The RESULTS UK Parliamentary delegation recently returned from Rwanda after a week long visit to observe the country’s remarkable best practices adopted to combat infectious diseases and the Millenium Development Goals. MPs Cathy Jamieson and Angus MacNeil alongside RESULTS staff Aaron Oxley (Executive Director) and Aparna Barua (ACTION Project Associate) met with health centre staff, patients and civil society organisations across the country to learn and discuss health issues and the impact of tuberculosis (TB) on development.
The progress made in health and other sectors over the last 16 years after genocide is truly remarkable considering the widespread loss of life, failure to maintain the infrastructure, looting and neglect of important cash crops during 1994. The economy has since strengthened, with per-capita GDP (PPP) estimated at $951 in 2008 compared with $390 in 1994. Rwanda is a country of few natural resources, and the economy is based mostly on subsistence agriculture by local farmers using simple tools. Since the mid 1980s, farm sizes and food production have been decreasing, in part to due the resettlement of displaced people. However, despite Rwanda’s fertile ecosystem, food production is often unable to keep pace with population growth and food imports are required.
Despite these economic hardships, the Rwandan Government has prioritised health. In 2010, the government spent 11 per cent of national expenditure on healthcare, compared with 3.2 per cent in 1996. In the face of poor outcomes on child and maternal mortality as well as HIV, TB and malaria epidemics, the Ministry of Health has been successful in involving all elements of Rwandan society, civil society, donor partners and government to work together in delivering an integrated health care package that is inclusive of all those that need medical help.
During the week long visit to Rwanda, the delegates met with Dr. Michel Gasana, Head of the TB and Leprosy Unit, who guided the delegates around the Kimironko Health centre in Kigali District. This health centre was typical of many district level health centres that that were equipped to address the three major diseases as well as maternal health. All pregnant women are tested for HIV and TB and are counselled to encourage couples testing within the health centre. It clearly illustrated how HIV and TB screening are now an integral part of the maternal health care package in Rwanda, recognising the risk and impact of these two diseases on women and maternal health.
At the Kabutare Hospital and laboratory in the Southern Province, the delegates were shown around the district laboratory in which both HIV and TB testing were conducted. HIV/AIDS seroprevalence and TB incidence are declining due to government policies on testing patients for both diseases and being able to receive treatment at the same health post. The delegates also met with MDR-TB patients who described their painful journey through treatment in isolation from their families and communities for several months at a time. The visit highlighted the need for greater investment into shorter drug treatment regimens, and the delegates were excited to hear about the arrival of the GeneXpert machine in the coming months; a diagnostics tool that can detect TB and strains of drug resistant TB in less than two hours.
In meetings with the Ministry of Health and civil society involved in the delivery of health care, it was clear that human resources for health remains a significant challenge. While much of the population has now subscribed to a national health insurance scheme, the quality of healthcare is low and needs improvement. While 87 per cent of the population has access to healthcare, there are only two doctors and two paramedics per 100,000 people and the 60,000 community health workers across the country play a key role in active case finding and health education. The Government is seeking to improve the situation as part of the Vision 2020 development programme, which aims to turn Rwanda into a middle income country by 2020. This vision recognises that economic growth alone is not sufficient to bring about the necessary rise in the standard of living of the population. To vanquish hunger and poverty, growth must be Pro-Poor, giving all Rwandans the chance to gain from the new economic opportunities.
One of the key reasons cited for Rwanda’s remarkable progress in tackling maternal mortality and infectious diseases has been the public and political will to address key health issues. The future looks bright for Rwanda and there is a distinct role for Rwanda to play in sharing its knowledge of best practices in health to neighbouring countries and donor partners.