"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 – a pillar of our national policies – which has allowed Rwanda to have community-based health insurance (Mutuelles de Santé) 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.
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.
"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/
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: http://www.newtimes.co.rw/section/article/2015-04-11/187761/
"This year,for the first time, I spent the entire first day ofKwibukain 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."
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.
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.
I hope you will take a moment to read my OpEd published by the New Times on 18 February 2015 regarding the need to strengthen our institutions to assure a better health system for Rwandans.
"We know how far we have come to be where we are today. As I reflect upon several achievements attained not only as the health sector but the entire nation, I am also reminded of the long journey ahead to meet the set goals in the interest of all Rwandans.
A good example is the positive outcomes we have witnessed following the decentralization of our health system. Decentralization in Rwanda has translated into real and meaningful empowerment, placing critical responsibility in the hands of the local leaders.
This empowerment has grown in parallel with the increasing capacity of the central government to monitor, evaluate, and strengthen its auditing role. This has helped improve accountability across all levels to ensure we are doing all we can to better the healthcare system.
For instance, by applying the fiscal decentralization with the national budget, hospitals have been assigned their funds through the district budgeting process. Also, other health financing strategies for the country are based on decentralization.
This includes the community-based health insurance known as Mutuelles de Sante, which serves as a useful example to demonstrate how the local and central governing structures work together. It also shows how we are continually learning and adapting to improve the program.
Mutuelles was created about 15 years ago and it is now undergoing its third major reform. The first reform involved changing the amount that each household paid for their health insurance premiums.
At first, each household paid for a single household, but the reform ensured that each household would contribute the amount appropriate to reflect the number of people in their domicile to improve fairness of the contributions across the country as well as financial access for all.
The second reform involved the implementation of the stratification system, so that each person would pay in accordance with their income as opposed to a flat fee per person. The third reform is ongoing.
The government is transitioning the management of Mutuelles to the financial professionals at the Rwandan Social Security Board which has the mission to provide quality management of health insurance. This will ensure the sustainability of the programme.
All of these reforms have relied upon an effective decentralization of responsibility and authority to the local governments that also oversee Mutuelles starting at the district level; the direct management of the Mutuelle staff by the local administration puts the Mayor in charge of this programme in that district.
In general, this decentralization structure has been working well. Having local leadership overseeing the local implementation of Mutuelles has been helpful. These local leaders have, on the whole, been loyal, trustworthy and hardworking, and are dedicated to their mission vis-a-vis their administrees.
Unfortunately, however, there have been a handful of local leaders who have been dishonest – acting as though they were more powerful than Rwandan institutions. They did so by stealing the hard-earned money that people had placed to get their health insurance locally.
And such dishonest acts were discovered through the complementary, central auditing system in place through the Ministry of Internal Affairs, the Ministry of Local Government, Ministry of Finance and Economic Planning, and the Ministry of Health.
In Rwanda, we have a zero tolerance for corruption. Thus, at all levels, we create institutions, such as the auditing system noted above, that reinforces accountability and discourages dishonest actionsby making the cost of corruption high.
In this case, those local leaders who unjustly took money from the health insurance pool for their own personal gain were appropriately identified by this system. These individuals will be held accountable for their criminal actions and will reimburse up to the last penny of what they have taken, even if this means that they have to sell their assets.
Rwandans should rest assured that their investment into their health insurance will not be lost. We have learned from this experience that we can be even more vigilant in our fight against any form of corruption, nepotism, or any crime moving forward.
Creating systems that reinforce honesty and accountability is very vital to protecting our integrity, our rights, and development as a country, especially as we strive to reach our Vision 2020 goals.
Yet this experience has taught us that we need to foster the growth of honest local leaders coupled with improved central level institutions that bolster accountability and reassure the people that their interests are being protected.
I am grateful to live and work in a country where systems are strong enough to identify and correct problem areas or loopholes. Our effort to learn from both our successes and mistakes allows us to continuously improve every day in our efforts to protect public goods, community assets and people’s rights.
The writer is the Minister of Health "
*Published in the New Times on 18 February 2015. Available at: http://www.newtimes.co.rw/section/article/2015-02-18/186076/
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:
"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."
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