Magazine article New African

From Ihangane to Universal Health Coverage

Magazine article New African

From Ihangane to Universal Health Coverage

Article excerpt

The progress of Rwanda's health systems delivery over less than two decades has been nothing short of astonishing. From a broken-down country following the genocide in 1994, Rwanda has met virtually all its MDGs and has installed perhaps the most efficient universal health coverage, including medical insurance, in Africa. Vincent Gasana describes how the country's community-based approach has delivered a world-class healthcare system.

In Rwanda a word you hear a lot is Ihangane; it's an encouragement to bear up, often offered in resignation, when nothing more can or will be done. Until the RPF (Rwanda Patriotic Front) led government came into office in 1994, Ihangane was just about all that could be offered in lieu of medical attention when illness struck, particularly for the poorest in the community.

Yet Rwanda is now one of the few countries to have achieved virtually all the Millennium Development Goals (MDGs), especially in child and maternal health, and has gone from Ihangane to universal healthcare coverage. How does a country with one of the world's smallest GDPs achieve such a thing?

After the devastation of the 1994 genocide against the Tutsi, the idea of the country reaching any developmental milestone was to most observers the stuff of fantasy. By the time the RPF defeated the genocidal government, 1,074,17 men, women and children had perished. Among them were doctors, nurses, medical researchers and even medical students. However, health coverage for all was part of the RPF's vision for national transformation.

In 2005, infant mortality was 86 deaths per thousand, down from 107 in 2000; by 2014-15 the figure had dropped to 32 per thousand. Maternal mortality rates were 1,070 per 10,000 in 2000; by 2014-15 they had dropped to 210.

The governments target for infant and maternal mortality is respectively 30 per thousand, and 200 per 10,000. With Rwanda's detractors increasingly targeting the country's statistical office, it is worth mentioning that these figures are supported by many multilateral institutions, including the World Health Organisation (WHO) and the World Bank.

And the dramatic changes in infant and maternal health are reflected in other areas from malnutrition and HIV prevalence to tuberculosis and malaria. Life expectancy is now just over 64 years, up from 49 in 2000. Extraordinary though they are, these developments are not surprising. They are a logical result of an unyielding government determination to build an inclusive healthcare system.

To realise its vision, the government pulled together a coalition of partners nationally and internationally, tapped into the Rwandan culture of community self-help, linking different parts of economic development to achieve a single end. The advances in infant and maternal mortality for instance owe a great deal to the Rwandan culture of volunteering for the community, coupled with not only mobile coverage but also the government's drive for development in ICT.

Heroes of change

The heroes of this piece are the community health workers, armed with basic mobile phones. There are now 45,000 of them around the country. Each village has its own health workers, who usually work in threes, two women to one man. They are unpaid volunteers, elected by the community, one of the criteria being good character.

They were originally given basic training in midwifery, and taught to relay information to doctors and nurses in health centres. Their responsibility is to support every woman in their area from the moment they learn of their pregnancy to the birth of their child. …

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