Tuesday, March 22, 2011

My message to Partners In Health (PIH): an association that has dedicated decades to improving the welfare of the world's vulnerable

The Government of Rwanda views healthcare as a basic human right. National healthcare delivery is rooted in Rwanda’s commitment to addressing the health concerns of all Rwandans while paying close attention to the most vulnerable persons. This rights-based approach has permeated Rwanda’s health strategy. It is articulated in Rwanda’s Economic Development and Poverty Reduction Strategy,  Rwanda’s Vision 2020, and the United Nations’ Millennium Development Goals. The general aim is to engage the nation in a participatory effort to eradicate poverty and the many ills it brings.

This Guide aligns itself with the overall healthcare strategy of the Ministry of Health of Rwanda, specifically in the regulation of development partner initiatives, and in the promulgation of policies and the execution of programs.

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, 42 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. The reality that all Rwandans – even the poorest – have  access to primary health care represents the strength of the Government and its development partners’ stance on health care and human rights.

Achievements such as these are pivotal. In another decade, Rwanda will undoubtedly continue to see its people living longer, healthier lives. The gross domestic product per capita will also likely increase, and Rwanda’s population will be in better economic shape.

And yet, the current top killers do not account for all of the country’s disease burden. Regretfully, there remains a serious gap in Rwanda’s current health care system. Noncommunicable diseases (NCDs) – probably accounting for about 25% of the national burden of disease – 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. In such countries, risk factors for NCDs include obesity, tobacco use, and other factors termed poor lifestyle choices. However, in Rwanda, and other developing countries, this is not the case. NCDs are instead linked to malnutrition, infection, congenital abnormalities, toxic environments, and lack of access to basic health care. These are all ultimately caused by poverty. And HIV/AIDS, tuberculosis, malaria and neglected tropical diseases – all diseases endemic to the poorest nations – further contribute to risk factors for NCDs whether treated or untreated.

Rwanda is acutely aware of the need to both treat its population and to protect its population from emerging risk factors that accompany urbanization. Over the next five years, the country foresees itself expanding access to integrated chronic care by building on the existing healthcare platforms established by HIV/AIDS programs. Expanded access and improved options for preventing and treating chronic illnesses and NCDs would have a tremendous impact on morbidity and mortality. Currently, there are many disease-specific advocacy groups in Rwanda fighting for advanced care for conditions such as cardiovascular illness, diabetes, epilepsy, and hemophilia. The challenge for Rwanda is to identify and execute the right set of integrated strategic plans for preventing and treating NCDs. Chronic care integration is one such plan.

Inshuti Mu Buzima (IMB) – the sister organization to the Harvard-affiliated non-profit, Partners in Health (PIH) – was invited to work in partnership with the Ministry of Health of Rwanda at the end of 2003. IMB-PIH has put itself at the service of Rwanda’s vision for health care by devoting itself to the needs of the entire populations of three districts. In particular, it has made a unique contribution in the area of chronic care and NCDs. This approach has led to a joint undertaking between the Ministry of Health and IMB-PIH, including a conference in January 2010, which was focused on how to tackle non-communicable diseases in Rwanda. Through such discussions, chronic care integration has been identified as a central unit of strategic planning to improve the health of the Rwandan population. Other units of planning for NCDs include gynecologic care at district hospitals; improving the quality of generalist physician care at district hospitals; histopathology; cancer care; cancer surgery; cardiac surgery and neurosurgery. Now, in January 2011, Rwanda finds itself equipped with a healthcare system capable of launching chronic care integration; and IMB-PIH finds itself prepared to advise, advance and support the effort.

Many Rwandans could afford the prevention and treatment of uncomplicated cases of common diseases such as malaria or pneumonia, but most could not 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 rooted in 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. And we implore other low-income countries to take seriously the non-communicable ailments of their patient populations – ailments which most of their citizens must simply endure, because they cannot pay for treatment. Rwanda has made great strides in combatting communicable diseases under the leadership of the Government. The Ministry of Health and our development partners affirm our unwavering dedication to preventing and treating noncommunicable diseases, and making chronic care available to all. It is in this context that I am proud to be collaborating on this publication by Inshuti Mu Buzima - Partners in Health.