Thursday, July 9, 2015

Rwanda's Quest for Universal Health Coverage

The following essay on Rwanda's Quest for Universal Health Coverage was featured in the Commonwealth Health Partnerships annual booklet, which is now available online:

I encourage you to look over the various essays on topics related to UHC, ageing, governance, NCDs, and much more throughout this publication.

Wednesday, June 17, 2015

The importance of claiming our future

I was pleased to co-author an article with Nigel Crisp that was recently published in the Lancet.  You can view the article here:  In the piece, we summarize some of the fundamental motivations behind our efforts to contribute to a recent book titled "African health leaders: making change and claiming the future." 

Sunday, May 10, 2015

Op-Ed in New Times on Labour Day

Below is an Op-Ed I composed for the New Times that was published on Labour Day in Rwanda.  May we continue to "ignore detractors".

"Today, as we celebrate the International Labour Day, I reflect upon the great challenges that Rwanda faced 21 years ago and then consider the great progress that has been made by all the workers in Rwanda; I am so proud to call Rwanda my home.
However, when I read news articles suggesting that our progress is somehow “following in the footsteps” of other countries, I find this argument wanting. Though it may not be intentional, such a characterization of our progress has the insulting implication that workers in Rwanda are incapable of seeking out innovative solutions to improve their lives on their own.
My conclusion is that some of the people who make such claims, many of whom have never set foot in Rwanda, believe that a country of black people in the heart of Africa is incapable of achieving the kind of progress they only read or hear about.
On the contrary, under the visionary leadership of President Paul Kagame, workers in Rwanda have demonstrated great will and ability to plan and deliver substantial improvements on our economy, health, education and governance sectors.
After 1994, much of the world viewed Rwanda as a failed state. They expected us to stay disorganised. That has always been their expectation of black Africans, a pre-judgment that is not immune to racism. Indeed such analysis unveils a pernicious double standard.
Thus, for those who have observed Rwanda’s progress, they have been surprised. According to the World Bank, Rwanda still only has a GDP per capita of $638. Yet, we have made progress that exceeds this level of development.
We have managed to do more with each available dollar.
The world does not expect that workers in Rwanda keep streets clean, and that the country is governed according to the rule of law. A population full of energy and hope, a police force that protects and services the people without asking for a bribe, an army that protects civil rights and uses its personnel to promote the health, education and wealth of the citizens under its protection. And yet this is the reality here.
And still, today, 21 years after the Genocide, people are astonished that we used our own energy and forward looking minds to get out of the dark hole that characterised our past, and even more so, that we have done this in one generation. 
Their surprise is due to the unwarranted low expectations of us. They cannot deny the undeniable evidence that such progress has been made, they only argue that it is because we have followed in the steps of others. Often, they suggest that we are mimicking Singapore, as opposed to building our future based on our own Rwandan values.
The desire to strive for excellence is universal. To simplify the pursuit of excellence in Rwanda to an effort to “mimic” or copy another’s success undermines all the Rwandan workers who have made Rwanda’s journey possible. We do not need other countries to inspire us to work for the good for our people.
We have had our own innovations that have contributed to Rwanda’s development. These include Gacaca courts, the One Cow per Family programme (Girinka), the national dialogue (Umushyikirano) during which leaders are held accountable by the electorate, and the conception of global partnerships such as Rwanda’s Human Resources for Health Programme, which is creating high quality physicians to improve our nation’s health.
Other examples include community participation to facilitate vaccination of 90 per cent of our children with 11 vaccines, a record rate of coverage. Another example is the community empowerment of people in villages to select 45,000 dedicated voluntary health workers.
I could also talk about the national policy to ensure equity in human development and access to health opportunities even for the most vulnerable Рa pillar of our national policies Рwhich has allowed Rwanda to have community-based health insurance (Mutuelles de Sant̩) a health centre staffed by nurses in each sector (except 18, to be covered soon), a district hospital in each district, and a provincial hospital in each province. In addition, three new referral hospitals are planned to ensure that Rwandan citizens are equitably served.
We certainly have had the accompaniment and support of tremendous partners since 1994 and we are absolutely grateful to them, but it is the Rwandan people who, with their relentless efforts, have fundamentally driven this progress.
I am grateful for the transformative leadership that holds us accountable to ensure we meet the highest expectations, that does not accept actions that would promote double standards, and promotes the fulfillment of human rights as we carry forth on this path towards a better tomorrow. 
Happy International Labour Day!
The writer is the Minister for Health."

*Published in Rwanda New Times - 1 May 2015 - 

Thursday, April 30, 2015

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: 


"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 - 

Reflections on Kwibuka21

Below is my Op-Ed on Kwibuka 21 that was published in New Times in April 2015.  I hope you will take a moment to read through these reflections on what happened in Rwanda 21 years ago and where we are today.

The full article on the New Times website can be found here:


"This year, for the first time, I spent the entire first day of Kwibuka in my village.  It was a moving way to begin the 21st commemoration of the Genocide against the Tutsi. As I spent the day alongside my neighbours, many of whom suffered so much from the Genocide, I found myself moved by the courage of the great people of Rwanda.
For the survivors who chose to seek reconciliation as opposed to revenge, you have allowed this country to move forward to where it is today.  I am deeply humbled by your courage to forgive.
By doing so, you have offered your hand to lift Rwanda from the ashes it once was.
Today, we are a peaceful and strong country.  We are proud of what we have become.  As His Excellency President Paul Kagame has said, “this country has changed for the better and for forever”.  I am thankful for this transformative leadership that has guided and inspired us all along this difficult but meaningful journey.
Immediately after the Genocide against the Tutsi, 21 years ago, much of the world viewed Rwanda as a lost cause.  They expected us to fail if we were left to our own devices. They believed, as usual, that it was a place that required a hero from the outside. But they were mistaken.  Our heroes are you the survivors and you our great President, Paul Kagame, who led us to our journey of recovery.
Mister President you are a true hero for leading those who ended the 1994 Genocide.  You are a hero for continuing to lead us in our quest for stability, peace, development and prosperity.
My other heroes are those survivors who have faced unimaginable suffering, trauma and pain and yet are striving daily for a better future for all Rwandans - for both survivors and perpetuators and the generations to come. I salute the values that have guided you, including the spirit of self-determination and ownership. Agaciro.
Because of you, Rwanda has shown that poverty, savagery, revenge and terror are not acceptable destinies.
Our story since 1994 has also helped to show how misguided and harmful opinions can be when it comes to false global solutions to assist nations that are trying to overcome great obstacles.
For instance, some justified withholding life-saving health interventions from Rwanda’s children because it will add “man-years of human misery”, (The Lancet)[i].  There are some in this world that promote such failures to humanity.
I could provide many other examples of international organisations that essentially did the same in so many areas.
The world failed to imagine that Rwanda could be where it is today.  We have thus proven these dangerous skeptics wrong.  We have shown that we can break dangerous cycles of despair through forgiveness, reconciliation, and standing united for a brighter future.
Many describe Rwanda’s transformation over the past two decades as nothing short of a miracle.  And yet this discredits the intentional and participatory processes that we have developed as a country to overcome these formidable obstacles.
Under the guidance of our President, a leader who knew that a brighter future would only be possible if Rwandans internalised and worked towards this vision collectively.  We trusted him and he leads this movement to be innovative in our collective thinking. We have refused to leave the most vulnerable behind and held strong to our commitment to equity.
We have created policies that are relevant and responsive to the community at the grassroots level.  We have sought out partners who share in our Vision 2020 and beyond.  And so much more.  Such innovations have translated into consistent economic growth and unprecedented health improvements, among others. Thank you Mister President.
While we have come so far, we all know that we have a long way to go under your guidance.  Our journey has only begun.  But this promising future for our beautiful land of a thousand hills would not be possible without the critical, challenging first steps that our beloved survivors took to pursue real and lasting reconciliation.
To each of you, I hope you know how deeply I admire your courage and thank you for the opportunity to learn from you and be with you in this journey towards a brighter future for all Rwandans."

Friday, April 24, 2015

Promoting the Health of Our Children - Remarks at Children's Week Conference in Stockholm

I was delighted to participate in this year's inauguration of Children's Week conference in Stockholm.  I hope you will take time to listen to this video of my remarks, which includes a call for strong principles to restore and preserve the health of our precious children.

Friday, March 6, 2015

Interview with European Times

I had the opportunity to meet with a team from the European Times and share reflections on the progress we have made in the health sector and a number of our goals to further this progress.  

Minister of Health Highlights Impressive Progress and Future Goals

Dr. Agnes Binagwaho, a paediatrician, has been Rwanda’s Minister of Health for the past four years. She discusses the efforts Rwanda is making to bring high-quality, affordable healthcare to its people and outlines current and future projects.
 European Times: How has the Rwandan healthcare sector evolved over the past decade?
 Dr. Agnes Binagwaho: Rwanda has achieved more progress in its healthcare sector than expected, in spite of limited funding. Great improvements have been made in access to services, financing, equipment and human resources. The Ministry of Health is working with high synergy across sectors to use funding as efficiently as possible. Rwanda has reduced death rates from AIDs, malaria and TB, and now offers universal access to HIV treatment. Around 90% of Rwandan children have been vaccinated with ten different vaccines. We are steadily increasing the number and quality of our healthcare professionals and we have implemented an advanced electronic information system for the healthcare network.
 European Times: What are your current goals for the healthcare sector?
 Dr. Agnes Binagwaho: The ministry’s mission is to bring good health to all Rwandans. Having made great progress in combating communicable diseases, Rwanda now needs to tackle non-communicable diseases. The ministry has launched preventive campaigns concerning protection from HIV infection, the need to wear seatbelts and helmets, and the risks of smoking. We will continue to expand the healthcare network and will upgrade existing hospitals to three more referral and four provincial hospitals. The ministry is promoting private-sector participation, public-private partnerships, education and investment in healthcare infrastructure. Public-private partnerships are already very important in the healthcare sector, since around 40% of the country’s hospitals are privately owned but benefit from government support.
European Times: What are the main challenges the healthcare sector faces?
 Dr. Agnes Binagwaho: We need more healthcare professionals and more specialists in different medical fields, including oncology. Rwanda now has nine nursing schools which will graduate a total of around 900 nurses per year. We need to quadruple the number of Rwanda’s healthcare professionals so Rwanda welcomes private universities offering healthcare training. Expanding the healthcare infrastructure is one of the Ministry’s goals.
European Times: What are the opportunities for foreign investors?
Dr. Agnes Binagwaho: In addition to investment in healthcare training, the Ministry of Health wants to attract investment in private healthcare facilities and high-quality pharmaceuticals, and may outsource the management of public hospitals. Investors should keep in mind that Rwanda is well placed to become a regional healthcare hub.