Saturday, December 13, 2014

Securing Health For the Next Generation

An Op-Ed that I recently wrote on ways to improve healthcare for the next generation was featured in Uganda's newspaper New Vision on 12 December. The full article is available at this website: http://www.newvision.co.ug/news/662800-securing-health-for-the-next-generation.html#.VIq-RCh3aVU.gmail and provided below:
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"When I served as a pediatrician in Rwanda’s public hospitals, I devoted myself to building a future where children could reach their full potential without fear of disease.


Today, as Rwanda’s Minister of Health, I can attest to the great progress our country has made to improve the health of everyone living in the “land of a thousand hills.” But I also recognize how critical it is to keep pressing onward, not only as a country, but also as a continent.

Africa is home to some of the fastest growing economies in the world, but the benefits of this progress have not been felt equally.  For far too many, basic health care remains out of grasp. Millions of Africans simply do not have access to health facilities staffed with trained workers, or even to experienced community health workers. Even for those fortunate enough to live in close proximity to a health facility, many cannot afford to pay for basic healthcare services.

The time has come to commit to making affordable, quality health care the cornerstone of Africa’s development. Several African countries have taken a stand on providing health services  
    to all their citizens, and their efforts are already paying off through healthier communities.

Twenty years ago, Rwanda was a nation devastated by genocide and war: Nearly eight in ten people lived in poverty, our health system was all but destroyed, and one in four infants didn’t make it to his or her fifth birthday.

Today, even though we still have a long way to go, Rwanda is flourishing. This is due to many factors, including a collaborative governance structure that aims to extract the most value for our people from the money spent.

Rwanda’s visionary approach to prioritizing the nation’s health has also been instrumental in achieving this progress.

Combining national resources with international donor support, we have developed a system to improve both geographic and financial access to quality basic care for all Rwandans. 

Through our community-based health insurance scheme, called Mutuelles de Sante, approximately 90 percent of the population has health insurance, with another 7 percent reached through civil, military, or private insurance.

Even in the most remote villages, Rwandans can rely on local community health workers to deliver 80 percent of the preventive and primary care services and connect them to advanced care when needed. Under this system, Rwandans can access care without fear of financial ruin.   

The results of this approach, driven by a deep commitment to health equity, have been striking: Since 2000, infant mortality has decreased by 66 percent, child mortality has decreased by more than 70 percent, and deaths from HIV, malaria, and TB have fallen by nearly 60 percent.  Rwanda’s children were the first in sub-Saharan Africa to receive the vaccines for pneumonia and the human papilloma virus (HPV).

Other African nations are also making important strides towards universal health coverage. Each country is developing its own model to provide coverage for its people—informed and influenced by our distinct cultures, histories, populations and settings.  For example, in Uganda, the government has committed to establishing mandatory health insurance for all citizens by 2025. Going forward, it is necessary that each country feel ownership of both the successes and failures of the approach they opt to take.

Whatever the approach, health systems should be participatory in nature, ensuring that communities provide “buy in” to the value of having health insurance, as well as a sustained political commitment to scale up these efforts.  This will help ensure that no one remains beyond the reach of efforts to provide affordable, quality care.

The need for universal health care has never been greater throughout the world, and especially in Africa. Despite commendable progress in health over the past decades, Africa still faces the highest burden of disease, and continues to have far too many weak health systems. The recent Ebola epidemic has highlighted what is at stake for all of us if we fail to invest in both strong health systems alongside good governance. 

Health coverage is also a major financial challenge. Millions of Africans suffer financial hardship due to catastrophic expenditure whenever they are sick. According to the World Health Organization, about half of health care expenses in our region are paid out-of-pocket, and a 2009 study in Health Affairs found that one in every three households in Africa must borrow money or sell their possessions just to pay these fees.  

No family should have to choose between getting well and going bankrupt, especially when we’ve witnessed what a powerful force national health care can be for stability and economic growth. When governments invest in affordable health care, the whole population is healthier.  There are real economic benefits: there is less absenteeism at work, and the money saved by avoiding these consequences of poor health can be invested in building stronger futures for families and communities. School fees can be paid, new business can be started, and households can build savings.

Politically, there has never been a better time for us to invest in universal health coverage. Two years ago today, the United Nations unanimously endorsed universal health coverage. Global institutions such as The Rockefeller Foundation and, more recently, The World Bank, have elevated the benefits of UHC globally, and to date more than 80 countries have asked the World Health Organization for assistance in implementing universal health coverage.

Today, we mark the anniversary of this landmark decision with the first-ever Universal Health Coverage (UHC) Day, a global call-to-action that has garnered unprecedented support from more than 500 organizations.

As we look beyond the 2015 Millennium Development Goals, African leaders face an incredible opportunity: If we invest in our health systems now—which we know yields an impressive return for the investment—we can build an Africa where individuals, families, and entire nations reach their full potential. 

Together, we can chart a course for a stronger, more resilient Africa and world."

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From Uganda's newspaper New Vision - web link: http://www.newvision.co.ug/news/662800-securing-health-for-the-next-generation.html#.VIq-RCh3aVU.gmail  

Friday, December 12, 2014

Rwanda's Health Care System & The Services Investment Forum 2014


At the 2014 Services Investment Forum (SIF) recently held in Kigali, I was delighted to participate in the panel discussion focused on our country's healthcare system.  We covered a number of topics, including how to improve quality, the drivers of prices of healthcare services, the decentralization framework that has improved geographical proximity to care, as well as where we are going as a country.  We also discussed Rwanda's health services strategies, current challenges and opportunities, and proposed solutions to overcome the existing challenges for Rwanda.  There is much to be done to create the infrastructure and environment we need to position Rwanda as a health care hub of excellence for the region and the world. And we are motivated to do this important work.  You can watch my remarks here:

Services Investment Forum 2014 Video - Available at:


Universal Health Coverage


I was so pleased to have the chance to contribute some remarks regarding the importance of Universal Health Coverage (UHC) as a global coalition celebrated UHC Day 2014 on 12 December 2014.  You can view a video of my remarks that was presented at a launch day event in London, UK, at the London School of Hygiene and Tropical Medicine and learn about all of the great work of this coalition through their website: http://universalhealthcoverageday.org/welcome/ .  We should all continue to monitor and support this great #HEALTHFORALL campaign.

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Coverage of my remarks at LSHTM 
(Link)


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The Video of My Remarks
(Link)




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Here are a few additional stories regarding UHC Day

1) Press Release from Rockefeller Foundation -  https://twitter.com/RockefellerFdn/status/543517004947525633/photo/1
2) Rwanda New Times Article - http://www.newtimes.co.rw/section/article/2014-12-13/184004/ 


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UHC Campaign 






Saturday, October 4, 2014

How Design Can Heal

Please take a moment to watch this video by our friends in architecture - the MASS Design Group - who helped to construct the Butaro hospital.

Link: http://vimeo.com/106936022


Friday, September 19, 2014

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.
Chart showing estimated decline in mortality rate of children under 5, given enhanced health-sector investments.
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."
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See full article on this web link: http://ic2030.org/2014/09/grand-convergence/ 

Monday, September 15, 2014

Holding Institutions Accountable


Please see my OpEd that was published in today's New Times:

http://www.newtimes.co.rw/section/article/2014-09-15/180939/



World Health Organisation and UNICEF accountability – we are not yet there


"I am very proud to serve for a country that has prioritized the health and wealth of its children. This is evidenced by activities, laws, policies, strategies and plans implemented by various sectors. This is normal because our people are our riches. And among them – the most precious are our children because they are our future and we always fight to improve their health and well-being.
On a personal note, as a pediatrician, I am deeply motivated to improve the lives of children. Any effort to reduce unnecessary suffering and harm to a country’s future generation is laudable because – like so many Rwandans – I believe that the value of a country is how it treats the most vulnerable among its people. And our children are the most vulnerable of our citizens.
This is why that I, along with so many others, was shocked to see news of a report that was released by the United Nation’s Children Fund (UNICEF) titled “Hidden in Plain Sight: A Statistical Analysis of Violence against Women and Children”, which included findings – that if true – would make Rwanda one of the most violent countries in the world vis-à-vis its treatment of children.
When looking more closely at the story behind the implausible numbers, however, it was astonishing to see how many flaws existed in this report. Even the report authors made disclaimer after disclaimer about how limited their methods were. They reported projections of data – as opposed to real data – and failed to explain what informed these projections. Not surprisingly, their findings are so far from the truth.
For instance, the Rwanda Demographic Health Survey – which is an internationally recognized data source to document the status of the health and well-being of our people and is done in partnership with those who published and promoted this report (WHO, UNICEF), shows a very different picture relative to the recent flawed report. Additionally, the real data on child homicides recorded by the Rwanda police suggests that the UNICEF report estimated a child homicide rate that was over 10 times as high as reality in Rwanda. (see table below)
Observations on the data related to Rwanda profile:


Table: Observations on the data related to Rwanda profile.
Flawed data – such as these – cannot simply be apologized for in a “technological appendix” or the “limitations” of a study (which never would make news headlines). Instead, they have real consequences. They can easily damage the reputation of development plans of a country. They can easily redirect time and policymaking efforts to “problems” that don’t actually exist.
This report teaches us to reflect upon a few key things:
First, efforts to hold international institutions accountable are blocked and they still allow themselves total impunity to publish defamatory reports without any consequences to themselves.
Second, this puts into question the commitment of these institutions to human rights. One of the major principles of human rights is a participatory process. By extension – as countries are made up of human beings – the people of these countries should be given the right to participate or review the report. Reports – right or wrong – on country performance should never be disseminated without being shared with the country to inform them of the findings so that eventually, they can show evidence of the false allegations or use the information – if accurate – to generate positive change.
In conclusion, I just want to recall the imihigo contract that we have just signed across sectors and level of responsibilities as a country to guarantee accountability of each leader at all levels. It is something that the UN may consider adopting to help guarantee better use of their organization’s influence and the other useful work that they undertake everyday in partnership with member states.
The Author is the Rwanda Minister of Health."
Published in the New Times - 15 September 2014 - Link: http://www.newtimes.co.rw/section/article/2014-09-15/180939/

Tuesday, September 9, 2014

PhD Life and Reflections

Given my background as a pediatrician and enthusiasm for research, I was very proud to be the first person to receive a Doctorate of Philosophy (Ph.D.) from the College of Business and Economics of the University of Rwanda in August 2014.  My thesis on improving the health of children with HIV/AIDS in Rwanda has meant a great deal to me.

More information regarding the announcement of the degree can be found here. I've also included a picture from the special graduation day below:



Additionally, since receiving my PhD, a number of people have inquired about my ability to manage the various responsibilities before me in a given day.  I very much enjoyed my interview with the New Times reporter - Collins Mwai - who captured my reflections on this topic in this piece published on Sept. 3rd: http://www.newtimes.co.rw/section/article/2014-09-03/389/news-career:-dr-binagwaho-tips-on-juggling-education-and-work  (see text below)



"Following its merger, the University of Rwanda passed out its first graduates in various disciplines and levels this year and among them was Dr Agnès Binagwaho, the Minister for Health.


Dr Binagwaho was conferred with a Doctorate of Philosophy (PhD) in Health Management and did research on the HIV/Aids epidemic, with Rwanda as her case study.
Binagwaho, who started the course in 2008 before the merger of the institution, managed to juggle her studies, her ministerial role, her work as a senior visiting lecturer in the Department of Global Health and Social Medicine at Harvard Medical School and clinical professor of pediatrics at the Geisel School of Medicine at Dartmouth, USA.
In an exclusive interview with Women Today’s Collins Mwai, the minister explains the reasons, necessity and modalities of higher learning.
You are a minister, a lecturer in two top universities in the world and you have a stable career. Why the need to return to school?
The President always says “never remain in your comfort zone, always challenge yourself.” I am a strong believer in that too. The day you believe you have nothing to learn is the day you begin to die. Even in retirement, there are numerous lessons to learn.
How did you juggle between your roles through school?
We all have the same number of hours in a day; it is up to you to choose how you will spend your time. I prefer to spend mine learning and doing research. I was comfortable juggling my various roles and school. It is always easier if you have a passion for what you do.
You had the capacity to undertake your PHD anywhere in the world but you chose to do it here, why?
I first registered as a PhD student at the university while it was still National University of Rwanda (NUR). While working, a PhD takes between four and six years, it happened that I graduated after the universities had merged.

I wanted to do a PhD in my country because in many areas, this country is quite advanced in policy planning and strategy. We have riches and innovation. I am against the idea of going out for PhDs when quality education is available here. To anyone in doubt about the quality of our higher learning institution, I can tell them for sure that I did not experience challenges while pursuing the qualification.

I also wanted to prove to people who I work with that it is possible to balance work and school. If I can do it, they too can do it.

At the ministry we have been urging people to take on master’s degrees, currently most people have the qualification while others are pursuing PhDs. I am a strong believer that the best thing you can do for yourself is add more knowledge to what you have.

The requirement to work at the Ministry previously was a degree, now it is a master’s degree; we have made arrangements so that they can all have an opportunity to advance. Higher learning is a benefit to the institution and the people served by the institution. From my Ministry I have seen them have better and in-depth understanding of circumstances and solutions to approach them.

If you research more on what you do, you become a master in the domain and can perform better. It is an advantage to you, your institution and your community.

Most women of the young generation currently view higher learning only as a means to higher salaries; you clearly see it quite differently, why is that?

Money and a high salary is not the end, it should not be, it is just a tool. We have people who are rich but end up taking their lives. Education gives you fulfillment and purpose. Continuous education has numerous benefits. You will never know enough.

There has previously been talk that quality higher learning can only be obtained abroad, do you believe so too?

It is not true, in one way; even those institutions come here to learn from us. They borrow ideas from here and go teach them abroad. That is part of what we are trying to educate people in the Ministry, to do further research, document their findings, and share it on bigger platforms internationally.
I came to Rwanda as a young pediatrician, being here I have had an international dimension and learnt in numerous ways over the years. You do not have to go abroad to learn, I have been known for what I have learnt and done here, I never asked for a job at Harvard, they asked me.

You can create the universal bank of knowledge here. Some ministries in this country have pioneered initiatives and leadership models that have never been practiced anywhere in the world. There is a lot to learn from here, it is time people realised how much the world can learn from us.
Among other things you are a lecturer, what is the one thing you insist on with your students?

The importance of participatory processes; working closely with the community that you are working for, you need to listen to them and learn from them. People in certain positions need to work with the people for the people.

What would you say of people with high academic qualifications but do not reflect their qualifications in performance?

They probably do not further their studies to serve better, or challenge themselves. Some could study to have bigger titles on their business cards. They also probably do not have well laid plans and strategies. Always have one. Since I began working in leadership positions I have learnt that as long as you have a guide like Vision 2020 and Economic Development and Poverty Reduction Strategy (EDPRS2) you can come up with strategies to get there.

What advice do you have for people reluctant to pursue higher learning?

Education is key, the more educated you are the more functional you are. Good education is one that helps you improve the world around you and is practical. There is no limit, the best reward you can have is to see the result of what you do. Do not run after money, it will always be needed, but it is never the end." -New Times, Rwanda - 2014 Sept 3rd (Collins Mwai)