Rwanda: Using Innovation through Drones to Save Lives

 

Video produced by Zipline. 2016. 

Africa: Govt Closer to Using Drones in Medical Supplies Delivery

Published on May 15, 2016 at 7:32 pm in All Africa by Julius Bizimungu

Article retrieved from:

http://allafrica.com/stories/201605160346.html

Zipline Inc, a California-based robotics firm Friday announced details of a partnership with Government to make on-demand deliveries of life-saving medical products using drones.

This follows a deal signed in February, between the government and the firm to build infrastructure for unmanned aerial system (UAS) to ensure efficient logistical transportation of medical supplies in the country.

Speaking during a press briefing, the Minister for Youth and ICT, Jean-Philbert Nsengimana, said that Rwanda is ready to receive the first delivery of drones.

"We have had a fruitful and a fun-filled week talking about the forth industrial revolution at the World Economic Forum (WEF). I think it's very significant for people to know that what they might think will be achieved in future, is already here in Rwanda. We already have the technology that people think we will have in the future. Rwanda is ready to receive the network of drones, and I truly believe this is going to shape the future," Nsengimana noted. 

Challenges

Often, essential health products don't reach the people who urgently need them.

According to the World Health Organisation (WHO), millions of mothers and children die every year due to conditions that could be prevented or treated with access to simple, and affordable medical interventions.

However, in the developing world, access to these interventions is hampered by what is known as the last-mile problem: the inability to deliver needed medicine from a city to rural or remote locations due to lack of adequate transportation, communication and supply chain infrastructure.

The distribution of blood products is particularly challenging given the strict temperature requirements and short shelf life. Africa has the highest rate of maternal deaths in the world, mainly due to post partum hemorrhaging, which makes access to lifesaving blood transfusions critically important for women across the continent.

In Rwanda, rural hospitals have struggled with supplies in the past due to their isolated locations. Most life-saving supplies are currently delivered via motorcycles.  According to Dr Agnes Binagwaho, the Minister for Health, the initiative is truly a life-saving technology.  "We have established that if we manage to use this technology, it will be a life-saving initiative. There are a lot of advantages, but I'm also hopeful that as pioneers we learn by doing. Although, I can't predict how many lives will be saved, even saving one life is crucial," she said.

What Zipline is bringing

According to Keller Rinaudo, Zipline Chief Executive Officer, the company is working with the government of Rwanda to create a network of delivery drones that will ferry medical supplierding to the World Health Organisation (WHO), millions of mothers and children die every year due to conditions that could be prevented or treated with access to simple, and affordable medical interventions.

However, in the developing world, access to these interventions is hampered by what is known as the last-mile problem: the inability to deliver needed medicine from a city to rural or remote locations due to lack of adequate transportation, communication and supply chain infrastructure.

The distribution of blood products is particularly challenging given the strict temperature requirements and short shelf life. Africa has the highest rate of maternal deaths in the world, mainly due to post partum hemorrhaging, which makes access to lifesaving blood transfusions critically important for women across the continent.  

The network will have capacity to make 50 to 150 deliveries per day, using a fleet of 15 drones, each with twin electric motors and an almost eight-foot wingspan. The unmanned drones will use GPS to navigate, and will airdrop supplies before returning to the landing strip from which they were launched.

"The inability to deliver life-saving medicines to the people who need them the most causes millions of preventable deaths each year. Zipline will help solve that problem once and for all. We've built an instant delivery system for the world, allowing medicines and other products to be delivered on-demand and at a low-cost, anywhere," said Rinaudo.

Starting July, the government will begin a public-private partnership with Zipline for the last-mile delivery of all blood products throughout the country. A team of Rwandan and American engineers will set up and operate Zipline's first Hub in Muhanga District. From this Hub, Zipline will deliver life-saving blood to 21 facilities located in the Northern, Western, and Southern Provinces.

Zipline plans to expand services to Eastern Province in early 2017, putting almost every one of Rwanda's 11 million citizens within range of lifesaving medical product deliveries.

The partnership will strengthen ongoing efforts by the Ministry of Health to deliver a high standard of health care.

The Importance of Innovation in Global Health

Please see this piece that I enjoyed writing with my fellow Lancet Commissioner for the Global Health 2035 report, Gavin Yamey, regarding how critical it is to celebrate, support and encourage innovation as we work diligently to achieve the goals before us to achieve a grand convergence in global health.

Please see the article here: http://ic2030.org/2014/09/grand-convergence/ 

"A remarkable opportunity for global health transformation is now at our fingertips.

If we make the right health investments—to scale up existing health interventions and delivery systems and to develop and deliver new tools—we could see a “grand convergence” in global health within our lifetimes. Within one generation, we could reduce the rates of infectious, maternal, and child deaths in nearly all low- and lower-middle-income countries down to the low levels seen today in richer countries like Turkey, Chile, and Costa Rica (Figure 1).

One in ten children in poor countries dies before his or her fifth birthday; by 2035, we could reduce that rate down to one in fifty. We could prevent 10 million maternal, child, and adult deaths each year from 2035 onward. But this grand convergence cannot be achieved without innovation to discover tomorrow’s disease control tools.

We had the privilege of serving as members of The Lancet Commission on Investing in Health, chaired by Lawrence Summers and Dean Jamison. The commission published an ambitious yet feasible road map for achieving convergence, called Global Health 2035. The road map has three key components.

The first is mobilizing financing. The “price tag” for low- and lower-middle-income countries to achieve convergence is an additional $70 billion per year from now to 2035. Fortunately, these countries are on course to add $10 trillion per year to their GDP over that time period. Public investment of less than 1% of this GDP growth could therefore fund the grand convergence. Some countries, of course, will still need external assistance to finance their health programs.

The second is targeting this financing toward the most cost-effective health interventions. Early investment in scaling up modern methods of family planning, antiretroviral medication, and childhood vaccinations would have a particularly large and rapid payoff.

The third is increasing funding for R&D. Our modeling found that even with aggressive scale-up of today’s tools to 90% coverage levels, convergence would not be achieved. Low-income countries would get only about two-thirds of the way. To close the gap, new technologies will be needed. Countries that adopt new tools experience an additional 2% per year decline in their child mortality rate over countries that do not—an “acceleration” that is crucial for reaching convergence.

The most important way that the international community can support the grand convergence is by funding the discovery, development, and delivery of the next generation of medicines, vaccines, diagnostics, and devices. International funding for R&D targeted at diseases that disproportionately affect poor countries should be doubled from current levels (US$3 billion per year) to $6 billion per year by 2020. Game-changing technologies that could help achieve convergence include a single-dose radical cure for vivax and falciparum malaria and highly efficacious malaria, tuberculosis, and HIV vaccines.

Figure 1. Estimated decline in child mortality rates from enhanced health-sector investments. The “convergence target” is 20 deaths per 1,000 live births, similar to the current child mortality rates in high-performing middle-income countries.

The public health and economic benefits of achieving convergence would be profound. Every $1 invested from 2015 to 2035 would return $9 to $20, an extraordinary return on investment.

We have at our fingertips one of the greatest opportunities available to improve human welfare. The question is: will we seize it?

Photo: US Centers for Disease Control/James Gathany. Illustration: PATH."

**

See full article on this web link: http://ic2030.org/2014/09/grand-convergence/ 

Lecture given to Dartmouth University students 'building a health sector alongside a nation"

I gave this lecture given to Dartmouth University students to share how we built a health sector alongside a nation. It is the health sector contribution to Rwandan rebirth the past 20 years
the story of the Rwanda health sector after the 1994 genocide against the Tutsi. a story of ownership accountability participation equity sciences and fight for sustainable development.

Follow the live lecture using the following link: https://www.youtube.com/watch?v=_PfKMAb1I-g

Uniting to uproot malnutrition in Rwanda

I published the following article in December 2012 in The New Times. The full text is available online, and you can also read it below.

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Uniting to uproot malnutrition in Rwanda

Dr. Agnes Binagwaho, Minister of Health of the Republic of Rwanda

While Rwanda has made dramatic progress in decreasing child mortality over the past ten years, reducing the rate of deaths from 183 per 1,000 live births in 2000 to 54 in 2011, chronic height-for-age malnutrition (or stunting) has remained too high among children under the age of five. Earlier this year, His Excellency President Paul Kagame challenged the nation to eliminate the root causes of stunting by working together through a multi-sectorial approach from the community to the central level and across sectors. 

The rate of stunting among children under the age of five years was found to be 51 per cent in 2005; by 2010, it was still far too high at 44 per cent. Over the same timeframe, the prevalence of underweight had declined by roughly 30 per cent, from 18 per cent to 11 per cent of children. Based on this and numerous studies by the Ministries of Health and Agriculture, it was clear that the driver of persistent malnutrition was not a lack of sufficient food, but a complex set of social, cultural, and economic factors interacting to prevent many children from accessing a healthy diet.

This challenge necessitated a multi-pronged approach to identify and combat the fundamental causes of malnutrition with significant emphasis on prevention. The most important strategies identified as priorities for action were the diversification of food sources, systematic growth monitoring of children at the community level, early detection of malnutrition,  access to clean drinking water, and, most importantly, widespread awareness about the kinds nutritious diets children need and how to prepare them.

Existing programmes to promote access to a balanced diet among the most vulnerable have been strengthened, and new initiatives have been launched to fill gaps. The Ministry of Agriculture has continued to provide leadership in the national Girinka (One-Cow-per-Family) programme, Akarima k’igikoni (kitchen gardens), and One Cup of Milk per Child programs, and the central government has supported these initiatives by doubling the agriculture budget between 2006 and 2011.

More than 200,000 cows have now been distributed to families categorized as ubudehe socioeconomic  1 and 2 (equivalent to the poorest households), and these animals have begun to bear offspring which recipient families then pass along to their neighbors who have yet to receive a cow. 

With the support of local communities through monthly umuganda communal work days, kitchen gardens consisting of nutritious vegetable and fruit plants have continued to be scaled up across the country among ubudehe 1 and 2 families. Schools in 14 of 30 districts now receive one liter of milk per 3 each week, and this programme will be expanded to cover every school in the nation in the near future.

To ensure that children who do become malnourished – whether through severe or moderate growth shortfalls, underweight, or stunting – are linked to the health system and provided with appropriate treatment (from Plumpy’nut Ready-to-Use-Therapeutic Food to multivitamin supplementation), the Ministry of Health has incorporated monthly growth monitoring into the national community health system. 

The country’s 45,000 community health workers (responsible for child health, reproductive health, and health promotion) now make regular household visits and can report children found to be malnourished to their local health centre, district hospital, and the central level via the cell phone-based RapidSMS system. Referrals of malnourished children have begun to occur much more rapidly than in years past, and preliminary data from the Ministry’s community health information system (SISCOM) show that moderate malnutrition has fallen by half between January and November 2012 – from 1.2 per cent to 0.6 per cent at the community level.

To contribute to improving the population’s access to potable drinking water, in addition to the work done by the Ministry of Infrastructure, the Ministry of Health has worked with partners to provide water filters to nearly 2,000 households in ubudehe1 and 2 across the country, with plans to scale up to the 600,000 poor households across the entire country

 In addition to existing forms of filtration and purification (such as chlorination tablets), these filters help to improve hygiene and hence minimise children’s exposure to pathogens that cause diarrheal disease. Furthermore, recent international data from the United Nations project Rwanda to be on track for Millennium Development Goal 7, which includes key indicators for access to water and sanitation. 

These developments are crucial to the fight against malnutrition, as persistent diarrheal disease prevents children from absorbing the nutrients they need and makes them feel sick so that they do not eat enough. This is another reason why the Ministry of Health worked with the GAVI Alliance to roll out the rotavirus vaccine for the prevention of one of the most dangerous causes of diarrhea this May, and preliminary data show nearly 95 per cent coverage among infants.

All of these interventions will be essential if Rwanda is to succeed in our goal of dramatically reducing the prevalence of all forms of malnutrition. With the bounty of agricultural resources our land provides and the wisdom of the Rwandan farmer, we have all the tools we need to keep every child healthy and growing. 

But ensuring that improved availability and diversity of food sources translates into better health outcomes for the most vulnerable children requires more than accelerating production – it necessitates a revolution in the way that families prepare their children’s food and understand the importance of their children receiving nutritious diets for a brighter future. 

For this reason, the government has started a massive educational campaign on “how to cook,” and pamphlets have been distributed across the country detailing the kinds of foods that children need, how to cook them, and the importance of proper hygiene and exclusive breastfeeding for children under the age of six months. 

Demonstration kitchens are being rolled out in districts across the country, to show families recipes that make use of local foods in such a way as to maximise their nutritional value to children using traditional cooking methods. 

Each umudugudu will hold a meeting to strategise on ending malnutrition on December 27 of this year, and these meetings will result in the publication of comprehensive local plans.

To conclude, Rwanda has made great progress this year towards the goals we have set as a people under the leadership of our President. But our job will not be finished until every single child is assured a healthy and balanced diet, until no mother worries about how to feed her baby, until no household goes without a clean water source or a hygienic and sustainable toilet. 

From scaling up drugs for HIV to reducing child mortality, our nation has proven that we have what it takes to achieve what some have called impossible, and I have absolute faith that together we will successfully apply this same sense of purpose to the fight against malnutrition. 

I can guarantee you that your public servants in the Ministries of Agriculture, Gender and Family Promotion, Local Government, Education and Health are spending sleepless nights working with our colleagues and partners to devise, scale, and monitor solutions to the root causes. 

If you have specific complaints about the response to malnutrition or suggestions on how to improve, I urge you to engage with us via Twitter through @RwandaMOH and my personal account @agnesbinagwaho. Be specific –name names, share exact locations, and we will explore every claim. Furthermore, the next #MinisterMondays Twitter and SMS (via 0788386655) discussion on Monday, December 17 will address the state of the malnutrition response, and I look forward to your participation.

The writer is the Minister of Health of the Republic of Rwanda.

Bringing Mondays with the Minister to Communities

As previously discussed on my blog, I recently began a series of online discussions through Twitter to allow Rwandans, colleagues, and partners around the world to discuss issues related to health policy. These chats, held on Monday afternoons twice per month, are entitled “Mondays with the Minister.” 

I believe that equitable access to information and participation in debates around public health issues is a right of all citizens of the world, and I particularly avail myself for my fellow Rwandan citizens. I find this access important in all aspects of the Ministry of Health’s work. I am grateful to the owner of the ICT company Nyaruka, who leads by the same principles and worked at no cost with me on this project in order to allow Rwandans to send questions and comments by SMS for the discussion. Because cell phone coverage in Rwanda is over 60%, and because each of the three community health workers per village have cell phones, all Rwandans should be able to contribute a question or comment if they wish. The owner of the ICT company Nyaruka also graciously proposed to make this access free forever, as far as it is for a program that shares the same goals of open communication for improving health. 

Mondays with the Minister discussions will be held every two weeks. The time of may change, but they will always last for two hours duration. 

The next Mondays with the Minister chat will be Monday, 12 December from 3:00 p.m. to 5:00 p.m. The topic for discussion and debate will be malnutrition in Rwanda and what the Ministry of Health is doing to address the problem. 

To join on Twitter, follow me on Twitter at @agnesbinagwaho. To join by SMS, send a message to 0788 38 66 55 between 3:00 p.m. and 5:00 p.m. And, if dialing from outside of Rwanda, please dial: +250 788 38 66 55. You can also see the questions submitted by SMS and their answers at listen.nyaruka.com. I consider this and the Twitter forum to be a great opportunity for improving service delivery by incorporating the direct suggestions of the population, who are at the center of all decisions made by the Ministry of Health. I welcome your questions and look forward to productive and inclusive discussions!

Twitter: @agnesbinagwaho

SMS: 0788 38 66 55

Web: listen.nyaruka.com

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Harvard Ministerial Leadership in Health Program: Advisory Board Meeting

On Saturday, 5 November 2011, the Harvard Ministerial Leadership in Health Program held an Advisory Board meeting in South Africa. I gave a talk over Skype on what kind of support would be valuable to Ministers from an international collaboration seeking to provide counsel and expertise. You can read it below. You can also download a PDF copy of the slides I designed and presented for the meeting as well.

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What Kind of Support Would Be Valuable to Ministers?

Honorable Ministers and dear colleagues, ladies and gentlemen:

Before beginning, I would like to quickly thank: the organizers of the Harvard Ministerial Leadership Advisory Board for the invitation to join; and to my colleagues from around the world for your dedication and collaboration. Your question for me was: “What kind of support would be valuable for Ministers”. I would like to first lay the foundation by defining what the role of the Minister is within the Government. And I will use the example of Rwanda.

The role of the Minister depends on the Cabinet; and the role of the Cabinet is to get the country from Point A to Point B in order to improve the situation of the population. Cabinet is akin to a steering committee that validates and enforces decisions of technical sectors for the implementation of the nation’s vision under the leadership of the President-elect. So the Minister’s role boils down to being the implementer of a national vision that is guided by the Cabinet, articulated by the President, and informed by the population.

In Rwanda, Ministries are working together into Clusters in order to maximize synergies and overlaps in target interventions. This Cluster method began in 2009, and divided all Ministries into three Clusters. The Ministry of Health is part of and chair of the Social Cluster, which includes Gender, Education, Local Government, Infrastructure and Youth. These are all of the important ministries for social development. This organization enhances collaboration and cooperation, while allowing Ministers to lead policies and make strategic decisions according to the availability of infrastructural, financial and human resources. This assures connections and smooth implementation. Decisions made must be harmonized with Ministries within and outside of a given Cluster. This also increases each member’s knowledge of what is needed for good social development – it is the same for increasing the economic knowledge for the economic cluster, etc.

Ministers must plan, reach countless targets, and monitor closely – these are not easy tasks, as we need to coordinate and get many national and international partners to work together around one plan. This gathering can bring valuable support to Ministers to identify the goals of the goals of their health sector, what it takes to get there, and identifying what is needed to ensure that the plan stays on course. Based on this example, I see some opportunities for improvement where support for Ministers would be valuable.

For Setting Targets

• Agreeing on a shared and inspired vision for your country, because alone you will achieve nothing.
• Articulating goals and policies to achieve them by using participatory processes and evidence-based decisions.

For Strategic Planning

• Working across clusters and constituencies to build consensus and synergies, and taking a holistic approach for development, as health is not a stand-alone. Health is too important to leave it just to Ministers of Health!

For Monitoring & Evaluation

• We need to do periodic measurement of progress and shortfalls by structuring systems for documentation and learning so that we can take lessons to improve our future work. This allows us to rectify quickly when needed – if you implement fast, you increase your targets. In Rwanda, we have already achieved many health sector targets for our Vision 2020, so we sit and review for more ambitious ones. This brings a culture of flexibility and allows us to always do the best at the moment. 
• Inculcating culture of transparency and accountability for all is key for the success of the sector.

All of this said, we must be very careful to avoid the trap of thinking that simply articulating a vision and planning your monitoring and evaluation strategy will be enough. Setting targets, and measuring how you are doing against them, these are the fun parts. The real trick is in the delivery, and let me be very clear: there are no magic shortcuts here. As the Harvard Ministerial Leadership Advisory Board, we must be sure to also focus on the key middle part of the equation in the middle of this slide – the process of implementation.

I believe that there are seven steps for executing your vision, and each of these must draw on a ministerial culture of discipline and entrepreneurship. First, a Minister must be able to honestly assess the situation of your health sector – to plot where you are right now.

Next, you must choose your team – a team designed to succeed, not one that you are most comfortable with. You need people who have the courage to stand and challenge you. You must have the right people before you can start moving in the right direction.

Third, you must focus on building momentum; this does not mean that you are always progressing at a fast pace – it may be very hard to get things moving at first, but with consistency, small steps add together to become a powerful force with a life of its own.

In order to build such a culture in all members of your team, you as the Minister must lead by a disciplined example. Act out your Ministry’s values in your own actions.

Fifth, I believe that the key to successful execution is to focus on your outputs, in the way that a well-run business does, but in the social realm.

Your team must understand the importance of running your health sector like a business focused on social outputs of health and wealth for the population. You are not after financial profits, but you must measure your progress in health outcomes with the same careful attention that the best CEOs apply to their bottom line. Always have in mind that your end product is health and wealth in a cost-effective manner, meaning the best you can possibly achieve given the investment you make.

Finally, you must be aware of the right time to take advantage of technology to help accelerate your planning cycle and your delivery process. This does not mean jumping at every new gadget – you must be strategic about how a new technology well-applied could make your vision take off. This requires the ability to see ahead. It must also to be a cost-effective analysis, like a chief of industry sometimes invests one million to save ten million.

All of this matters only if Ministers of Health are ready to be the leaders that our health sectors need. When the health sector experiences success, give credit to the. When there is failure, the Ministers have to look in the mirror and take responsibility instead of looking out the window. I thank you again for having me. This presentation contains many ideas that I am ready to develop with you and to share with my colleagues.

Thank you so much for the opportunity to speak with you all.

Rwanda, The Entrepreneurial Nation

I published the following Commentary piece in the New Times on Tuesday 18 October 2011. The original publication can be accessed HERE. 

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Rwanda, The Entrepreneurial Nation

We define entrepreneurship as thinking out of the box, transforming one’s innovation into goods and products, and creating demand by marketing them. Rwanda is a country that lives by many characteristics of an entrepreneur; we are an entrepreneurial nation.

First, entrepreneurs must have the willingness to take risks. Rwanda has taken many risks in the post 1994 genocide period. For example, it was a risk to abolish the death penalty at a time when there was a massive call for justice. This decision was made after much reflection and a review of the global evidence that the legal taking of life has never changed any crime level or improved Human Rights. As our President Paul Kagame said, mass execution could not have been the right answer to the mass murders of the 1994 genocide in Rwanda. As a result of this courageous abolition of the ultimate punishment, Rwandans have a sense of satisfaction, welfare, and the value of life.

Another major risk taken by Rwanda was to strive for unity and reconciliation by believing that the example of good leadership can change the minds of even the worst. This risk has helped Rwanda to turn thousands of former genocidaires into peaceful, progressive, and active builders of the new Rwanda. The abolition of the death penalty and the promotion of national unity and reconciliation have contributed greatly to the healing process and the reduction of crime in our country, and this has encouraged Rwandans to invest their energy in development.

Rwanda thinks out of the box and is a home to innovation. When the traditional European justice system failed to meet our desire for justice in our timeframe during the life of Rwandans (as it would have taken more than 100 years to sort out all of the cases), we modernized the gaccaca courts. In a participatory manner, we discussed this innovation and found a way to implement it. Communities received justice, and We transformed this innovative legal idea into human good, and there was massive demand for it in Rwandan communities who then received justice.

A second quality of a true entrepreneur is knowing oneself – knowing who you are and where you stand without complacency. We know and we are proud of who we are in Rwanda. We have the ambition to be better everyday and have a clear vision of it: our Vision2020. We define ourselves by strong national principles, such as not leaving out of benefits the most vulnerable among us. This applies to our economic progress, access to education, access to health services, and many other public goods. Rwanda’s economic development strategy consists of many pillars that promote a strong private sector for our country, producing taxes that support education and health for all Rwandans by building schools, hospitals, buying drugs, and paying health professionals.

In the education sector, all the nation benefits from our nine year basic education program which keeps girls at school through the age of fifteen. Soon, our twelve year basic education program will keep all students in school through the age of eighteen. It will be coupled with the TVET program that aims to give employment to all.

We all know that educating women increases the health and wealth of families. Thus, Rwanda prioritizes education for all and access to health services for all. Again, these goals are set through a participatory process; if we don’t want to leave people out of the benefits of our progress, we must not leave them out of the decision-making process.

The third quality of an entrepreneur is passion for a purpose and a burning desire to achieve their goals. Rwanda has the passion – just listen to the speeches of our leaders. You will see that under the lines of their words lies all of the vibrant passion of this nation. We have the burning desire to be a middle-income country, and make no mistake that we will get there as each of us puts all our energy to the effort.

The fourth characteristic of an entrepreneur is the tenacity to succeed in the face of obstacles, and Rwanda has it. Tenacity is what our leadership has shown since 1994, when our vision of security and our plans for development were attacked. Rwanda chooses our own way for development, as so many solutions offered by the international community were not sustainable, were too slow, or lacked possibility to bring progress to Africa. So many commentators at that time and through today made their own prescriptions for peace, education and health as if they believe that it is normal for Africa to remain dirty, sick, and begging.

This is linked to another entrepreneur quality demonstrated by Rwanda, that of being a solution-maker herself. Our nation is one of home-grown solutions. This is what we discussed with youth convened in Rwanda on many occasions by His Excellency and First Lady Jeannette Kagame through the Imbuto Foundation for enlightening forums. The most recent of these forums was in August 2011, when youth from across the East African region discussed their goal to be ambassadors of change.

I could describe additional entrepreneurial traits that Rwanda has as a country, but I prefer to take examples from the health sector, the area that I know best. All of these qualities of entrepreneurship are evidenced through visible innovations, taking the risk to implement these innovations, maintaining the tenacity to sustain them, and creating the demand for our sector’s public goods in Rwanda and around the world. We reviewed the concept of universal access to care and devised a uniquely Rwandan way to provide it through community health insurance. We thought out of the box and created the “Mutuelle de Santé” system for access to care, inventing a national means of implementing a system of performance-based financing for heath workers to expand access while emphasizing quality. We have transformed health care into a public good in Rwanda, and other countries from around the world now demand our model. These are good politics that translate into good politics.

Furthermore, we have installed three elected community health workers in each of Rwanda’s 15,000 umudugudu villages, creating a cadre of 45,000 across the country. This is also an innovation. Each community health worker volunteers for the position and is then elected by her community. The Ministry of Health pays all based on the quality and quantity of their services rendered. Of the money we give them, 70% goes into a cooperative that will help them to create economic growth at community level. By transforming Rwanda’s capacity to harness the power of health to stimulate economic growth at the community level, our people can gain wealth and buy more health, creating a virtuous social cycle by producing economic opportunity through health problem-solving. The success evidenced by the health sector exists across all sectors of the Rwandan government, explaining our economic growth and improvement in the wellbeing of our population.

Rwanda is spreading widely a spirit of entrepreneurship at all levels, from the very top of the central government to the community. I remember reading a beautiful article in Fortune magazine describing His Excellency the President Paul Kagame as a CEO running his country like a private enterprise. I agree, we are an entrepreneurial and proud nation with a vision.