Twenty years ago this week, Rwanda's genocide began. Over the course of 100 days, more than 1 million people would be murdered, and after the violence ended, the country—including its health care system—was left in ruins. Cholera outbreaks were rampant, HIV was widespread and people no longer trusted the few doctors who remained in the country because of their ties (suspected or legitimate) to the genocidal regime, the Atlantic reports.
In just two decades, however, according to a new study published in The Lancet, Rwanda has gone from one of the world's most health care-deprived countries to a stand-out example of what effective strategies promoting health equity can achieve. The study's authors include physician and writer Paul Farmer, who's best known for his work in Rwanda, and Agnes Binagwaho, Rwanda's Minister of Health. Their findings:
In the years that followed [the genocide], a new course set by a new government set into motion equity-oriented national policies focusing on social cohesion and people-centred development. Premature mortality rates have fallen precipitously in recent years, and life expectancy has doubled since the mid-1990s. Here we reflect on the lessons learned in rebuilding Rwanda's health sector during the past two decades, as the country now prepares itself to take on new challenges in health-care delivery.
In addition to doubling the country's life expectancy, childhood mortality, likewise, has declined by two-thirds, the Atlantic reports, Rwanda enjoys higher vaccination rates for children than those reported in the U.S. New HIV infections have dropped by 60 percent over the past decade, and HIV treatment is free. These changes largely came from within the country, not from humanitarian aid. The Atlantic elaborates:
In 1995, Rwandans received an average of 50 cents per person in foreign assistance for health. Only a decade ago did Rwanda receive its first major international grants to treat HIV, tuberculosis, and malaria.
The government actively promoted health equity, stating that everyone had a universal right to healthcare and creating a community-based insurance and care systems, the Atlantic explains. Here's more on how that system was implemented and how it works:
In 1998, a new government launched a consultative process to create a national development plan based on inclusive social cohesion and health equity, involving substantial investments in public health and healthcare delivery. Community-based health insurance and performance-based financing systems began in three of the country’s districts and expanded nationwide in 2004.
In 2010 the Ministry of Health instituted a three-tiered premium system based on Rwanda’s socioeconomic assessment system, ubudehe. There was simultaneous decentralization and integration of health services, increasing domestic funding alongside external resources. By 2010, 58 percent of foreign assistance was able to be channeled through Rwandan national systems, compared with an average of 20 percent in post-conflict settings.
Thanks to these efforts, Rwanda has far exceeded expectations forecast by development experts in past years. While Rwanda's care system is still not perfect (its life expectancy, 60 years, is still well below the world average), the authors of the new study think it exemplifies just how far a country can come with some conscientious strategizing and investments.