Sunday, May 26, 2013

Specialized medical education: a necessary tool for development and the right to health in Rwanda

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: (Accessed 21 June 2012).