Direct Democracy and the Health Sector: Umushyikirano 2011

Below is my piece in the New Times published on 9 January 2012. You can click here to read the article on the New Times website.

Direct Democracy and the Health Sector: Umushyikirano 2011

By Dr. Agnes Binagwaho

During the holiday season, I took time to reflect on the highs and lows of the past year. Without a doubt, one of the events that made me most proud to be a public servant for the people of Rwanda in 2011 was our National Dialogue Day, or Umushyikirano.

As written in Rwanda’s 2003 Constitution, the country hosts a two-day exchange of ideas, comments, and questions hosted by the President of the Republic at Parliament each December. On December 8 to 9, 2011, officials from the health sector joined representatives of the people as well as leaders from the central government to the village level for the Ninth National Dialogue at Parliament in Kigali.

The Dialogue draws on Rwanda’s principles of transparency and participation, allowing Rwandans from across the country and around the world to join and follow the conversation through free (reverse-billed) SMS messages, phone calls, Twitter, Facebook, live radio, and television broadcasts. Phone calls and SMS have been the foundation of Umushyikirano in past years, but 2011 saw the first incorporation of Twitter and Facebook messages. The addition of social media, a powerful tool for new kinds of interaction across traditional boundaries, made this the most inclusive and intense Umushyikirano yet.

Umushyikirano is a home-grown communications platform that facilitates open and deep dialogue. Over the close to eighteen years since the 1994 Genocide against the Tutsi, Rwanda has created many original innovations to ensure good governance and continual progress in the country. As one of the most empowering innovations, Umushyikirano is enshrined in the Constitution, guaranteeing that the people of Rwanda retain their right to participate in all decisions that guide their life and always have this forum (among many others) for expressing their proposals for improved policies as well as their judgments on the work of their elected leaders.

In reflecting on the central role of Umushyikirano in the Government’s decision-making process, I do find myself wondering how anyone who takes the time to learn the fundamentals of Rwanda’s political process could feel justified in saying that this country lacks political space or the freedom of speech. I grew up in Belgium and have spent years in other European countries and spent time in the United States, but I have never seen anything else quite like Umushyikirano – direct democracy on such a scale that harnesses the power of the telephone and internet; this exists only in my motherland, Rwanda.

Thanks to the rapidly expanding penetration of the mobile phone in Rwanda today, citizens from each and every corner of the country’s 15,000 imidugudu villages and countless diaspora communities can offer their views on every subject – whether the topic they wish to address is on the day’s agenda or not. Together, leaders and citizens reflect on potential solutions to the biggest challenges to our national development and the welfare of all Rwandans. This is true and direct democracy, where the officials entrusted with implementing national policy can be held accountable for their actions by each and every citizen.

I have attended each Umushyikirano since 2003, but this year was my first as Minister. The main themes for the 2011 discussion were governance, social welfare, justice, and the pursuit of economic development. All Ministers and directors of central government institutions directly concerned, were organized into panels that discussed each of the four topics with the live assembly of approximately 1,000 at Parliament and the rest of the nation through phone and computer.

The health sector presented on recent developments in Rwanda’s community-based health insurance program, Mutuelles de Santé, describing progress towards universal enrollment and the implementation of the new policy dividing premiums into three tiers based on families’ socioeconomic status. All Directors of specific health programmes and departments and other key staff from the Ministry of Health participated remotely throughout the entirety of Umushyikirano; some watched the live video feed in the main meeting room, others listened through the radio and read SMS messages, while several others joined through Twitter and Facebook. All together, we responded to each and every question regarding the health sector.

As always in Rwanda, we presented not only the Ministry of Health’s achievements but also our greatest challenges so that we might collectively reflect on ways to overcome them and to perform better for the population. This year, we have delayed the collection of insurance premiums for the 75% of the population who pay their own premiums and also the transfer to districts and communities the funding to cover premiums for the 25% who are fully supported by the Government after being identified as indigent through Ubudehe - Rwanda’s community-based system for establishing each household’s level of insurance premiums (and other socioeconomic indicators).

One major challenge facing the health sector that was closely examined during Umushyikirano is malnutrition. An unacceptable 44% of children under the age of five remain chronically malnourished or “stunted” (to be distinguished from acute malnutrition or “wasting”), and 38% of children under the age of five suffer from some form of anemia. During Umushyikirano, we collectively determined that the way forward in combating malnutrition must be a multi-sectorial approach driven by a cultural revolution aimed at sustainably changing the ways we teach families about growing, cooking, and serving the foods that end up on the plates of pregnant women and young children.

Rwanda does not lack the agricultural resources to properly nourish all our people, but we have been inadequately educating families about proper nutrition for too long. It is time to accompany the population in working together as one, for improved maternal and child health through nutritious diets. At Umushyikirano, the people of Rwanda set a deadline for the Government and its partners to eliminate the root causes of malnutrition within just six months. This approach is similar to that of tackling one of the greatest challenges of poor living conditions by guaranteeing all households with iron sheet roofing in order to eradicate thatched roofing through the Bye-bye Nyakatsi programme.

A third issue concerning the Health sector, discussed during Umushyikirano is the fact that Rwanda still depends on external financing for more than 45% of the health sector annual budget. As our Government and people know well, self-reliance can only be achieved through economic growth. Rwanda’s path away from dependency will be driven by sustainable development, and will involve generation of revenues through the health sector in the near future. The Ministry of Health will continue to do its part to reduce the importation of expensive drugs and consumables by relying on high-quality locally manufactured generics when possible as well as promoting private health facilities and providers. By encouraging the growth of the private sector, we can increase domestic tax revenues without raising taxes – this revenue will then be used to help increase the availability and quality of public sector services for all including the poor, as well as to invest in the education of more highly trained medical specialists for the benefit of all Rwandans.

In addition to debating major challenges facing the health sector, participants in Umushyikirano raised questions about the organization and quality of health care in Rwanda. Several Facebook users asked why some health professionals with diplomas remain unemployed by the public health sector, and the Ministry of Health responded by observing that the employment in the health sector depends on mindset – professionals should stop waiting for the government to automatically employ them and instead create their own opportunities or explore jobs in the private sector to serve the population across the country. We also received questions from some patients via SMS asking why they were not transferred outside of the country for certain kinds of care. We answered that the national referral system is organized to provide decisions that are based on cost-effectiveness depending on available scientific evidence about when and where to send patients in the case that treatment cannot be offered in Rwanda. In some cases, medicine cannot do much for diseases at advanced stages (or for some diseases at any stage), and this is why we invest much more in preventive services and quality improvement in Rwanda’s health system.

I wholeheartedly congratulate each of my colleagues in the Ministry of Health for their responsiveness to participants through SMS, Facebook, and Twitter, and I am proud to serve as their Minister. At this year’s Umushyikirano, there were no major criticisms targeted by the population at any sector, and the health sector has achieved a high satisfaction rate at 75%. Of course, we will not be satisfied until this figure reaches 100%; we know that the remaining 25% represents our weakness in customer care and the way that patients are handled – we commit to strive for improvements in these areas at all levels.

At this year’s Umushyikirano, multiple home-grown solutions were presented and still others developed through dialogue between citizens and their elected leaders. Economic development and self-sufficiency were at the heart of the debate throughout the sessions; this gave me a strong sense of pride in my Rwanda. Our nation’s constant emphasis on accountability and access to information as a human right gives me great hope for our future. At the Tenth National Dialogue in December 2012, I look forward to being able to say that we at the Ministry of Health have done our very best to live up to the expectations of the Rwandan population, for they deserve nothing less.

Honorable Minister Agnes Binagwaho will be hosting a discussion on vaccines in Rwanda through Twitter and SMS on Monday, 9 January 2012 from 5:00 – 7:00 p.m. You can join her “Mondays with the Minister” chats twice each month by following her on Twitter at @agnesbinagwaho or by sending comments by SMS to 0788 38 66 55 during the specified time.

Health, Human Rights, and Democracy in Rwanda

Below is my piece in the New Times published on 11 December 2011. You can click here to read the article on the New Times website. 

Health, Human Rights, and Democracy in Rwanda

By Dr. Agnes Binagwaho

Success in Rwanda’s health sector is due to the fact that the Government works as one in pursuit of an integrated and community-driven development process. This past year, I have read and listened to many great newspaper articles and speeches about Rwanda’s social and economic progress since 1994 that highlight the country’s unprecedented achievements but conclude with a single sentence or two that intends to make the reader or listener doubt all of these achievements.

Listening to such reflections on my country has caused me to reflect on a number of trends since my return to Rwanda in 1996. Still much needs to be done and as a nation and as a people, we have pursued with fierce urgency the integration of participatory democratic principles and equitable social policy to ensure that all Rwandans benefit from the process of development. We promote and strengthen our democracy by always engaging our people – Rwanda’s true wealth – in the formulation and implementation of policies for health, education, gender, youth, decentralization, financing, infrastructure and other.

In order to do so, the Government must apply an integrated and collaborative approach across all sectors. His Excellency Paul Kagame, the President of Rwanda, makes this quite clear when responding to a new policy proposal from a member of his Cabinet, asking first without fail: “What will this mean for the people, and how does it link to our poverty reduction and economic development strategy?” The evidence and results of such an approach can be seen at all levels, exemplified by a number of uniquely Rwandan approaches to the empowerment of our citizens.

One fine example of communities working together for national development is the monthly day ofUmuganda, a voluntary work day on the final Saturday of each month. Community members in villages, towns, and cities across Rwanda collaborate on various service projects. Activities are identified and selected through a participatory process, and often include building schools or health centres, planting trees, or clearing areas for the construction of new homes for the community’s most vulnerable families. Umuganda creates momentum for the development of all sectors, as public sector agencies often choose to contribute resources to these projects (and Ministry officials often join in the work around the country). All of these initiatives serve the pursuit of health; even the construction of a school will facilitate increased uptake of health services in the next generation because a well-educated woman is a highly valued member of a family who is well taken care of.

Other national programs similarly fight poverty and promote economic growth in ways that amplify the work of the health sector. For instance, the Ubudehe process of village-level community decision-making that includes “poverty-mapping” (or communal categorization of households into socio-economic categories based on income and needs) allows for better targeting of social services and pro-poor subsidies for items such as our community-based health insurance program, Mutuelles de Santé. In the Ministry of Health, we use Ubudehe and district level data to proportionally allocate our malnutrition interventions (such as the One Cow per Family and kitchen garden programs) towards the most affected areas of the country.

In order to catalyze economic development at the community level, our Government undertakes massive sensitization campaigns around financial savings. Umurenge Savings and Credit Cooperatives (SACCO) were established across Rwanda to increase access to financial services among the rural poor. Today, all of the country’s sectors manage their own SACCO with technical assistance from the central government. These cooperatives are voluntary, and they allow each citizen to contribute what they want to the communal savings pool. With these savings, the community can provide loans (same amount as invested by the citizen) to individuals who agree to reimburse the cooperative for the amount. One district I visited two weeks ago, Burera, has a savings pool of over one billion Rwanda francs. Umurenge SACCO is a very successful program for economic empowerment through the creation of community-owned and directed capital.

The Ministry of Health also uses cooperative savings mechanisms to compensate our 45,000 clinical services providers the community health workers (CHWs) through performance-based financing. Each community elects the CHWs in a participatory and open manner, after which they are trained by the Ministry of Health in prevention, care, and referral of the most common causes of diseases and mortality among communities in Rwanda. As I have written about elsewhere, our massive team of CHWs has contribute to dramatic improvements in health outcomes over the past five years, including a 50% decline in child mortality, a 70% decline in malaria incidence, a 52% increase in the proportion of mothers delivering at health facilities, and a 450% increase in the uptake of modern family planning methods. They serve as the first line of defence against the biggest killers, addressing 80% of the burden of disease through home-based care, but also stand ready to link patients to health centres or district hospitals via ambulances that they contact with their cell phone.

Economic development at the community level is crucial to Rwanda’s long-term vision for the health sector, because we want every Rwandan to be capable of contributing premiums to the Mutuelle de Santé program. When visiting officials from our partners in the United States or Europe ask how we plan to make this vision sustainable, I like to show them a graph of Rwanda’s recent economic growth – about 8% for the past several years, which has contributed to the expansion and flourishing of our poverty reduction programs.

Rwanda has the vision of becoming a middle-income country that is able to self-finance our pro-poor social interventions and guarantee equitable access to high-quality medical care. When I join in for Umuganda or visit a SACCO and see our people’s unwavering commitment to our nation’s vision, I have no doubts that we will make it. To empower Rwandan citizens economically, we promote a spirit of independence to make the best choices for themselves. This is the basis of democracy; when you are dependent and begging, you cannot direct your life.

Full civil and political rights are essential to human development and are highly valued in Rwanda, but we can never forget that these must be built upon a foundation of social and economic rights. If a woman fears that her child may die of malaria for want of a 500 Rwandan franc treatment, being able to vote will not serve her in the short term if it is not link with economic growth; if a man does not have enough money to feed his family or send his children to school, the ability to nonviolently express grievances will not fill stomachs or pay school fees. Civil and political rights and social and economic rights can and must be mutually reinforcing; neither is sufficient alone – we must assure them all. This understanding is woven into the very fabric of our nation’s Constitution and each of our major social sector policies; we must never forget it.

I am truly delighted that more and more high-level officials from the Governments of our long-time development partner countries are coming to see firsthand what we are doing in Rwanda. I have the feeling that we are all truly contributing to a revolution that will bring more health and wealth to our people. Our partners deserve to see how we are using the investment in the health and wealth of our population. In the global humanitarian market, the value of money invested in Rwanda is incredibly high due to lack of corruption, our dedication to participatory processes, and our reliance on integrated cross-sectorial approaches to tackling policy challenges. As a public servant, I am so proud to belong to Rwanda, a country that has pro-poor human-focused policies in practice, and to its population, who are the most valuable resource our country will ever have.

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Press Release: MoH appreciates support from USG

Below is the press release I published in the New Times on 10 December 2011. Click here to read the article on the New Times website.

Press Release: MoH appreciates support from USG

Kigali - The Ministry of Health would like to clarify a story published in the Chronicles Newspaper issue no. 008/5th-11th Dec 2011 titled, “US responds to Minister Binagwaho’s criticism,’ which was captured in a wrong context.

The Author of the story plays around with figures and creates a false impression of discontent on the part of the Government of Rwanda, and the Health sector in particular, regarding the US Government’s support.

This is wrong.

The U.S. Government is a great friend of Rwanda and the major supporter of our Health sector. U.S. Government support has saved thousands of lives in Rwanda and strengthened our health system. By implying that we do not understand how the global economic crisis has impacted the global flow of aid—and U.S. Government support included —the article misleads your readers.

We commend Washington’s flexibility during this period of economic difficulties, having agreed to reorient funds to support some of our major strategies for sustainable health sector development. For example, the PEPFAR transition process allows all clinical services to be managed directly by the national system, which serves to strengthen district hospitals and support our decentralization efforts.

The article does not recognize our appreciation for this thoughtful and innovative support.

Friends may not agree 100% of the time, but we know that the U.S. Government is committed to working closely with us through this challenging period and will keep supporting us more with less, as President Obama said months ago.

The article ignores the tremendous achievements that we have made together, and the important discussions that are ongoing in order to sustain our success in the health sector, and embrace change to make more sustainable investments for better health. We all understand this, and Rwanda is up to the task.

MOH management

Minister of Health

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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.

Accelerating the MDGs through ICT: The Case of Rwanda

On June 10, 2011, I was part took part in a high level working session at the United Nations Headquarters in New York on “Digital Health for Digital Development: Connecting the Millennium Development Goals and Non-Communicable Diseases in 2011.” In Rwanda, information and communications technology (ICT) in the health sector is key to what we have accomplished in the past five years.

Utilizing various forms of ICT, we have been able to create and monitor a health system that allows both urban and rural populations to benefit from services. This system has improved financial and geographic access to quality health care throughout the country, even to those most impoverished.

Over the course of the last five years, the under-five mortality rate has dropped by half, we have achieved universal access to HIV therapy and we are now addressing HIV/AIDS as a chronic disease. The percentage of married women using any modern method of contraception went up from 10 % to 45%, and the access gap has narrowed rural and urban married women. More women than ever before are now delivering their babies in health facilities; the current facility-based delivery is 69%, much higher than the  30% we had in 2005. More than 95% of Rwanda’s 11 million people have health insurance. Full vaccination coverage is now 90%, when it was 70% in 2005. The percentage families who seek treatment for children from a health facility provider has also increased. Pediatric treatment sought for acute respiratory disease has risen from 26% to 50%; for diarrhea it increased from 14% to 37%; and for fever it went from 27% to 43% in 2005.

The aforementioned achievements have led to a dramatic increase in life expectancy in Rwanda. And yet, in fighting the current top killers, we are only able to increase life expectancy to approximately 54 years, since infectious diseases do not fully account for morbidity and mortality rates in Rwanda. Our health sector still has serious gaps with respect to delivery of services for non-communicable diseases (NCDs). The World Health Organization has estimated that NCDs account for about 25% of the national burden of disease in Rwanda; however these disease have yet to be addressed in a strategic and systematic way.

To be able to reach the Millennium Development Goals, we need to reinforce prevention, care, treatment and rehabilitative services needed for both communicable and non-communicable diseases without decreasing the attention we currently have on combating communicable diseases. In doing so, we will need to ensure that care for all diseases – including chronic illnesses – is accessible to all.

Accordingly, over the next five years, Rwanda anticipates expanding access to integrated chronic care by building on the existing healthcare platforms established by programs fighting infectious diseases. We plan to embrace information and communications technology to expand care through several high impact interventions, mainly referred to as e-Health solutions. E-Health solutions are vital in order to create an effective and sustainable health system. Such innovations help to solve challenges in health system, including the lack of infrastructure and the shortage of professionals. Since roads are still difficult to traverse in some remote areas, ICT facilitates the sending of information, plans, and reports between urban and rural areas, saving both time and money.

Rwanda further supports ICT for health because the right to health cannot be separated from the right to information. And the use of new technologies and communications interventions are the most accurate and timely way to provide information. The flow of information in Rwanda concerns four stakeholders in the health sector: the patients, the policy makers, the healthcare providers and the program managers. As for patients, there must be strong health education platforms to inform them of how, when, and where to seek proper care. Also, once on treatment, patients should know the reasons for which it is important to go for timely medical follow up appointments and be compliant to treatment. This is extremely relevant, since follow-up appointments not only aid their recovery, but they also avoid dangerous resistances to epidemic diseases like TB. Patients would be informed of these issues through ICT tools made available to health professionals at all levels: community health workers would use their cellphones and central and district managers, health centres, district hospitals and referral hospitals would use web-based tools. For policy makers and program managers, ICT is essential because it enables the design of health policies and programs that are informed by evidence and based on up-to-date information. In general, the use of ICT has proven to be a very effective, secure, rapid and accurate way to serve patients and program managers. This is why the Government of Rwanda has put ICT as a top priority for the development of its health sector recognizes that there is an urgent need to build e-Health capacity.

As such, Rwanda has embarked on an ambitious journey to ensure that technological innovation becomes a central part of the healthcare ecosystem.

The initial phase began with devleoping a policy, a strategy and an action plan. Our health sector ICT plan is integrated into two master plans: our health sector strategic plan and our national ICT plan. Many applications of E-health have already been installed. One example of such applications are web dialogues. These are entry points for information access and exchanges between professionals and semi-professionals who work in remote areas, and therefore have difficult access to journals and books. It is also a tool of sensitization, reflection, idea expression, and innovation. Since it is virtual, it does not require physical infrastructure and runs at no cost. Through the exchange of biological and immunological patient information, x-rays, ultrasounds, lab samples for cancer, and so forth, clinicians can receive data, confirm diagnoses and make informed decisions. For example, health facilities in the US and Europe connect Rwandan health professionals to counterparts in other countries through the internet. This allows for free communication between these countries and comparison of differential diagnoses, among other core features. ICT also allows for the horizontal exchange of information between policy makers, programs managers, and community workers at the grassroots level. It allows for vertical exchange between those three categories, thereby breaking down barriers to knowledge and communication.  This has created an international family of global health workers that help to bring international communities on board with the decisions that concern them. These communication exchanges can take on many different models allowing countries to choose which one best suits them. As a result, we can quickly gain time by building on the experience of our peers around the world and web-based free information can dramatically improve local, national and global health.

Without ICT, all of Rwanda’s programs in the health sector would be unmanageable. For example, the healthcare financing system is web-based and manages over 90% of Rwandans enrolled in health insurance, along with a performance-based compensation program in our 450 health facilities. Rwanda’s ART program, which provides antiretroviral therapy for 80% of people living with AIDS in need of treatment, is also managed through web based technology. Now that we have started to tackle non-communicable disease we are in need of ICT more than ever.

Over the past few years, we have also seen an emerging area where healthcare is delivered using mobile phones, otherwise known as mobile health (or mHealth). ICT also allows Rwanda to gather localized MDG reports. Community health workers and health professionals do active case findings on fever and malnutrition, perform maternal mortality audits, and collect information on all maternal deaths in the country via mobile technology in order to better understand why young healthy Rwandan women can be at risk of death during pregnancy or delivery. Additionally, many other programs in Rwanda have web-based management, such as health surveillance, public health reporting, drug procurement, drug tracking, the blood bank, and E-learning. One of our big challenges is in coordinating ICT tools so that these web based management systems are efficient and synergetic.

Given all above reasons, it is clear why the Government of Rwanda has put ICT as a top priority in the development of our health sector, as it recognizes the urgent need to build e-Health capacity in order to provide and maintain highly effective, reliable, secure, and innovative information systems to support clinical decisions, patient management, education and research functions. This approach will be crucial to ensuring the sustainability of an integrated and coordinated healthcare system in Rwanda which will efficiently provide high quality, gender-, geographical- and age-equitable services.

The final advantage of using an ICT approach is that we save trees since we are saving the paper used for plans, reports, files, mails, and so on. At a time when experts recognize the danger of global warming to the Earth, environmental programs should also award the use of ICT by the Government of Rwanda!

The Role of King Faisal Hospital Today

I wrote the following blog post, "The Role of King Faisal Hospital Today," in 2007. I am sharing it on my new blog as it has not been previously published, but some of the information is out-of-date. It does accurately describe the vision of the Ministry of Health for King Faisal Hospital and its role in our health system. 

All sectors of the Rwandan Government are dedicating substantial efforts to achieving our national development objectives. Together with the support of partners from around the world, the Government has strived to endow the country with innovative tools and programs that aim to make the necessary changes in the health sector to enlarge the range of quality services given to the population.  The programs in question are complementary and have specific objectives. Through this support, Community-Based Health Insurance, RAMA, the decentralization of sanitary systems, the equipment of district hospitals, referral hospitals, and King Faisal Hospital in Kigali have become essential pillars of the development plan of the health sector.  

Among the health sector’s various achievements, one of the most impressive is that more than one million Rwandans now have community-based health insurance and all Rwandan civil servants are now covered by RAMA as of late 2007. Among other resources available to public programs, we now have substantial funds for the fight against HIV/AIDS that are being used to control the epidemic in a way that builds the national health sector, as well as funds for new equipment in district hospitals, referral hospitals, and health centers across the country. These achievements have benefited the whole population.

At the same time, thanks to the Government's advocacy in negotiating with partners across many continents, King Faisal Hospital has increased its capacity to provide services to the country’s sick. King Faisal Hospital can now offer very specialized abdominal surgery by laparoscopy as well as other state-of-the-art technology in orthopedics, orthodontic care, and ophthalmology services. More specialties will continue to join the array of services offered on a regular basis.

Beyond this immediate improvement in the spectrum of available services, King Faisal Hospital has a mission of training that aims to assure capacity building of Rwanda’s medical students, general practitioners, and specialists.  With the support of the Ministry of Health and the United Nations Development Program, the hospital now has a telemedicine center that allows exchanges and continuing education programs through linking King Faisal to teaching hospitals around the world. Our population, our medical students, and our physicians are increasingly benefiting from it. Other strong partnerships have been created to allow cardiac catheterization and open heart surgery, treatments usually outside of the financial means of most Rwandans. Now, thanks to solidarity on the part of Australian, American, and Belgian physicians who come on surgical and capacity-building trips, the average Rwandan can benefit from these services at King Faisal Hospital. 

Thanks to Community-Based Health Insurance, RAMA, and the Ministry of Health’s national referral system, patients referred through the normal process can receive specialized care offered King Faisal at costs comparable to care offered at CHUK. A patient is generally referred from a health center to a district hospital to a referral hospital if necessary. These referral hospitals can then refer to King Faisal Hospital for care that is not available elsewhere. In the case of severe medical emergencies, a patient can be referred directly to King Faisal Hospital without progressing through the standard tiered referral process. 

Referral to King Faisal Hospital is free for the poorest Rwanda if they have the requisite administrative documents from ubudehe. As a result of this social justice-based access policy, the more King Faisal Hospital has high-level quality and varied care, the better the Rwandan population will be taken care of. King Faisal Hospital also allows our tourists or our investors who spend time in Rwanda to be assured that they will have access to high-quality health care should the need arise. This is a great way to attract and retain investors.

We have a long way to go, but the Government along with its partners has put in place a system so that all can receive affordable and quality care, even for the poorest citizens because the Government pays for them.  Rwanda has a national goal of becoming a middle-income country within the coming decades. Therefore, it is essential to sustain efforts to assure access to high-quality health care to all.