDS Day marked on December 1.
16 December 2011
Kamonyi — South Korean Ambassador to Rwanda, Heon Lee, Wednesday, commissioned a Korean-funded community development centre in Nyarubaka Sector, Kamonyi District.
The Rwf 42 million centre was set up by the Korean International Cooperation Agency (KOICA), through the Global Civic Sharing (GCS) – a Korean initiative focusing on community development.
The multipurpose facility will be used for such activities as training in agriculture, livestock and language; which will be run by volunteers by next year, according to Hong Min-Kee, the GCS Project Coordinator.
Ambassador Heon Lee said that such community based projects were in the spirit of strengthening bilateral ties between the two countries.
The visiting Secretary General of Global Civic Sharing, Cho Hyeo-Joo, said: “With this new start, GCS hopes to contribute towards improving education in the area.”
The Mayor of Kamonyi, Jacques Rutsinga, noted that the Korean government has supported various sectors in the district, in areas of health, economic activities and educational projects.
By Dr. Agnes Binagwaho
Dr. Agnes Binagwaho
Success in Rwanda’s health sector is due to the fact that the Government works as one in pursuit of an integrated and community-driven development process. This past year, I have read and listened to many great newspaper articles and speeches about Rwanda’s social and economic progress since 1994 that highlight the country’s unprecedented achievements but conclude with a single sentence or two that intends to make the reader or listener doubt all of these achievements.
Listening to such reflections on my country has caused me to reflect on a number of trends since my return to Rwanda in 1996. Still much needs to be done and as a nation and as a people, we have pursued with fierce urgency the integration of participatory democratic principles and equitable social policy to ensure that all Rwandans benefit from the process of development. We promote and strengthen our democracy by always engaging our people – Rwanda’s true wealth – in the formulation and implementation of policies for health, education, gender, youth, decentralization, financing, infrastructure and other.
In order to do so, the Government must apply an integrated and collaborative approach across all sectors. His Excellency Paul Kagame, the President of Rwanda, makes this quite clear when responding to a new policy proposal from a member of his Cabinet, asking first without fail: “What will this mean for the people, and how does it link to our poverty reduction and economic development strategy?” The evidence and results of such an approach can be seen at all levels, exemplified by a number of uniquely Rwandan approaches to the empowerment of our citizens.
One fine example of communities working together for national development is the monthly day ofUmuganda, a voluntary work day on the final Saturday of each month. Community members in villages, towns, and cities across Rwanda collaborate on various service projects. Activities are identified and selected through a participatory process, and often include building schools or health centres, planting trees, or clearing areas for the construction of new homes for the community’s most vulnerable families. Umuganda creates momentum for the development of all sectors, as public sector agencies often choose to contribute resources to these projects (and Ministry officials often join in the work around the country). All of these initiatives serve the pursuit of health; even the construction of a school will facilitate increased uptake of health services in the next generation because a well-educated woman is a highly valued member of a family who is well taken care of.
Other national programs similarly fight poverty and promote economic growth in ways that amplify the work of the health sector. For instance, the Ubudehe process of village-level community decision-making that includes “poverty-mapping” (or communal categorization of households into socio-economic categories based on income and needs) allows for better targeting of social services and pro-poor subsidies for items such as our community-based health insurance program, Mutuelles de Santé. In the Ministry of Health, we use Ubudehe and district level data to proportionally allocate our malnutrition interventions (such as the One Cow per Family and kitchen garden programs) towards the most affected areas of the country.
In order to catalyze economic development at the community level, our Government undertakes massive sensitization campaigns around financial savings. Umurenge Savings and Credit Cooperatives (SACCO) were established across Rwanda to increase access to financial services among the rural poor. Today, all of the country’s sectors manage their own SACCO with technical assistance from the central government. These cooperatives are voluntary, and they allow each citizen to contribute what they want to the communal savings pool. With these savings, the community can provide loans (same amount as invested by the citizen) to individuals who agree to reimburse the cooperative for the amount. One district I visited two weeks ago, Burera, has a savings pool of over one billion Rwanda francs. Umurenge SACCO is a very successful program for economic empowerment through the creation of community-owned and directed capital.
The Ministry of Health also uses cooperative savings mechanisms to compensate our 45,000 clinical services providers the community health workers (CHWs) through performance-based financing. Each community elects the CHWs in a participatory and open manner, after which they are trained by the Ministry of Health in prevention, care, and referral of the most common causes of diseases and mortality among communities in Rwanda. As I have written about elsewhere, our massive team of CHWs has contribute to dramatic improvements in health outcomes over the past five years, including a 50% decline in child mortality, a 70% decline in malaria incidence, a 52% increase in the proportion of mothers delivering at health facilities, and a 450% increase in the uptake of modern family planning methods. They serve as the first line of defence against the biggest killers, addressing 80% of the burden of disease through home-based care, but also stand ready to link patients to health centres or district hospitals via ambulances
that they contact with their cell phone.
Economic development at the community level is crucial to Rwanda’s long-term vision for the health sector, because we want every Rwandan to be capable of contributing premiums to the Mutuelle de Santé program. When visiting officials from our partners in the United States or Europe ask how we plan to make this vision sustainable, I like to show them a graph of Rwanda’s recent economic growth – about 8% for the past several years, which has contributed to the expansion and flourishing of our poverty reduction programs.
Rwanda has the vision of becoming a middle-income country that is able to self-finance our pro-poor social interventions and guarantee equitable access to high-quality medical care. When I join in for Umuganda or visit a SACCO and see our people’s unwavering commitment to our nation’s vision, I have no doubts that we will make it. To empower Rwandan citizens economically, we promote a spirit of independence to make the best choices for themselves. This is the basis of democracy; when you are dependent and begging, you cannot direct your life.
Full civil and political rights are essential to human development and are highly valued in Rwanda, but we can never forget that these must be built upon a foundation of social and economic rights. If a woman fears that her child may die of malaria for want of a 500 Rwandan franc treatment, being able to vote will not serve her in the short term if it is not link with economic growth; if a man does not have enough money to feed his family or send his children to school, the ability to nonviolently express grievances will not fill stomachs or pay school fees. Civil and political rights and social and economic rights can and must be mutually reinforcing; neither is sufficient alone – we must assure them all. This understanding is woven into the very fabric of our nation’s Constitution and each of our major social sector policies; we must never forget it.
I am truly delighted that more and more high-level officials from the Governments of our long-time development partner countries are coming to see firsthand what we are doing in Rwanda. I have the feeling that we are all truly contributing to a revolution that will bring more health and wealth to our people. Our partners deserve to see how we are using the investment in the health and wealth of our population. In the global humanitarian market, the value of money invested in Rwanda is incredibly high due to lack of corruption, our dedication to participatory processes, and our reliance on integrated cross-sectorial approaches to tackling policy challenges. As a public servant, I am so proud to belong to Rwanda, a country that has pro-poor human-focused policies in practice, and to its population, who are the most valuable resource our country will ever have.
Agnes Binagwaho, MD, PhD hc
Minister of Health of the Republic of Rwanda
Edwin Musoni, New Times
The Mayor of the Kigali of City, Fidele Ndayisaba, has said that government may consider dedicating one day in a month to sports to help ensure the good health of Rwandans.
He made the remarks during an interview with The New Times on the sidelines of a health awareness event held at the Amahoro National Stadium. The event was organised by the Rwandan Heart Foundation and the Rwandan Diabetes Association.
The day was held in recognition of the International Day against Diabetes.
Ndayisaba noted that Rwanda has an opportunity to save most of its people from killer diseases without spending money.
“Sports is a major preventive measure against non-communicable diseases; this is why we intend to introduce a mass sports day that would be held at the village level every month,” said Ndayisaba.
He added that the day would be modelled along the monthly community work (Umuganda) where residents converge to clean up their neighbourhoods.
“People of the same village will be meeting to do sports, interact and share developmental ideas. This is a multipurpose activity, it improves the health of the people and develops their societies,” said the Mayor.
He noted that people should make use of sidewalks constructed by the roadsides instead of over-relying on cars as walking is necessary as a sport.
During the event, the Rwanda Heart Foundation together with the Rwandan Diabetes Association conducted free testing of diabetes and possible heart complications to hundreds of people who had showed up for the event.
According to Dr. Joseph Mucumbitsi, a cardiologist, heart diseases claim over 17.2 million lives annually.
“80 percent of those affected are from less developed countries and some of the major causes include how we feed and live. Some people eat too much food than their bodies require and do not do any sport. In the end, they gain too much weight,” said Mucumbitsi.
There are many risky factors that may lead to cardiovascular diseases and diabetes combined under the metabolic syndrome.
Metabolic syndrome is a combination of medical disorders that, when occurring together, increase the risk of developing heart disease (cardiovascular) and diabetes.
Mucumbitsi gave the example of a general testing exercise conducted in 2007. He revealed that of the 960 people who took part, eight percent had hypertension, 12 percent were abnormally obese while 27 percent had intermediate obesity.
He said that the Heart Foundation had requested the government to increase funding to fight Non-Communicable Diseases – including heart disease and diabetes – as well as setting up sports facilities at the village level.
“Sports has been proven to be the main prevention factor from cardiovascular disease. It is advised that a person walks thirty minutes every day for at least four days a week. This is very important to people who spend a whole day in the office,” said Mucumbitsi.
A Kigali resident, Vivian Mukantaganzwa, who weighed 100kgs in August last year, told The New Times that doctors advised her to consider undertaking sports, otherwise she risked contracting cardiovascular diseases.
“I started doing sports right away; I jog for four hours a week and cover about 35 kilometers and now I weigh 82kg. I have been tested and doctors told me I am in a good condition, although they advised me to continue cutting down my weight to about 65kg,” Mukantaganza noted.