Wednesday, May 22, 2013

Rebuilding Rwanda’s health system

April 2013

Post on GAVI Web

These are exciting times for the people of Rwanda. Less than two decades after the1994 genocide,we are making substantial progress. Recent studies suggest that more than one million Rwandans were lifted out of abject poverty and our people are better protected from some of the most devastating diseases that not only threaten our health but also our continued productivity and economic growth. As we continue to focus our efforts on the improvement of our health and look forward to continuing progress on many of the health-related Millennium Development Goals (MDGs), it is important to take stock of how far we have come and the reasons for our achievements.
In Rwanda public health policies have been inspired by our vision 2020 and commitment to the MDGs. Not only have they helped guide our public health plans and activities, they have also served as important progress indicators. Consistent with MDGs 4, 5 & 6, we have made improvements of the health of our mothers and children a national priority. To date, Rwanda has more than halved child mortality and we look set to achieve the MDG targets for cutting both infant mortality, under-five mortality and maternal mortality by 2015. Rwanda is ranked among five countries recognized for having reduced maternal mortality by more than half; alongside Malawi, Ethiopia, Nepal and Yemen. This is partially because we have been prioritizing family planning and women’s health.
From the very beginning, we recognized that efforts to better our health could not try to fully replicate those of more developed nations. Constrained by limited financial and human resources, we needed to find a model that worked for our people and that was based on our shared history, culture and health realities. As part of our Vision 2020 process, we reached out to the Rwandan people to reflect on how to accelerate our development with innovative strategies and being as ambitious as the developed countries for we want the best for our people.  We then developed a process and strategic plan that we once again took to the people to ensure that it was workable at the local level.  We needed to do it the Rwandan way and I believe our home grown solutions have helped us to focus on substantial targets.
Much of our work has been guided by a focus on engagement with all levels of our society, because we believe that 80% of the burden of disease needs to be solved at the community level. We have decreased the financial and geographic barriers in the access of health. A better service delivery system combined with basic education and awareness campaigns have resulted in a broad utilization of health services. In each village our three elected Community Health workers have helped to ensure the accountability and transparency needed to implement effective health interventions at the local level. This has given us a large advantage in the implementation of broad immunization efforts that must encompass the vast majority of the population to be successful.
Our government’s commitment to adequate prevention efforts and in particular our focus on the scaling of immunization program have been a significant driver of our results. The government of Rwanda has worked closely with the GAVI Alliance and its partners, WHO and UNICEF, to immunize children against many common diseases. As a result of this support, by 2008, we have reached 95% of babies born in Rwanda with essential vaccines to protect them against five key childhood diseases. This level of coverage is seldom reached on the continent of Africa or anywhere else in the world and is a testament to the political will of our leaders at all level, combined with the support of our people and our international partners. We have been at the forefront in terms of vaccinating our girls against HPV. Rwandan children now have access to the 11 vaccines recommended by WHO for routine immunization. Just recently, in March, we launched the Measles and Rubella immunization campaign. Over four days in which  healthcare workers worked around the clock, across the country, to vaccinate almost five million children between the ages of 9 months and 14 years.
The partnership with GAVI Alliance also extended to strengthening the health system so that once we secured these vaccines we could effectively deliver them to our children. Our delivery system now has the capacity and ability to protect the cold chain supply so that we will be able to leverage this work to continue to deliver vaccines.
Despite all this, we still have a long way to go. Among children and women, chronic childhood malnutrition remains high, as well as severe anemia; contraception remains underused by many Rwandans and while infant and child mortality have decreased dramatically, neonatal mortality remains a challenge. Rwanda also faces a substantial burden of non-communicable diseases. We have developed actions plans at village, sector, district and referral point of care to tackle these and other unmet challenges.
Our health efforts – similar to many of our development efforts- have been implemented in partnership between the government, the people and our international partners. We have adopted the processes of using scientific evidences, equity, and participation for more efficient results with our few resources.
The government of Rwanda is committed to building on its proven achievements and to expanding immunization so that we can reach the universal goal of reducing child mortality by two thirds by 2015. The 1994 genocide has devastated Rwanda and made it very difficult to achieve the MDGs. It was a said impossible challenge to achieve the MDGs, however, the determination of the people of Rwanda, the good leadership at all levels focussing on the health of Rwandans and the policies that have been adopted have open the way to achieve the MDGs and laid the foundations for a healthier future.