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.”
WEDNESDAY, 11 APRIL 2012 09:42 BY EUGENE KWIBUKA
Rwanda genocide survivor has found a business niche in Ottawa
In Vanier, a suburb in the eastern neighborhood of Ottawa known for its large francophone population, Bon Marché, which just opened last year, has become the place to go shopping for exotic groundnut flour, cassava, sweet potatoes, dried red or black beans, and many other products imported from East and West Africa and the Caribbean.
“The community of people from East Africa is growing,” says Alain Ntwali, one of the owners of the shop, in his vernacular Kinyarwanda. “Since we know that people from Uganda like matoke from their own country and Kenyans like maize flour from Kenya, what about providing them with what they need?”
The 29-year-old merchant recounts how he came to Canada in 2005 after surviving the 1994 genocide against the Tutsi in Rwanda. “There are many opportunities in Canada and there aren’t many people who get a chance to live here and enjoy those opportunities,” he says standing in front of a black cloth on one of the store’s shelves that reads ‘Never again 1994.’
Ntwali survived the genocide by first hiding in Nyamirambo, a suburb of Kigali. He then went to Hotel des Mille Colline, a high profile hotel in the city, where he stayed until the United Nations mission in the country facilitated for him and many other Tutsi survivors to escape the danger.
Although his siblings—two sisters and three brothers—survived as well, the subsequent violence didn’t spare his father Anselme Sakumi, his mother Immaculée Gasibirege, and his many aunts, cousins and other relatives who died in the same horror that killed an estimated 800,000 to one million ethnic Tutsis and some moderate Hutus over the course of 100 days from April 6 to July 16, 1994.
It is during this period that Ntwali spends a fair amount of time grieving and ensuring that survivors in Ottawa will commemorate the genocide with their families, members of the Rwandan community in Canada and their Canadian friends. He leads the activities through Humura, an association representing Tutsi Genocide Survivors in Canada’s National Capital Region.
Ntwali is also involved with activities that seek to ensure that Canada doesn’t become a safe haven for those who committed the genocide, and was among the people who prepared a letter that urged the Canadian government to urgently deport Leon Mugesera back to Rwanda before it finally did.
Ntwali, one of more than 100 Rwandan genocide survivors who live in Ottawa, says the city has proved to be a fairly good place for the survivors to live. The area’s proximity to some federal government jobs and both big and small private businesses in the capital is very useful.
It also helps, he says, having some distance between his new life and the tragedy of the past, a finding that has been confirmed Emmanuel Habimana, a Rwandan psychology professor at Université du Québec à Trois-Rivières, Québec. According to research conducted by Habimana, Rwandan genocide survivors in Canada are better able to deal with post-traumatic stress disorder than their counterparts in Rwanda.
But home is still home and although Ntwali enjoys his Canadian life, which he shares with his wife and their soon to be born baby, the possibility of returning one day still enters his mind.“It all depends on how life treats you,” he says. “You may find opportunities in other places and go there, but for the moment my life is here in Canada.”
Health Professional Opportunities and Recruitment System
Bringing Health Professionals back to Rwanda for short-term capacity building missions
Are you an experienced Rwandan health professional living abroad and wishing to make meaningful contribution to development efforts in your country of origin through donation of your time; share your talents and expertise? Then, MIDA Health Rwanda Project might be the right partner for you.
Are you a Manager of a healthcare institution in Rwanda that is in need of human resource for health development or capacity building? Then, MIDA Health Project might be the right door for you.
MIDA Health is a joint project between the International Organization for Migration (IOM), the Ministry of Health (MOH) and the Ministry of Foreign Affairs and Cooperation (MINAFFET) of Rwanda and that uses skills and expertise from Rwandan diaspora health professionals and provides opportunities to support the national health strategy and the health sector and enhance their linkage to their home country.
The objective of the project is to contribute to the development of human resources in the health sector and encourage diaspora members to enhance their linkage to their home country.
The following key areas have been identified as priority to receive support from available health professionals from the Rwandan diaspora: Orthopedic Surgery, Neuro surgery, Maxillo facial, Plastic surgery, Pediatrics, Gynecology & Obstetrics, Internal Medicine, Internist Nephrologists, Internist Oncologist, Bio medical engineer, Histopathologist, etc.
Who can apply for the project?
1. Rwandan living and working abroad with a relevant background in health care or a related field;
2. Health institutions in Rwanda (Special attention is given to rural and district hospitals), and ;
3. Exceptionally, non-Rwandan health professionals willing to volunteer in Rwanda.
What does IOM offer?
1. Assistance with visa and work permit application (i.e. licensing);
2. Organizing travel arrangements, and lodgings in collaboration with hosting institutions;
3. Providing health and travel insurance;
4. Briefing to selected participants before deployment so that the roles and responsibilities of both participant and the host beneficiary institution are understood and agreed upon.
5. A subsistence allowance to each participant;
6. Supervision and monitoring during assignments.
For further information or application, please contact:
IOM Rwanda, MIDA Health Project
Tel.: (+250) 252 58 67 10
Mobile Phone: +250 78 88 08622
For further details about the vacancies, please visit http://www.jobs.rwandandiaspora.gov.rw
To apply for the project, Health Professionals interested can register on the above link and send their CV with the application letter to the above email by mentioning subject line: MIDA Health Rwanda Vacancy.
For more information on IOM, please visit http://www.iom.int
For more information on Public Health Sector in Rwanda, please visit http://www.moh.gov.rw