Below is my
contribution to Ubuzima Magazine, published by the Rwanda Health Communications
Center and the Rwanda Biomedical Center.
I recommend
you to read the full magazine! Lots of great updates on our health sector from
the MOH and RBC. July2012,Vol.69(2)
Specialized
medical education:
a necessary
tool for development and the right to health in Rwanda
By
Dr. Agnes Binagwaho
Minister
of Health of Rwanda
In Rwanda,
equity is a principle written into our Constitution, and is found throughout
Vision 2020, our roadmap for development. As in all sectors in Rwanda, the
health sector has conceived policies, strategies, and plans based on equity
that are aligned to the national developmen plan. Vision 2020 provides clear
and flexible directives for achieving health and wealth in the framework of
social justice for all.[1]
As such, we are wholly dedicated to ensuring that the fruits of science are
beneficial to all – both providers and patients alike.
This
approach has driven the gains made over the past decade by Rwanda in improving
the health of its population, particularly in the area of infectious diseases.
Mortality due to HIV disease decreased by nearly 78% between 2000 and 2010, and
malaria mortality decreased by 76% between 2005 and 2011. [2],[3]
The utilization of primary health care interventions has increased
dramatically, and we have seen rapid declines in both maternal and child
mortality rates of approximately 50% in recent years.[4]
Rwanda offers ten vaccines at no cost to all children; coverage rates for these
vaccines range between 90-96%.4 Life expectancy in Rwanda has
increased from 30 in 1995 to 55 in 2010. This gain has given ground for
degenerative and chronic illnesses to commonly be expressed whereas in the past
the Rwandan population had not survived to the age where those pathologies
existed regularly enough to make them public health priorities.[5]
These achievements are due in part to equitable policies, evidence-based
interventions, continuous adoption of scientific innovation, with a focus on
community-based approaches. By virtue of the work of Rwanda’s 45,000 community
health workers who receive constant training in preventive, diagnostic, and
curative skills to be able to address 80% of the disease burden at the village level.
In light of these achievements, it is time to take the health sector’s progress
to the next level. To do this, we must educate current and future professionals
in medical specializations and sub-specializations enabling them to prevent,
diagnose, and treat pathologies common and new to our population, including
chronic care for HIV positive persons, and side effects of antiretroviral
therapy.
In 2009,
the President of the Republic of Rwanda spurred the Ministry of Health to find
an inventive way to increase the number of highly specialized health
professionals practicing in Rwanda in order to accelerate Rwanda’s pace toward
becoming a middle-income country. After deep reflection within the health
sector, we identified a way to increase the quality and quantity of health
professionals who not only can maintain gains since 2000 in their capacity to
tackle infectious diseases, but who can also address new pathologies and
adaptations in the epidemiological landscape in Rwanda.
We decided
to conceive a plan to improve human resources for health by building a
knowledge base and increasing Rwanda’s capacity to provide academic and
clinical training to the next generation of highly skilled health care
providers who will then become the teachers and trainers themselves. The
training program, coupled with purchasing new medical equipment and improving
the health infrastructure, will certainly increase access to high quality care
and advance Rwanda’s overall development.
The result
is the National Human Resources for Health Strategic Plan 2011 – 2016 and its
implementation plan: the Human Resources for Health (HRH) Program. The HRH program has been conceived within the
framework of using the “3 Ones” principle of having one governance body (the
Government of Rwanda), one action plan (National Human Resources for Health
Strategic Plan 2011 – 2016), and one monitoring and evaluation plan. By
repurposing existing bilateral and multilateral donor funds from development
partners including PEPFAR, USAID, the Global Fund, GIZ, BTC, DFID, and the
Swiss Cooperation, the Ministry of Health has been able to secure enough
funding for a successful launch of the HRH Program in August 2012. The
Government of Rwanda has also contributed greatly to the resources available
through the Capacity Development Public Secretariat.
The HRH program seeks to address Rwanda’s critical
gap of skilled specialized health workers and the inadequate amount and caliber
of equipment available in health facilities that presently hinders clinical
training and service delivery. The program was designed to increase the quality
and quantity of physicians, nurses, and hospital managers through partnership
and mentorship. The Ministry of Health
has established a partnerhsip with over a dozen top American universities,
including five schools of nursing, seven schools of medicine, and one school of
public health. These schools comprise the US Academic Consortium, which has
been working with Rwanda to develop more than 15 specialty and sub-specialty
areas including: anesthesiology, surgery, internal medicine, obstetrics and
gynecology, pediatrics, critical care and traumatology nursing, surgical
nursing, healthcare administration, and more.
For this seven-year program starting in August
2012, ever year 100 US faculty members will be deployed to Rwanda for one year
at minimum. They will be paired with Rwandan educators in the Faculty of
Medicine and Faculty of Nursing Sciences at the National University of Rwanda
as well as all schools for A1 Nursing. US faculty will work together with their
Rwandan counterparts to increase local training capacity and the quality of
clinical teaching offered to students. As
each year of the program progresses, Rwandan faculty will obtain increased
capacity in teaching and training, and will eventually assume full
responsibility for specialized medical education in Rwanda.
The investment of American, European, and Rwandan
taxpayers for the development of Rwanda’s health sector in this novel and
unprecedented model will be sustainable in the long-term because all residents
who benefit from this training will sign a contract with the government to
serve in the public sector for several years upon completion.
This new
initiative for human resources for health in Rwanda is included in the legal
framework, in the Health Sector Strategic Plan III, and in the development of
the new Economic Development and Poverty Reduction Strategy that is currently
underway. The planning and execution of this major program have been truly
multi-sectoral and reflect the commitment and collaboration of leaders in across
the health, finance, education, and justice sectors, in addition to medical professional
associations. We have worked as a team to revolutionize the way Rwanda can
train its health professionals in such a way that guarantees equity in the
quality of an increased quantity of services to all Rwandans no matter where
they live or who they are. Our fellow Rwandan citizens deserve nothing less
than the best.
[1] Ministry
of Finance and Economic Planning, Government of Rwanda. (2000). Vision 2020. Kigali, Rwanda.
[2] World
Health Organization. (2012). World Health Statistics 2012. Geneva, Switzerland:
World Health Organization.
[3]
Karema C. (2012). Personal Communication.
[4] National
Institute of Statistics of Rwanda and Macro International, Inc. (2012). Rwanda
Demographic and Health Survey 2010. Calverton, MD: Macro International, Inc.
[5] World
Bank. (2012). DataBank: World Development Indicators and Global Development
Finance. Available: http://databank.worldbank.org/
(Accessed 21 June 2012).
