The Government of Rwanda views healthcare as a basic human right, and as such, our healthcare delivery model aims to serve all Rwandans, especially the most vulnerable. This rights-based approach is at the root of Rwanda’s health strategy. It is articulated in Rwanda’s Economic Development and Poverty Reduction Strategy, Rwanda’s Vision 2020, and our commitment to the United Nations’ Millennium Development Goals. A major objective of Rwanda is to engage the nation in a participatory effort to eradicate poverty and the many ills it brings.
Over the past decade, Rwanda has seen under-five mortality drop by half. We have achieved universal access to HIV therapy and now are able to address HIV/AIDS as a chronic disease.
More women than ever are delivering their babies in health facilities, and more than 95% of Rwanda’s 11 million people have health insurance. Rwanda’s successes in preventing and treating top killers – malaria, tuberculosis, HIV/AIDS, respiratory infections, and diarrheal diseases – have led to a dramatic increase in life expectancy.
With over 400 health centers, 40 district hospitals, and 45,000 community health workers providing care at village level, Rwanda has created a system to bring health care to both its urban and rural populations. This system has improved financial and geographic access to health services to all Rwandans, even the poorest. And our accomplishments represent the strength of the Government’s stance on health care and human rights and the support of its development partners.
Achievements such as these are pivotal. In another decade, Rwanda will without any doubt continue to see its people living longer and healthier lives. The gross domestic product per capita will also likely increase because of a healthier population, and Rwanda’s population will be in better economic shape.
However, by fighting the current top killers we are only able to increase the life expectancy to approximately 54 years as infectious diseases do not account for all of the country’s morbidity and mortality burden. Our service delivery still has serious gaps as noncommunicable diseases (NCDs) which probably account for about 25% of the national burden of disease according to World Health Organisation have yet to be addressed in a strategic and systematic way.1
These diseases include cardiovascular disease, cancer, epilepsy, pulmonary disease, and diabetes among others. These are global diseases and yet, more often than not, NCDs are thought to be problems of middle and high-income countries. I want to stand strongly against that. If in the North, risk factors for NCDs include obesity, tobacco use, and other factors called poor lifestyle choices, tobacco and nutritional factors impact also the health of our population. Tobacco because the quality of the cigarettes in Africa is not controlled and it contain more toxics. The nutrition factors are important but more because of undernutrition than overnutrition. But if we don’t tackle life style and nutrition now, when our economy will grow, overnutrition will replace undernutrition as the main cause of malnutrition.
In general, NCDs in the developing world are linked to malnutrition, infection, congenital abnormalities, toxic environments, and lack of access to health care services required to tackle NCDs early enough. All of these factors are ultimately exacerbated by poverty. On top of that, HIV/AIDS, tuberculosis, malaria and neglected tropical diseases contribute seriously to increasing the risk factors for NCDs whether treated or untreated.
Rwanda is aware of the need to both treat its population and to protect its population from emerging risk factors that accompany urbanization and we have started to work on it. Over the next five years, the country anticipates expanding access to integrated chronic care by building on the existing healthcare platforms established by programs fighting infectious diseases.
Currently, there are many disease-specific advocacy groups in Rwanda and in the world fighting for advanced care for conditions such as cardiovascular illness, diabetes, epilepsy, and hemophilia. The challenge for a country like Rwanda is to coordinate those efforts, and identify and execute the right set of integrated strategic plans to prevent and treat NCDs in a holistic manner. This is important as infectious diseases, chronic diseases, non-communicable diseases, hurt the same members of our communities; and also, service will be delivered by the same health professionals in the same health centers across all illnesses. We talk about human as an entity, and so infectious disease, NCDs and chronic care has to be integrated to serve those human individuals without making them lose time and continium of care. For example, when someone has a cardiac disorder and gets malaria and suffers from cancer – we must make sure that all care should be should be timely given. And because of equity, and equality in access to care, we need to do our best to provide quality integrated care where people are living.
Currently, many Rwandans are able to afford the prevention and treatment of uncomplicated cases of common diseases such as malaria or pneumonia, but most cannot afford the costs of chronic care of HIV/AIDS, heart disease, diabetes, epilepsy or cancer. Therefore, chronic lifelong treatment and managed care for NCDs must be derive from a publicly-sponsored, tactical and efficient plan to achieve accessibility and affordability. Already Rwanda has taken steps to tackle some of the prevention issues unique to NCDs, including the improvement of household cooking stoves and access to treatment for streptococcal pharyngitis, among myriad other steps. But we have much work to do. We will never achieve our development goals if we don’t take seriously the non-communicable illnesses of our patient populations – illnesses which most of our citizens must simply endure since they cannot pay for treatment. Without decreasing the attention we currently have on combating communicable diseases, we affirm our constant dedication to preventing and treating noncommunicable diseases, and making chronic care available to all.