Ministry of Health Commemoration Event

I was honored to participate in the commemoration events in Nyanza where we commemorated our brothers and sisters killed during the 1994 genocide against the Tutsi.  Afterwards, we held an event for 35 Ministry of Health colleagues who were killed during the genocide against the Tutsi 21 years ago.  

Please read the New Times article, written by Jean Mugabo, that described the event.  

Full article written by Jean Mugabo of the New Times can be found here: http://www.newtimes.co.rw/section/article/2015-04-25/188184/ 

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"The health sector has recommitted to fighting  Genocide denial country continues to mark the 21st anniversary of the Genocide against the Tutsi.

 "Remembering the departed is a responsibility to every Rwandan, but it is even more important to our profession which is tasked to save lives"

‘‘Everybody was created to live, not to be killed. And remember the perpetrators are still there. So, we have to fight them, and fight Genocide ideology, denial and trivialisation,” said James Kamanzi, the Acting Director General of Rwanda Biomedical Centre (RBC).

Kamanzi was speaking at Nyanza Genocide Memorial site in Kicukiro District during an event to remember the 35 former employees of the Ministry of Health (MoH) who were killed during the Genocide.

He noted that the Genocide was stopped by Rwandans and urged health workers to strive for self-reliance.

“No one can love Rwandans or solve their problems more than Rwandans themselves. When the United Nations Assistance Mission for Rwanda (UNAMIR) left amidst the brutal killings, the RPF Inkotanyi stopped the Genocide. ‘‘So, learn from their heroic actions, never wait for foreign aid but seek to be self-reliant,” he said.

Encouraging everyone to comfort and support survivors, Kamanzi stressed the importance of remembrance in ensuring that the notion of ‘Never Again’ is a reality.

At least 11,000 Genocide victims are buried at Nyanza memorial site, including 3,000 who were killed at Nyanza and 8,000 from nearby areas.

Naphtal Ahishakiye, the Executive Secretary of the umbrella of Genocide survivors associations, Ibuka,  recounted the awful killing of 3,000 people who had sought refuge at the former Ecole Technique Officielle (ETO) Kicukiro, currently the Integrated Polytechnic Regional Centre (IPRC) Kigali.

 “At the height of the Genocide, the Belgian peacekeepers said that their mission was over and withdrew from ETO School on April 11, leaving at least 3,000 Tutsi behind.

‘‘Interahamwe militia marched them to Nyanza and massacred them from there. About 100 were rescued by the RPF the next day when the killers were on the way to finish them off,” he said.

During the event, Dr Agnes Binagwaho, the Minister for Health, led other officials at the ministry, to lay wreaths on the graves of Genocide victims there.

The event was followed by a ‘walk to remember’ from IPRC to MoH offices, where commemoration activities continued.

 After lighting the flame of hope, participants listened  to  testimonies of two Genocide survivors.

 Constantin Ntaramana, a worker at the National Centre for Blood Transfusion (NCBT), testified how he was confined to his work place and fed on glucose for about three weeks.

 “I was at work in NCBT on April 6 (1994), but failed to leave when the Genocide started.

‘‘I stayed there, hiding in the ceiling and feeding on serum glucose until late May when someone took me to the International Committee of the Red Cross. There, the RPF saved us from the killers,” he recalled.

Theogene Hakizimana also recounted how the Genocide robbed the lives of his parents and seven siblings.

“I was beaten and left for dead thrice, but survived thanks to God’s mercy.

‘‘I watched my father, and siblings being killed with machetes while hiding, but later I started wishing I could have been killed with them.

‘‘I used to sit by their dead bodies, waiting for my turn but I always survived,” he testified.

Hakizimana, is among the few who survived in his area of Nyaruguru District, commended the RPF for rescuing him.

Both Ntaramana and Hakizimana spoke of hope for a better future."

*New Times Article written by Jean Mugabo - http://www.newtimes.co.rw/section/article/2015-04-25/188184/ 

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.

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[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).

Conceptualizing Global Health Delivery in Rwanda

I published the following piece in the New Times on Thursday, 23 February.




The traditional definition of public health has often been relatively narrow and focused on siloed programs, or the management of health for quick “cost-effective” impact. This definition cannot suit Rwanda’s approach to public health, as we know that the ultimate end of our programs must be to break the cycle of poverty and disease. This means managing in a high value way for supporting sustainable development, and this begins with always accounting for the cost of inaction.

Rwanda today is led by a leader who in my point of view runs this country efficiently as a value-driven private enterprise for sustainable and equitable economic growth. He will lead us to a be a middle-income country by 2020.  To support Vision 2020, our health laws, policies, strategies, and implementation approaches must be oriented towards breaking the cycle of poverty and disease that pulls down development. This important to keep in mind as face day after day much urgency and we have to solve them without undermining our future, as we know that some “quick win” interventions can in fact be the enemy of sustainable development when they are not designed thoughtfully and with the larger context in mind. 

This week, thirty-seven officials and professionals from the Ministry of Health, Rwanda Biomedical Center, and CHUK have gathered together with faculty from Harvard Medical School in Rwinkwavu, Kayonza District for the inaugural Global Health Delivery in Rwanda course. Led by my dear friend Paul Farmer, Kolokotrones Professor and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, the top-ranked American university has pioneered a new approach to global health partnership by teaching this course outside of the United States for the first time and brining it to the heart of Africa.

To make this course possible, Harvard has sent a team of professors to Rwanda, and the Ministry of Health has availed its training facilities in Rwinkwavu, to host the course with the support of Partners In Health/Inshuti Mu Buzima. This partnership has created a unique and collaborative learning environment that will pay dividends throughout the entire health Rwandan sector and beyond.

Last Sunday, young professionals and program managers were trained to be faculty members for future offerings of the Global Health Delivery in Rwanda course, learning how to share their experiences, to conceptualize their work using strategy and value analysis, and how to write their own cases to teach colleagues from around Rwanda and soon from around the entire world.

This course is about strategic thinking for better service delivery all along the cascade of services in the pursuit of optimal outcomes of prevention, care, and treatment. Students, faculty in training, and faculty exchange on techniques for better understanding the value added by each step within the cascade. For example, in our day-to-day management of the health sector, we realize the need to revise the usual approach to focusing on access by focusing on actual provision. Having an open door is sometimes not enough to meet the needs of the most vulnerable; sometimes, we must bring the services directly to them. 

We must also work towards a paradigm shift around traditional notions of cost effectiveness by emphasizing measurement tools that account for the impact of population health status on our country’s sustainable development process. This means implementing the health sector’s vision through a holistic approach driven by evidence-based and person-centered policies that are evaluated by rigorous monitoring, just as we would in building and sustaining a successful business. The inaugural Global Health Delivery in Rwanda course runs from 19 to 23 February this week, and will be offered twice per year from now on. I expect it to bring great things to Rwanda in the coming years. 

Mondays with the Minister: Vaccines and Immunization

On Monday, 9 January, I held the first Mondays with the Minister of 2012. It was a great start to the New Year. The topic of yesterday’s discussion was “Vaccines and Immunization in Rwanda.” We hosted the discussion on Twitter, and, through my new partnership with the Rwandan company Nyaruka, we were also able to integrate SMS into the discussion and received messages on that platform as well. Anyone who wishes to view either the Twitter or SMS discussions can do so here:

Twitter #MinisterMondays

and

Nyaruka #MinisterMondays

During #MinisterMondays yesterday, I received many questions, including:

• What has been most important achievement in the past few years regarding the immunizations? 
• Can you describe Rwanda’s involvement in efforts to find an HIV/AIDS vaccine?
• What are Rwanda’s experiences with the pneumococcal conjugate vaccine and treatment for pneumonia and are these two complimentary?

I posed a few questions for all participants as well, including:

• What do all you think is financial/human/moral cost of failing to implement 100% of possibilities provided by vaccines?
• Question for all: Developing an HIV vaccine is only longterm gender-equitable solution to pandemic. What do you think? 

It was a fantastic discussion and I learned from participants what some of their concerns are concerning vaccines and immunization. I can see that the reach of this forum is expanding and more and more people are beginning to communicate through these platforms. One thing I remarked during this last discussion was that several complaints were voiced (that were unrelated to the topic of this session). From this experience, I realized that the Ministry of Health must improve its sensitization of the population and empower people to use local outlets for complaints and concerns when their rights are not respected. There are faster ways to have your complaint heard in Rwanda, and to make individual and collective rights fulfilled!

Thank you all again for a great discussion yesterday. I look forward to connecting with you all – and more participants – again on 23 January. The next #MinisterMondays topic will be “Gender and Health.”

Follow along on Twitter or by SMS on Nyaruka

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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