"I am very proud to serve for a country that has prioritized the health and wealth of its children. This is evidenced by activities, laws, policies, strategies and plans implemented by various sectors. This is normal because our people are our riches. And among them – the most precious are our children because they are our future and we always fight to improve their health and well-being.
On a personal note, as a pediatrician, I am deeply motivated to improve the lives of children. Any effort to reduce unnecessary suffering and harm to a country’s future generation is laudable because – like so many Rwandans – I believe that the value of a country is how it treats the most vulnerable among its people. And our children are the most vulnerable of our citizens.
This is why that I, along with so many others, was shocked to see news of a report that was released by the United Nation’s Children Fund (UNICEF) titled “Hidden in Plain Sight: A Statistical Analysis of Violence against Women and Children”, which included findings – that if true – would make Rwanda one of the most violent countries in the world vis-à-vis its treatment of children.
When looking more closely at the story behind the implausible numbers, however, it was astonishing to see how many flaws existed in this report. Even the report authors made disclaimer after disclaimer about how limited their methods were. They reported projections of data – as opposed to real data – and failed to explain what informed these projections. Not surprisingly, their findings are so far from the truth.
For instance, the Rwanda Demographic Health Survey – which is an internationally recognized data source to document the status of the health and well-being of our people and is done in partnership with those who published and promoted this report (WHO, UNICEF), shows a very different picture relative to the recent flawed report. Additionally, the real data on child homicides recorded by the Rwanda police suggests that the UNICEF report estimated a child homicide rate that was over 10 times as high as reality in Rwanda. (see table below)
Observations on the data related to Rwanda profile:
Table: Observations on the data related to Rwanda profile.
Flawed data – such as these – cannot simply be apologized for in a “technological appendix” or the “limitations” of a study (which never would make news headlines). Instead, they have real consequences. They can easily damage the reputation of development plans of a country. They can easily redirect time and policymaking efforts to “problems” that don’t actually exist.
This report teaches us to reflect upon a few key things:
First, efforts to hold international institutions accountable are blocked and they still allow themselves total impunity to publish defamatory reports without any consequences to themselves.
Second, this puts into question the commitment of these institutions to human rights. One of the major principles of human rights is a participatory process. By extension – as countries are made up of human beings – the people of these countries should be given the right to participate or review the report. Reports – right or wrong – on country performance should never be disseminated without being shared with the country to inform them of the findings so that eventually, they can show evidence of the false allegations or use the information – if accurate – to generate positive change.
In conclusion, I just want to recall the imihigo contract that we have just signed across sectors and level of responsibilities as a country to guarantee accountability of each leader at all levels. It is something that the UN may consider adopting to help guarantee better use of their organization’s influence and the other useful work that they undertake everyday in partnership with member states.
The Author is the Rwanda Minister of Health."
Published in the New Times - 15 September 2014 - Link: http://www.newtimes.co.rw/section/article/2014-09-15/180939/
Given my background as a pediatrician and enthusiasm for research, I was very proud to be the first person to receive a Doctorate of Philosophy (Ph.D.) from the College of Business and Economics of the University of Rwanda in August 2014. My thesis on improving the health of children with HIV/AIDS in Rwanda has meant a great deal to me. More information regarding the announcement of the degree can be found here. I've also included a picture from the special graduation day below:
Additionally, since receiving my PhD, a number of people have inquired about my ability to manage the various responsibilities before me in a given day. I very much enjoyed my interview with the New Times reporter - Collins Mwai - who captured my reflections on this topic in this piece published on Sept. 3rd: http://www.newtimes.co.rw/section/article/2014-09-03/389/news-career:-dr-binagwaho-tips-on-juggling-education-and-work (see text below)
"Following its merger, the University of Rwanda passed out its first graduates in various disciplines and levels this year and among them was Dr Agnès Binagwaho, the Minister for Health.
Dr Binagwaho was conferred with aDoctorate of Philosophy (PhD) in Health Management and did research on the HIV/Aids epidemic, with Rwanda as her case study.
Binagwaho, who started the course in 2008 before the merger of the institution, managed to juggle her studies, her ministerial role, her work as a senior visiting lecturer in the Department of Global Health and Social Medicine at Harvard Medical School and clinical professor of pediatrics at the Geisel School of Medicine at Dartmouth, USA.
In an exclusive interview with Women Today’sCollins Mwai, the minister explains the reasons, necessity and modalities of higher learning.
You are a minister, a lecturer in two top universities in the world and you have a stable career. Why the need to return to school?
The President always says “never remain in your comfort zone, always challenge yourself.” I am a strong believer in that too. The day you believe you have nothing to learn is the day you begin to die. Even in retirement, there are numerous lessons to learn.
How did you juggle between your roles through school?
We all have the same number of hours in a day; it is up to you to choose how you will spend your time. I prefer to spend mine learning and doing research. I was comfortable juggling my various roles and school. It is always easier if you have a passion for what you do.
You had the capacity to undertake your PHD anywhere in the world but you chose to do it here, why?
I first registered as a PhD student at the university while it was still National University of Rwanda (NUR). While working, a PhD takes between four and six years, it happened that I graduated after the universities had merged.
I wanted to do a PhD in my country because in many areas, this country is quite advanced in policy planning and strategy. We have riches and innovation. I am against the idea of going out for PhDs when quality education is available here. To anyone in doubt about the quality of our higher learning institution, I can tell them for sure that I did not experience challenges while pursuing the qualification.
I also wanted to prove to people who I work with that it is possible to balance work and school. If I can do it, they too can do it.
At the ministry we have been urging people to take on master’s degrees, currently most people have the qualification while others are pursuing PhDs. I am a strong believer that the best thing you can do for yourself is add more knowledge to what you have.
The requirement to work at the Ministry previously was a degree, now it is a master’s degree; we have made arrangements so that they can all have an opportunity to advance. Higher learning is a benefit to the institution and the people served by the institution. From my Ministry I have seen them have better and in-depth understanding of circumstances and solutions to approach them.
If you research more on what you do, you become a master in the domain and can perform better. It is an advantage to you, your institution and your community.
Most women of the young generation currently view higher learning only as a means to higher salaries; you clearly see it quite differently, why is that?
Money and a high salary is not the end, it should not be, it is just a tool. We have people who are rich but end up taking their lives. Education gives you fulfillment and purpose. Continuous education has numerous benefits. You will never know enough.
There has previously been talk that quality higher learning can only be obtained abroad, do you believe so too?
It is not true, in one way; even those institutions come here to learn from us. They borrow ideas from here and go teach them abroad. That is part of what we are trying to educate people in the Ministry, to do further research, document their findings, and share it on bigger platforms internationally.
I came to Rwanda as a young pediatrician, being here I have had an international dimension and learnt in numerous ways over the years. You do not have to go abroad to learn, I have been known for what I have learnt and done here, I never asked for a job at Harvard, they asked me.
You can create the universal bank of knowledge here. Some ministries in this country have pioneered initiatives and leadership models that have never been practiced anywhere in the world. There is a lot to learn from here, it is time people realised how much the world can learn from us.
Among other things you are a lecturer, what is the one thing you insist on with your students?
The importance of participatory processes; working closely with the community that you are working for, you need to listen to them and learn from them. People in certain positions need to work with the people for the people.
What would you say of people with high academic qualifications but do not reflect their qualifications in performance?
They probably do not further their studies to serve better, or challenge themselves. Some could study to have bigger titles on their business cards. They also probably do not have well laid plans and strategies. Always have one. Since I began working in leadership positions I have learnt that as long as you have a guide like Vision 2020 and Economic Development and Poverty Reduction Strategy (EDPRS2) you can come up with strategies to get there.
What advice do you have for people reluctant to pursue higher learning?
Education is key, the more educated you are the more functional you are. Good education is one that helps you improve the world around you and is practical. There is no limit, the best reward you can have is to see the result of what you do. Do not run after money, it will always be needed, but it is never the end." -New Times, Rwanda - 2014 Sept 3rd (Collins Mwai)
I was very proud to be part of this Lancet Commission, which could help countries in these final miles of the 2015 Millennium Development Goals (MDGs) and to plan beyond...
The entire report overview in .pdf format can be found here: http://www.globalhealth2035.org/sites/default/files/policy-briefs/overview-english.pdf - text and figures are pasted below.
the growth in full income in low- and middle-income countries between 2000 and
2011 resulted from health improvements. Figure 3 summarizes estimates of the
contribution of health to growth in full income in 1990–2000 and in 2000–2011
for different regions of the world. As the world approaches the 2015
deadline for achieving the Millennium Development Goals and the international
community negotiates the next global framework, massive health disparities
still exist across countries. The vast majority of people who die from
preventable deaths caused by infectious diseases or maternal and child health
conditions live in low- and lower-middle income countries. Global Health 2035 is an ambitious
new investment framework to begin closing this health gap within a generation.
Written by The Lancet Commission on Investing in Health, a group of 25 renowned
economists and global health experts, Global Health 2035 provides a roadmap to achieving
dramatic gains in global health through a grand convergence around infectious,
child and maternal mortality; major reductions in the incidence and
consequences of non-communicable diseases (NCDs) and injuries; and the promise
of “pro-poor” universal health coverage. A “grand convergence”
in health is achievable within our lifetimes A unique characteristic of this
generation is that we have the financial and ever-improving technical capacity
to begin closing the global health gap. History shows that even poor countries
can achieve rapid declines in death rates by investing in health. Global Health
2035 points to the “4C countries”—Chile, China, Costa Rica and Cuba—which
started off at similar levels of income and mortality as today’s low-income countries,
but sharply reduced their preventable deaths by 2011. The 4C countries are now
among the best-performing middle-income countries. Global Health 2035 outlines a path
for today’s low- and lower-middle- income countries to achieve similar rates of
dramatic progress, reaching levels of mortality seen today in the 4C countries
and averting about 10 million deaths in 2035. The 2035 convergence goals are summarizedas “16-8-4”—reducing under-5
mortality to 16 per 1,000 livebirths (see figure 1), reducing annual AIDS
deaths to 8 per 100,000 population and reducing annual tuberculosis (TB) deaths
to 4 per 100,000 population. Global Health 2035 lays out a
detailed investment framework for national governments to achieve the “16-8-4”
convergence goals by:
scaling up new and existing tools to tackle HIV/AIDS, TB, malaria, neglected
tropical diseases and maternal and child health conditions; and
their health systems using a so-called “diagonal approach”—that is, building
systems that specifically improve these countries’ ability to tackle the
highest burden health challenges
About two-thirds of child deaths,
AIDS deaths and TB deaths now occur in middle-income rather than in low-income
countries. Achieving convergence therefore demands action that goes beyond
low-income countries to also focus on poor, rural sub-populations of middle-
income countries. The Commission estimates that the average
incremental cost of convergence for 34 low-income countries will be about US
$23 billion annually from 2016-2025, rising to around US $27 billion annually from
2026-2035. The incremental cost in lower-middle-income countries will be about
US $38 billion annually from 2016-2025, rising to around US $53 billion
annually from 2026-2035. The expected economic growth of middle- income countries
will easily allow these countries to finance convergence entirely from domestic
sources. While low-income countries will require some external assistance, they
should be able to finance most of the incremental cost of achieving convergence
themselves. The international community
should unite around the vision of Global Health 2035 and support the innovation
and technical assistance needed to achieve it The international community can best
support convergence by renewing its commitment to providing global public
goods, particularly health research and development (R&D), and managing
cross- border externalities, such as preparing for influenza pandemics. These
core functions have been neglected in the last 20 years. Convergence cannot be
achieved with today’s health tools, many of which are decades old. The
international community should double its current R&D spending from US $3
billion (see figure 2) to US $6 billion annually by 2020, with half of this
additional amount coming from middle- income countries. Some low-income and lower-middle-
income countries will continue to require external financial assistance to
scale up tools for achieving convergence. Eliminating malaria and combating
drug-resistant TB and the threat of drug-resistant malaria will in some cases
require assistance to middle- income countries. The returns to investing in
health are even greater than originally estimated The costs of convergence are
substantial, but the payoffs—in both health and economic terms—are much
greater. Global Health 2035 proposes a more comprehensive approach to measuring
the returns to investing health. The impact of health on economic
productivity has been well documented in recent years. Improved health has
contributed importantly to income growth in low-income and middle- income
countries, as measured using traditional national income accounting (based on
GDP). But while GDP captures the benefits
that result from improved economic productivity (the so-called instrumental
value of better health), it fails to capture the intrinsic value of better health—the
value of health in and of itself. Global Health 2035 reports a more
comprehensive understanding of the returns to investing in health by estimating
this intrinsic value using a “full income” approach. This approach combines
growth in national income (GDP) with the value people place on increased life
expectancy—that is, the value of their additional life years (VLYs). Global
Health 2035 estimates that 24% of Using the full income approach to estimate
the economic benefits of convergence in low-income and lower-middle-income
countries from 2015-2035, the benefits exceed costs by a factor of 9-20, making
the case for action even stronger. The full income approach provides
finance ministries, donors and other decision-makers with a strong rationale
for investing in health to put their countries on a path to rapid improvement
in national welfare. Fiscal policies can
dramatically curb NCDs and injuries, as well as leverage significant new
revenue for low-and middle-income countries One paradox of success in global
health is that when low- and middle-income countries successfully reduce deaths
from infections and maternal and child conditions, they then accelerate the
shift in their disease burden to NCDs and injuries in adults. Global Health
2035 lays out the steps that all low- and middle-income countries could take
now to delay the onset of NCDs to as late as possible in life and thus reduce
premature illness and death. National governments can curb NCDs
and raise significant revenue by heavily taxing tobacco and other harmful substances,
such as alcohol. They can redirect finances toward NCD control by reducing
subsidies on items such as fossil fuels, which produce air pollutants that
cause NCDs. A tobacco tax is the single most
powerful lever for curbing NCDs. In the next 50 years, for example, a 50% tax
on tobacco could prevent 20 million deaths in China and 4 million in India and
generate US $20 billion and US $2 billion annually in each country,
respectively. Donors and UN agencies should focus
on provision of technical assistance on tax and subsidy policies, regional
cooperation on tobacco (e.g. to reduce smuggling), and funding of population,
policy and implementation research on scaling-up of interventions for NCDs and
universalism, a pro-poor pathway toward universal health coverage (UHC), is an
efficient way to achieve health and financial protection In order to protect the poor from
impoverishing health costs, and to ensure that they benefit the most from the
investments laid out in Global Health 2035, countries should adopt “pro-poor”
pathways to insuring their citizens. The Commission endorses two pathways
to achieving UHC within a generation, which commit to covering the poor from
the outset (“progressive universalism”). In the first, publicly financed
insurance would cover essential health-care interventions to achieve
convergence and tackle NCDs and injuries (figure 4). Thispathway would directly benefit the poor, since
they are disproportionately affected by these problems. The second pathway
provides a larger benefit package, funded through a range of financing
mechanisms (e.g. payroll taxes, insurance premiums, copayments), with poor people exempted from
all payments.Governments should approach UHC
through progressive universalism—a commitment to reach the poor at the
outset—to yield high health gains per dollar spent and ensure the poor benefit
from health and financial protection. One immediate way that the
international community can support countries in implementing progressive universal
health coverage is by financing critical research, such as on the mechanics of
designing and implementing evolutions in the benefits package as the resource
envelope for public finance grows. Global Health 2035: A
Call to Action Global Health 2035 offers a new
vision for profoundly transforming the global health landscape within a
generation. Meeting its ambitious goals will require scaled up investments and
innovations in global health technology, health systems and policies. As an immediate first step toward
realising this vision, global leaders—including low- and middle-income
countries, donor nations, international agencies and civil society
organisations—should unite around the goal of convergence and incorporate it
into the post-2015 framework that is currently being negotiated. By harnessing the financial and
ever-improving technical capacity of our generation, we can avert 10 million
deaths in 2035 and ensure healthy, productive lives for millions more people—a
remarkable step toward closing the massive gap that has defined global health
for the past three decades. Figures (all from the Report Overview document)
the full report was published in the Lancet
on 3 December 2013 and can be found at www.lancet.com."
The above text and figures are from http://www.globalhealth2035.org/sites/default/files/policy-briefs/overview-english.pdf
The 06/25/2014, I had the great pleasure to publish in Huffington Post, this article with Mark Shriver, the Senior Vice President for Strategic Initiatives, Save the Children.
If 18,000 preschool kids and 800 moms were attending a World Cup game and they all died, no newspaper around the world would be silent. But that's exactly what happens every day around the world: 18,000 kids die before they reach the age of five and 800 moms die during pregnancy or childbirth. The biggest tragedy is that in both of these cases, most of these deaths are preventable.
Today, over 500 representatives from governments to non-governmental organizations to the private sector are gathering in Washington, DC to take on this challenge and discuss how we are "acting on the call to end preventable maternal, newborn and child deaths" -- a pledge that 176 governments and over 450 civil society organizations and faith-based organizations signed two years ago.
This is an opportunity not only to reflect on the tremendous progress made on improving maternal and child survival around the world, but also to double-down on our success and demand more attention and resources. Imagine how many lives could be saved if we coupled political will with sufficient resources focused on key interventions.
Over the last two decades we have nearly halved the number of children dying annually and reduced the number of maternal deaths by 45 percent. Twenty-five countries, including Rwanda, have reached Millennium Development Goal Four (reducing child mortality by two thirds) and a number of other countries are on track.
In fact, according to "Countdown to 2015 modeled data in 2013," Rwanda not only had already achieved an under-five-year mortality rate (U5MR) reduction of more than 70 percent, but it has the fastest rate of decline in child deaths of any country, ever.
Rwanda's success, while remarkable, is not a mystery. Investments were based on the evidence, tackling the biggest threats to child survival by increasing effective interventions such as vaccinations and breastfeeding rates. The government has put equity at the core of efforts to strengthen the health system from putting community health workers in villages and ensuring appropriate care facilities at the sector, district and provincial levels, as well as referral hospitals across the country. This approach to bring care and prevention near where the people are living has drastically improved the geographic accessibility for all. And this commitment to reach all Rwandans has been mirrored in the Vision 2020 strategy that will improve socioeconomic conditions.
Rwanda is a success story but much remains to be done: no country should stop before ending the last preventable child death. Many countries in Africa are experiencing success, but the risk of a child dying before five is still highest in the African Region -- about six times higher than that in the Americas. Today, a woman's risk of dying from childbirth in sub-Saharan Africa is more than 47 times greater than in the United States.
Rwanda proves that it doesn't have to be this way. A recent study by the World Health Organization noted that an additional $8 per capita per year investment in Africa could prevent up to four million maternal deaths, 90 million child deaths within a generation in the region. And the benefits can transform not only families, but also economies: investments in maternal and child health yields economic benefits including higher per capita incomes and increased labor force participation.
To end preventable maternal, newborn and child deaths globally, we must increase attention and resources in Africa. Today, USAID is releasing a report, Acting on the Call: Ending Preventable Child and Maternal Deaths that lays out a roadmap for dramatic progress over the next five years. The US and African Presidents will come together in August to talk about investing in future generations. Together, we have an opportunity to use this Summit to accelerate action in Africa to end preventable maternal, newborn and child deaths worldwide. Our hope is that this summit will increase collaboration between the U.S. and African partners to promote and deliver the most effective interventions and identify new and innovative resources.
There is no more important goal we can share, no more important investment in the future health and stability of the continent, than saving the lives of mothers and children.
I gave this lecture given to Dartmouth University students to share how we built a health sector alongside a nation. It is the health sector contribution to Rwandan rebirth the past 20 years
the story of the Rwanda health sector after the 1994 genocide against the Tutsi. a story of ownership accountability participation equity sciences and fight for sustainable development.
Follow the live lecture using the following link: https://www.youtube.com/watch?v=_PfKMAb1I-g
years after the end of the 1994 Genocide against the Tutsi, this July fourth
makes me reflect on what the events we remember today have brought to me as a
Rwandan, as an African, and as a woman, a mother, and a daughter. First and
foremost, I have come to understand that, to truly honor the sacrifices of our RPF’s
brave soldiers—who laid down their lives so that Rwandans might live in a
country free of discrimination, free of the fear of violence based on one’s
background, and free to pursue lives they value—we must work to own our
to our heroes, I now live in a country where all have an equal chance, whether
you are the nation’s newest baby girl in the most rural district, or whether
you are the head of Parliament. Thanks to this foundation, we have the
opportunity to build the future we want through dialogue and transparency.
this reborn Rwanda, our society is far from homogenous; this is such a
blessing, because it is our diversity that fuels the engine of innovation
behind recent progress. Certainly, many serious challenges lie ahead, and we
have so much more to achieve in order to give all of our brothers and sisters
the opportunities that they deserve. But we are continuously progressing each
day to achieve that vision, and on this July fourth, I hope we do not take
these efforts for granted.
today’s Rwanda, every citizen inside our borders or living all around the
world—whether they support the government’s efforts or hold different
views—identify themselves as Rwandans with pride. Today, we celebrate the
blessing of our shared identity as Rwandans, and pursue with renewed purpose our
mission to accelerate the journey to shared development by transforming our
Vision 2020 into our daily reality.
of our international friends see Rwanda’s recent achievements as a miracle of
humanity, compassion, forgiveness, inclusivity, and progressive thinking that
some claim could never be replicated elsewhere. But on this July fourth, as we
reflect on a journey spanning twenty years, it is clear that this is no
miracle. Anything that we have achieved has been through the determination and
shared efforts of millions of Rwandans to liberate our country from the spirit
of division, from fear, from ignorance, from the consequences of bad
leadership, and from the oppression of poverty.
we still have a long way to go, we are proud of what has been built to date. In
this spirit of reflection, I feel a strong sense of gratitude to the Rwandan
Patriotic Front for having halted the Genocide, and for protecting our people
and our nation these past two decades. By helping more than two million
refugees and displaced citizens to return home to peace and security, by making
our communities free from discrimination of any kind, and by building the
foundations of a democracy based on human rights, the sacrifices of our
countrymen and countrywomen and the leadership of our President Paul Kagame
have brought us here today. The liberation of 1994 recovered our dignity; the
daily work to liberate our minds is making us proud Rwandans and proud
this legacy, the Rwandan people can address the greatest challenges we have face
by owning them, working to take full responsibility in the face of complexity,
and harnessing the creativity of our people to find the solutions our nation
needs. If we carry this spirit forward, we will truly own our future for the
next 20 years and beyond.