Saturday, September 26, 2015

Vaccines in Rwanda

Please see this piece on vaccines in Rwanda recently published by Vaccineswork.  It was a pleasure working on this article with Anisha Hedge, a medical student at the University of Virginia who spent the past summer in Rwanda.  Here, we provide an overview of the benefits of vaccines in our efforts to improve the health and well-being of Rwanda. Please see the entire article here:

Rwanda’s sustainable strategy for saving lives

Agnes Binagwaho, Ministry of Health Rwanda and Anisha Hedge, University of Virginia School of Medicine.
Rwanda has demonstrated the value of vaccines over the past 15 years, as the rollout of new and underused vaccines has helped us reduce under-five mortality by two thirds, and achieve the fourth Millennium Development Goal (MDG) along the way. This year, as the world transitions to the Sustainable Development Goals (SDGs) and partners aim to end poverty by 2030, immunisation must remain at the core of the health agenda. As well as saving lives, the benefits of vaccination programmes stretch beyond immunisation to improving health services and promoting social integration, and Rwanda is the case study to prove it.

1. Vaccination campaigns at the centre of societal development

Rwanda has increased basic vaccine coverage (DTP3) from 77% in 2001 to 99% in 2014. In the last seven years Rwanda has introduced new and under-used vaccines against pneumococcus, rotavirus, rubella and human papillomavirus (HPV), and maintained high rates for traditional vaccines. Vaccination campaigns present the opportunity to reach out to the population with a range of other health services. During the pneumococcal campaign in 2009, advice was given on causes and symptoms of pneumonia to facilitate early detection and access to treatment. Community health workers also educated parents on good health practices such as breastfeeding and wholesome nutrition.

2. Achieving equality in healthcare 

To encourage equal access to health care, Rwanda holds a Mother and Child Health Week twice a year. It offers a range of health services; vaccination campaigns such as rubella and HPV for adolescent girls, the provision of iron tablets for pregnant and lactating women to prevent anaemia, vitamin A supplements for all children under five years and a family planning campaign for women of reproductive age.

A mother and baby at the launch of rotavirus vaccine in Rwanda in 2012, which protects against a leading cause of diarrhoea. Photo: Gavi/Diane Summers.

3. Forging national partnerships

Vaccination programmes have fostered new working relations between different governmental and non-governmental organisations. This was evident with the rollout of the HPV vaccine in schools in Rwanda which involved a partnership between the Ministry of Health, Ministry of Education, Ministry of Gender and Family Promotion and the Ministry of Local Government in order to reach adolescent girls in schools and communities. 

4. Strengthening healthcare infrastructure

Adequate health system infrastructure is essential for the effective rollout of vaccines. In Rwanda this has included improved waste disposal facilities for contaminated materials, new cold rooms for temperature-controlled storage and increased medical storage capacity. 

5. Sustainability

Currently, the Rwandan government self-finances all traditional vaccines, such as the tuberculosis vaccine BCG, and co-finances with international partners to provide new and under-utilised vaccines. This trend has been demonstrated with the pneumococcal vaccine and is currently unfolding with the HPV vaccine, which protects against major causes of cervical cancer. Looking ahead, we hope that as demand increases, vaccine prices will be driven down, thereby creating a sustainable future for vaccine provision. 
Globally, there is still a way to go. One in five children in Gavi supported countries still miss out on the basic package of childhood vaccines; around the world about 1.5 million children die from vaccine-preventable diseases each year. But as our country has shown, immunisation can sustainably address this inequity, and so much more besides. With immunisation as part of the next set of development goals, we can help all countries make the most of these vital tools, and we should — because life, whether lived in the remote areas of Rwanda or the suburbs of London, deserves a fighting chance.

Sunday, August 30, 2015

Angus Deaton’s Cartoonish Moral Calculus

In July of 2015, I posted this article in the Boston Review to address not only the absurd comments from Angus Deaton, but also the shocking, pervasive racism that is so often expressed by intellectual yet arrogant people. 

I spend a lot of time explaining and promoting Rwanda’s record on public health to audiences around the world. Together with our research and funding partners, Rwanda has made unprecedented strides on almost every health measure. We are one of the few developing countries that will meet all MDG targets. All Rwandans have access to health insurance, and maternal mortality has fallen at historically unprecedented rates.

For Angus Deaton, these gains only served to entrench dictatorship and repression in Rwanda. How? By threatening to let our children die unless altruistic and gullible Westerners pay our government to keep them alive.

Deaton believes that we ‘provide health care for Rwandan mothers and children’ in order to ‘insulate ourselves from the needs and wishes of our people’. I can’t tell if he means that Rwandans don’t wish for good health, or that our country would be more democratic if we neglected basic needs.

As a Rwandan, and as a physician, I have heard a lot of outrageous statements in my life. But Professor Deaton has invented an entirely new level of absolutism.

How does one begin to reply? More facts and figures about Rwanda’s progress would only reinforce Deaton’s grotesque logic. Testimonials from the donors and researchers who know Rwanda best would be dismissed as compromised.

Moreover, Rwanda is not the issue here, and I would feel no satisfaction if Deaton apologized to Rwanda and then went to pick on a different country that better exemplifies his stereotypes.

The issue is moral, and it concerns all of us. Deaton’s theory rests on the assumption that Africans don’t feel love for their children. It follows that President Kagame, being an African, sees children as a commodity, like copper or sweet potatoes, to be sold to people in the West who value their lives more highly.

Angus Deaton doesn’t know Paul Kagame from Kunta Kinte. The president is just a cartoon character he uses to argue against foreign aid. Deaton isn’t referring to the real Paul Kagame or the real Rwanda, but to a generic ‘other’ whose moral inferiority is so self-evident that it requires no elaboration.

In other words, Deaton knew his readers would share in the contempt. In point of fact, Paul Singer replied complaining about Deaton’s criticisms of his work; but he made no mention of the scandalous libel of President Kagame.

This is neither ignorance or carelessness. It is an ideology of moral superiority, a form of racism that is all the more pernicious because it has no name and leaves no marks on its victims. Eventually the victims internalize it and come to despise themselves.

By dropping the mask a little, perhaps Angus Deaton has done us all a favor. We need to have more honest conversations about the assumptions implicit in judgments we make about each other.

Rwanda’s story is tragic and hopeful in equal measure. Maybe the first step is for Angus Deaton, Paul Singer, and anyone else who feels concerned by this exchange, to visit Rwanda and see for themselves what kind of people we are, and how we care for our children. They would not be the first visitors to Rwanda who left with a deeper appreciation for our common humanity.

Thursday, July 9, 2015

Rwanda's Quest for Universal Health Coverage

The following essay on Rwanda's Quest for Universal Health Coverage was featured in the Commonwealth Health Partnerships annual booklet, which is now available online:

I encourage you to look over the various essays on topics related to UHC, ageing, governance, NCDs, and much more throughout this publication.

Wednesday, June 17, 2015

The importance of claiming our future

I was pleased to co-author an article with Nigel Crisp that was recently published in the Lancet.  You can view the article here:  In the piece, we summarize some of the fundamental motivations behind our efforts to contribute to a recent book titled "African health leaders: making change and claiming the future." 

Sunday, May 10, 2015

Op-Ed in New Times on Labour Day

Below is an Op-Ed I composed for the New Times that was published on Labour Day in Rwanda.  May we continue to "ignore detractors".

"Today, as we celebrate the International Labour Day, I reflect upon the great challenges that Rwanda faced 21 years ago and then consider the great progress that has been made by all the workers in Rwanda; I am so proud to call Rwanda my home.
However, when I read news articles suggesting that our progress is somehow “following in the footsteps” of other countries, I find this argument wanting. Though it may not be intentional, such a characterization of our progress has the insulting implication that workers in Rwanda are incapable of seeking out innovative solutions to improve their lives on their own.
My conclusion is that some of the people who make such claims, many of whom have never set foot in Rwanda, believe that a country of black people in the heart of Africa is incapable of achieving the kind of progress they only read or hear about.
On the contrary, under the visionary leadership of President Paul Kagame, workers in Rwanda have demonstrated great will and ability to plan and deliver substantial improvements on our economy, health, education and governance sectors.
After 1994, much of the world viewed Rwanda as a failed state. They expected us to stay disorganised. That has always been their expectation of black Africans, a pre-judgment that is not immune to racism. Indeed such analysis unveils a pernicious double standard.
Thus, for those who have observed Rwanda’s progress, they have been surprised. According to the World Bank, Rwanda still only has a GDP per capita of $638. Yet, we have made progress that exceeds this level of development.
We have managed to do more with each available dollar.
The world does not expect that workers in Rwanda keep streets clean, and that the country is governed according to the rule of law. A population full of energy and hope, a police force that protects and services the people without asking for a bribe, an army that protects civil rights and uses its personnel to promote the health, education and wealth of the citizens under its protection. And yet this is the reality here.
And still, today, 21 years after the Genocide, people are astonished that we used our own energy and forward looking minds to get out of the dark hole that characterised our past, and even more so, that we have done this in one generation. 
Their surprise is due to the unwarranted low expectations of us. They cannot deny the undeniable evidence that such progress has been made, they only argue that it is because we have followed in the steps of others. Often, they suggest that we are mimicking Singapore, as opposed to building our future based on our own Rwandan values.
The desire to strive for excellence is universal. To simplify the pursuit of excellence in Rwanda to an effort to “mimic” or copy another’s success undermines all the Rwandan workers who have made Rwanda’s journey possible. We do not need other countries to inspire us to work for the good for our people.
We have had our own innovations that have contributed to Rwanda’s development. These include Gacaca courts, the One Cow per Family programme (Girinka), the national dialogue (Umushyikirano) during which leaders are held accountable by the electorate, and the conception of global partnerships such as Rwanda’s Human Resources for Health Programme, which is creating high quality physicians to improve our nation’s health.
Other examples include community participation to facilitate vaccination of 90 per cent of our children with 11 vaccines, a record rate of coverage. Another example is the community empowerment of people in villages to select 45,000 dedicated voluntary health workers.
I could also talk about the national policy to ensure equity in human development and access to health opportunities even for the most vulnerable – a pillar of our national policies – which has allowed Rwanda to have community-based health insurance (Mutuelles de Santé) a health centre staffed by nurses in each sector (except 18, to be covered soon), a district hospital in each district, and a provincial hospital in each province. In addition, three new referral hospitals are planned to ensure that Rwandan citizens are equitably served.
We certainly have had the accompaniment and support of tremendous partners since 1994 and we are absolutely grateful to them, but it is the Rwandan people who, with their relentless efforts, have fundamentally driven this progress.
I am grateful for the transformative leadership that holds us accountable to ensure we meet the highest expectations, that does not accept actions that would promote double standards, and promotes the fulfillment of human rights as we carry forth on this path towards a better tomorrow. 
Happy International Labour Day!
The writer is the Minister for Health."

*Published in Rwanda New Times - 1 May 2015 - 

Thursday, April 30, 2015

Ministry of Health Commemoration Event

I was honored to participate in the commemoration events in Nyanza where we commemorated our brothers and sisters killed during the 1994 genocide against the Tutsi.  Afterwards, we held an event for 35 Ministry of Health colleagues who were killed during the genocide against the Tutsi 21 years ago.  

Please read the New Times article, written by Jean Mugabo, that described the event.  

Full article written by Jean Mugabo of the New Times can be found here: 


"The health sector has recommitted to fighting  Genocide denial country continues to mark the 21st anniversary of the Genocide against the Tutsi.
 "Remembering the departed is a responsibility to every Rwandan, but it is even more important to our profession which is tasked to save lives"
‘‘Everybody was created to live, not to be killed. And remember the perpetrators are still there. So, we have to fight them, and fight Genocide ideology, denial and trivialisation,” said James Kamanzi, the Acting Director General of Rwanda Biomedical Centre (RBC).
Kamanzi was speaking at Nyanza Genocide Memorial site in Kicukiro District during an event to remember the 35 former employees of the Ministry of Health (MoH) who were killed during the Genocide.
He noted that the Genocide was stopped by Rwandans and urged health workers to strive for self-reliance.
“No one can love Rwandans or solve their problems more than Rwandans themselves. When the United Nations Assistance Mission for Rwanda (UNAMIR) left amidst the brutal killings, the RPF Inkotanyi stopped the Genocide. ‘‘So, learn from their heroic actions, never wait for foreign aid but seek to be self-reliant,” he said.
Encouraging everyone to comfort and support survivors, Kamanzi stressed the importance of remembrance in ensuring that the notion of ‘Never Again’ is a reality.
At least 11,000 Genocide victims are buried at Nyanza memorial site, including 3,000 who were killed at Nyanza and 8,000 from nearby areas.
Naphtal Ahishakiye, the Executive Secretary of the umbrella of Genocide survivors associations, Ibuka,  recounted the awful killing of 3,000 people who had sought refuge at the former Ecole Technique Officielle (ETO) Kicukiro, currently the Integrated Polytechnic Regional Centre (IPRC) Kigali.
 “At the height of the Genocide, the Belgian peacekeepers said that their mission was over and withdrew from ETO School on April 11, leaving at least 3,000 Tutsi behind.
‘‘Interahamwe militia marched them to Nyanza and massacred them from there. About 100 were rescued by the RPF the next day when the killers were on the way to finish them off,” he said.
During the event, Dr Agnes Binagwaho, the Minister for Health, led other officials at the ministry, to lay wreaths on the graves of Genocide victims there.
The event was followed by a ‘walk to remember’ from IPRC to MoH offices, where commemoration activities continued.
 After lighting the flame of hope, participants listened  to  testimonies of two Genocide survivors.
 Constantin Ntaramana, a worker at the National Centre for Blood Transfusion (NCBT), testified how he was confined to his work place and fed on glucose for about three weeks.
 “I was at work in NCBT on April 6 (1994), but failed to leave when the Genocide started.
‘‘I stayed there, hiding in the ceiling and feeding on serum glucose until late May when someone took me to the International Committee of the Red Cross. There, the RPF saved us from the killers,” he recalled.
Theogene Hakizimana also recounted how the Genocide robbed the lives of his parents and seven siblings.
“I was beaten and left for dead thrice, but survived thanks to God’s mercy.
‘‘I watched my father, and siblings being killed with machetes while hiding, but later I started wishing I could have been killed with them.
‘‘I used to sit by their dead bodies, waiting for my turn but I always survived,” he testified.
Hakizimana, is among the few who survived in his area of Nyaruguru District, commended the RPF for rescuing him.
Both Ntaramana and Hakizimana spoke of hope for a better future."

*New Times Article written by Jean Mugabo - 

Reflections on Kwibuka21

Below is my Op-Ed on Kwibuka 21 that was published in New Times in April 2015.  I hope you will take a moment to read through these reflections on what happened in Rwanda 21 years ago and where we are today.

The full article on the New Times website can be found here:


"This year, for the first time, I spent the entire first day of Kwibuka in my village.  It was a moving way to begin the 21st commemoration of the Genocide against the Tutsi. As I spent the day alongside my neighbours, many of whom suffered so much from the Genocide, I found myself moved by the courage of the great people of Rwanda.
For the survivors who chose to seek reconciliation as opposed to revenge, you have allowed this country to move forward to where it is today.  I am deeply humbled by your courage to forgive.
By doing so, you have offered your hand to lift Rwanda from the ashes it once was.
Today, we are a peaceful and strong country.  We are proud of what we have become.  As His Excellency President Paul Kagame has said, “this country has changed for the better and for forever”.  I am thankful for this transformative leadership that has guided and inspired us all along this difficult but meaningful journey.
Immediately after the Genocide against the Tutsi, 21 years ago, much of the world viewed Rwanda as a lost cause.  They expected us to fail if we were left to our own devices. They believed, as usual, that it was a place that required a hero from the outside. But they were mistaken.  Our heroes are you the survivors and you our great President, Paul Kagame, who led us to our journey of recovery.
Mister President you are a true hero for leading those who ended the 1994 Genocide.  You are a hero for continuing to lead us in our quest for stability, peace, development and prosperity.
My other heroes are those survivors who have faced unimaginable suffering, trauma and pain and yet are striving daily for a better future for all Rwandans - for both survivors and perpetuators and the generations to come. I salute the values that have guided you, including the spirit of self-determination and ownership. Agaciro.
Because of you, Rwanda has shown that poverty, savagery, revenge and terror are not acceptable destinies.
Our story since 1994 has also helped to show how misguided and harmful opinions can be when it comes to false global solutions to assist nations that are trying to overcome great obstacles.
For instance, some justified withholding life-saving health interventions from Rwanda’s children because it will add “man-years of human misery”, (The Lancet)[i].  There are some in this world that promote such failures to humanity.
I could provide many other examples of international organisations that essentially did the same in so many areas.
The world failed to imagine that Rwanda could be where it is today.  We have thus proven these dangerous skeptics wrong.  We have shown that we can break dangerous cycles of despair through forgiveness, reconciliation, and standing united for a brighter future.
Many describe Rwanda’s transformation over the past two decades as nothing short of a miracle.  And yet this discredits the intentional and participatory processes that we have developed as a country to overcome these formidable obstacles.
Under the guidance of our President, a leader who knew that a brighter future would only be possible if Rwandans internalised and worked towards this vision collectively.  We trusted him and he leads this movement to be innovative in our collective thinking. We have refused to leave the most vulnerable behind and held strong to our commitment to equity.
We have created policies that are relevant and responsive to the community at the grassroots level.  We have sought out partners who share in our Vision 2020 and beyond.  And so much more.  Such innovations have translated into consistent economic growth and unprecedented health improvements, among others. Thank you Mister President.
While we have come so far, we all know that we have a long way to go under your guidance.  Our journey has only begun.  But this promising future for our beautiful land of a thousand hills would not be possible without the critical, challenging first steps that our beloved survivors took to pursue real and lasting reconciliation.
To each of you, I hope you know how deeply I admire your courage and thank you for the opportunity to learn from you and be with you in this journey towards a brighter future for all Rwandans."