Friday, April 22, 2011

The Right to Health cannot be separate from the Right to Information

Every human has a fundamental right to health. This includes the right to accessible services, and the rights to prevention, care, and treatment. In theory, the right to access should be equally distributed to all. In Rwanda, we strongly believe in this tenet. However, at present, it would be impossible for Rwanda provide all to everyone given how limited resources are. And yet, what we are able to do is to ensure that we continue to take the maximum measures to break barriers to access as the right to health care access also means making sure you take care of the most vulnerable groups. In targeting the most vulnerable populations, we remove financial, geographic, gender and age barriers and thereby render the situation more equitable. By focusing our efforts toward vulnerable children, pregnant women, and marginalized people, we expect to advance the quality of life for Rwandans and make life in Rwanda enjoyable for all.

In understanding what it means to grant individuals the right to health, we must acknowledge that this right is inextricably linked to the right to information. The right to information not only concerns the quality of the information but also the availability and dissemination of information through all channels, including the Internet. For policy makers and program managers, it is vital to be well informed in order to design health policies and programs that are evidence-based with accurate information. Moreover, in order for people to seek health services they need to be informed about existing services, and also about foreseen benefits or possible side effects or other disadvantages. If not, people will come to the wrong place, or go to the wrong person, at the wrong time.

Today, the right to information must also be considered a basic human right. We can recall in wartime Germany that Hitler started by controlling the information citizens were given in order to control their lives. Today the Internet is the biggest source of information.  Access to the Internet provides persons with access to information from around the world. This is why Rwanda has put information and communications technology (ICT) as a top priority in our development plan. In the past, before 1994, Rwanda has seen its fair share of poor politics of information sharing.
In what ways did former leaders prepare the Rwandan genocide in 1994? They controlled the Radios and TV. Without free access to information, people are bound only to what they are told.

Today the world is a big village. With the Internet there is access to a web-based library in less than one second. With the Internet, I can inform the global family of health providers of a question that is disturbing me, give an answer to a colleague, or simply send information.

Concretely, and in practice, what does it mean for Rwanda to make ICT a top priority? It means providing Internet access to all, particularly the 57% of Rwandans living below the poverty line. We are doing this by making primary education accessible to all, and we are continuing and improving a program called   One laptop per child .  Through this program, in all schools, every child will in the future, have access to a computer and to Internet.

People have questioned us: “Why do you need Internet when Africans are illiterate?” We answer, “Bring the tool, make people love it, and they will learn to use it.” Learning by doing is a principle for quick development. Furthermore, computer literacy is proven to improve reading and writing skills – the two are linked. Rwanda has shown that even in remote areas people are using the Internet. We can not leave out any Millennium Development Goal (MDG) if we want to succeed in our journey to development, and communication is an essential MDG.

Open Access Journals are strong modes through which we can improve access to health care.
Free, web-based medical journals are a good entry point for granting access to information for those in the health field. Free online journals are tools for sensitization, reflection, expression of ideas, and innovation; and they are virtual, and cost nothing.

It is necessary to not only have passive access to information, but also to exchange information with our peers. Such exchanges allow professionals to confront ideas and challenge each other in order to make better, more informed decisions. Increasing knowledge is not like mathematics in which one piece of information plus one piece of information equals two pieces information. In the context of online exchanges about health issues, pieces of information are more than the sum of their parts. Open Access Medical Journals are great tool to multiply knowledge, and to make a thousand pieces of information out of two. And yet, this is just one piece of the puzzle to improve healthcare. We need to consider open access in association with other tools: for example Global Health Delivery Online ( a website that connects and allows dialogue between media specialists, health specialists, general practitioners, nurses, Community Health Workers in more that 140 countries.

Global Health Delivery Online and other open access sources (e.g. journals) allow communication between countries on several levels. They allow horizontal exchanges of information not only between policy makers in different parts of the world, but also between programs managers, and community workers at the grassroots level. But more importantly, it allows vertical communication between all those categories as well. As such, we are enabled to break horizontal and vertical barriers to knowledge and communication.  This creates an international family of global health workers who bring communities on board with decisions that concern them. Finally, these modes of exchange break the affectation of people who believe that knowledge is only for selected part of societies.

These open tools create a progressive, and efficient revolution for the good of humanity. Web-based, free information will dramatically improve global health as it will make many models available for countries to choose from and decide what best suits them. As a result we gain time by using knowledge from around the world, and we are able to quickly build on the experience of our peers living near or far, and they from us.

Another basic development tool is access to education. As stated above, for access to health care, people need to be educated. For instance, in the fight against infection the presence of many health centers does not mean people go to the centers.  If people have a diagnosis, but do not seek care and treatment they may spread the disease. Therefore, we need to inform the population on where to get care. In addition, we must educate people on how to care for themselves; how to take drugs; and why its important to be compliant to the treatment not only for them but to avoid resistance; and why noncompliance is dangerous for the region, for the country, and for the world.

Increasing health, education, and information is all tied to poverty reduction; and increasing access to education, information, and health is at the heart of fighting against the cycle of poverty. Supporting Open Access Journals is supporting the world on its journey to real democracy, development, and welfare. Taking the example of Rwanda, during the decades of colonialism and before the current leadership, the country was run based on segregation. Education, health care, and information were not “for all”. The segregation was based on geography (North versus South), and on ethnicity (Tutsi versus Hutu). There was no promotion of gender or child wellbeing. This led to the denying of human rights and to the horrific genocide of 1994 – one million persons murdered in one hundred days as a result of brainwashing by leaders using information against humanity to push people to kill and to destroy. It rolled back our development. People are not bad at birth, but bad information and bad education can do this to good people.
In sum, we must continue promoting access to information, education, health care, …