Exchange about entrepreneurship and transformational leadership skills

Exchange about entrepreneurship and transformational leadership skills.

By Agnes Binagwaho

The 21^st May, I met with a delegation of 31 bright students from the Wharton School of Business of the University of #Pennsylvania. They came in #Rwanda as part of the #Wharton’s Global Modular Course (GMC) program. This team of Masters of Business students came in Rwanda to learn about entrepreneurship and transformational leadership skills in emerging markets. This MBA course aim to learn “in country” and on the ground, about these practical subjects.
We had a interesting interactive session in a panel between them, Honorable Minister of Agriculture;  Agnes Kalibata and the DG RSSB; Angelique  

The students got the approach right, since they met with us after they had visited several activities at community level; among them was a visit to beneficiaries of the project one cow, one family, one to a health center and another to a school. Following these field trips, it became easier for to explain how wealth and health of each and every citizen is at the center of our sustainable development plan.

We debated the Rwandan approach to gender equity, what were the next steps to take in that area. We discussed how our agriculture had brought food security; contributed in the fight against malnutrition and in the economic growth. We also explained how we sustain community health programs and generate economic growth at village level, with the community health workers cooperatives. These were examples of the ways in which all sectors contribute to the national journey in making the country a mid income nation.

We discussed the principle of the country’s ownership and consensus approach in regards to the decisions taken after wide consultations and vertical and horizontal people’s participation

They asked us how we prepare the next generation to sustain the  gains made and how in the future we intend to maintain the highly positive mood and energy of Rwandan and carry our development forward. We explained that we still have a long way to go and that every passing day, we prepare our future, this is part of everything we do, to create an enabling environment of peace, security and a climate for financial stability. For example we explained the requirements of the Human resources for Health since we will educate the doctors and specialists nurses we need as we use more health services than ever before as our population ages, because of the reduction in premature deaths, and also because the profile of our epidemiology and morbidity is changing. We also had exchanges on how we built the Community Health Insurance, which based on social solidarity, in order to reduce financial barriers to health services and how solidarity has helped mental health care recovery, in a country with too few mental health specialists. 

More over we are proud that for the majority today Rwanda is no longer associate only to 1994 genocide but to quick progress, attaining the MDGs, to promotion of universal access to basic rights such as education, and health, to home grown innovative solution, using our culture to find solution for who we want to be etc.… 

The students asked us what we would like them to take away from their visit in Rwanda we proposed to them to contribute to our social change to invest or having projects in Rwanda.

As they asked why the image in the northern press of our country is bad and don’t reflect the reality we told them to keep their critical analytic mind and not always to believe what is the written by press and to develop an evidence based judgment

Judge the democratie of a country on what are the outcome a for its people while harming no one on earth and not on rigid inappropriate scholar definitions.

Specialized medical education: a necessary tool for development and the right to health in Rwanda

Below is my contribution to Ubuzima Magazine, published by the Rwanda Health Communications Center and the Rwanda Biomedical Center.

I recommend you to read the full magazine! Lots of great updates on our health sector from the MOH and RBC. July2012,Vol.69(2)

Specialized medical education:

a necessary tool for development and the right to health in Rwanda

By Dr. Agnes Binagwaho

Minister of Health of Rwanda

In Rwanda, equity is a principle written into our Constitution, and is found throughout Vision 2020, our roadmap for development. As in all sectors in Rwanda, the health sector has conceived policies, strategies, and plans based on equity that are aligned to the national developmen plan. Vision 2020 provides clear and flexible directives for achieving health and wealth in the framework of social justice for all.[1] As such, we are wholly dedicated to ensuring that the fruits of science are beneficial to all – both providers and patients alike.

This approach has driven the gains made over the past decade by Rwanda in improving the health of its population, particularly in the area of infectious diseases. Mortality due to HIV disease decreased by nearly 78% between 2000 and 2010, and malaria mortality decreased by 76% between 2005 and 2011. [2],[3] The utilization of primary health care interventions has increased dramatically, and we have seen rapid declines in both maternal and child mortality rates of approximately 50% in recent years.[4] Rwanda offers ten vaccines at no cost to all children; coverage rates for these vaccines range between 90-96%.⁴ Life expectancy in Rwanda has increased from 30 in 1995 to 55 in 2010. This gain has given ground for degenerative and chronic illnesses to commonly be expressed whereas in the past the Rwandan population had not survived to the age where those pathologies existed regularly enough to make them public health priorities.[5] These achievements are due in part to equitable policies, evidence-based interventions, continuous adoption of scientific innovation, with a focus on community-based approaches. By virtue of the work of Rwanda’s 45,000 community health workers who receive constant training in preventive, diagnostic, and curative skills to be able to address 80% of the disease burden at the village level. In light of these achievements, it is time to take the health sector’s progress to the next level. To do this, we must educate current and future professionals in medical specializations and sub-specializations enabling them to prevent, diagnose, and treat pathologies common and new to our population, including chronic care for HIV positive persons, and side effects of antiretroviral therapy.

In 2009, the President of the Republic of Rwanda spurred the Ministry of Health to find an inventive way to increase the number of highly specialized health professionals practicing in Rwanda in order to accelerate Rwanda’s pace toward becoming a middle-income country. After deep reflection within the health sector, we identified a way to increase the quality and quantity of health professionals who not only can maintain gains since 2000 in their capacity to tackle infectious diseases, but who can also address new pathologies and adaptations in the epidemiological landscape in Rwanda.

We decided to conceive a plan to improve human resources for health by building a knowledge base and increasing Rwanda’s capacity to provide academic and clinical training to the next generation of highly skilled health care providers who will then become the teachers and trainers themselves. The training program, coupled with purchasing new medical equipment and improving the health infrastructure, will certainly increase access to high quality care and advance Rwanda’s overall development.

The result is the National Human Resources for Health Strategic Plan 2011 – 2016 and its implementation plan: the Human Resources for Health (HRH) Program.  The HRH program has been conceived within the framework of using the “3 Ones” principle of having one governance body (the Government of Rwanda), one action plan (National Human Resources for Health Strategic Plan 2011 – 2016), and one monitoring and evaluation plan. By repurposing existing bilateral and multilateral donor funds from development partners including PEPFAR, USAID, the Global Fund, GIZ, BTC, DFID, and the Swiss Cooperation, the Ministry of Health has been able to secure enough funding for a successful launch of the HRH Program in August 2012. The Government of Rwanda has also contributed greatly to the resources available through the Capacity Development Public Secretariat.

The HRH program seeks to address Rwanda’s critical gap of skilled specialized health workers and the inadequate amount and caliber of equipment available in health facilities that presently hinders clinical training and service delivery. The program was designed to increase the quality and quantity of physicians, nurses, and hospital managers through partnership and mentorship.  The Ministry of Health has established a partnerhsip with over a dozen top American universities, including five schools of nursing, seven schools of medicine, and one school of public health.  These schools comprise the US Academic Consortium, which has been working with Rwanda to develop more than 15 specialty and sub-specialty areas including: anesthesiology, surgery, internal medicine, obstetrics and gynecology, pediatrics, critical care and traumatology nursing, surgical nursing, healthcare administration, and more.

For this seven-year program starting in August 2012, ever year 100 US faculty members will be deployed to Rwanda for one year at minimum. They will be paired with Rwandan educators in the Faculty of Medicine and Faculty of Nursing Sciences at the National University of Rwanda as well as all schools for A1 Nursing. US faculty will work together with their Rwandan counterparts to increase local training capacity and the quality of clinical teaching offered to students.  As each year of the program progresses, Rwandan faculty will obtain increased capacity in teaching and training, and will eventually assume full responsibility for specialized medical education in Rwanda.

The investment of American, European, and Rwandan taxpayers for the development of Rwanda’s health sector in this novel and unprecedented model will be sustainable in the long-term because all residents who benefit from this training will sign a contract with the government to serve in the public sector for several years upon completion.

This new initiative for human resources for health in Rwanda is included in the legal framework, in the Health Sector Strategic Plan III, and in the development of the new Economic Development and Poverty Reduction Strategy that is currently underway. The planning and execution of this major program have been truly multi-sectoral and reflect the commitment and collaboration of leaders in across the health, finance, education, and justice sectors, in addition to medical professional associations. We have worked as a team to revolutionize the way Rwanda can train its health professionals in such a way that guarantees equity in the quality of an increased quantity of services to all Rwandans no matter where they live or who they are. Our fellow Rwandan citizens deserve nothing less than the best.

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[1] Ministry of Finance and Economic Planning, Government of Rwanda. (2000). Vision 2020. Kigali, Rwanda.

[2] World Health Organization. (2012). World Health Statistics 2012. Geneva, Switzerland: World Health Organization.

[3] Karema C. (2012). Personal Communication.

[4] National Institute of Statistics of Rwanda and Macro International, Inc. (2012). Rwanda Demographic and Health Survey 2010. Calverton, MD: Macro International, Inc.

[5] World Bank. (2012). DataBank: World Development Indicators and Global Development Finance. Available: http://databank.worldbank.org/ (Accessed 21 June 2012).

Same Old Problems, new approaches in 2013

Below is my contribution to issue 3 of Ubuzima Magazine, published by the Rwanda Health Communications Center and the Rwanda Biomedical Center.

I recommend you to read the full magazine! Lots of great information on our health sector from the MOH and RBC

Same Old Problems, new approaches in 2013

By Dr. Agnes BINAGWAHO

Despite lingering challenges, 2012 was another year of incremental performance in health delivery to the Rwandan population. One visible improvement was the 50 percent reduction in acute malnutrition. However we need to not only reduce acute malnutrition but reduce the incidence of malnutrition in general.

That can be achieved by focusing our efforts on prevention. We have changed the way malnutrition is monitored because we realized that the source of the problem does not reside with the health sector alone but cuts across other sectors like Agriculture and Minaloc ( the Local Government Ministry), which are responsible for kitchen gardens, tree planting, distribution of small livestock, such as poultry for producing eggs, goats for milk etc.

However, the population also needs to be educated on how to eat these nutrients properly when they are available and that falls under Migeprof (Gender Ministry) and the National Women’s Council. The National Women’s Council which is decentralized down to village level will be used to help in monitoring not just kitchen gardens but the plate of the child as well. This is the first time we are going to monitor not what is available to the village and the family but the nutrient value in what children are actually eating.

To fight malnutrition of under-fives, we have hatched a new plan to complement what we have been doing. Because many pregnant women are themselves malnourished, they give birth to malnourished children. So we are also going to monitor the plate of the pregnant woman and then monitor the plate of the child as well.

Volunteers from the National Women’s Council will meet with families to see what the children are eating. Before this, we were monitoring only the kitchen garden but the reality is that while the garden or cow may indeed be there, their products are not being given to the child. That is the next frontier in monitoring the fight against malnutrition.

HRH

Overall my impression of the Human Resources for Health program is that it is positive thus far. We need to increase the number of health professionals in order to assure quality care for Rwandans. By improving basic care, reducing child and maternal mortality, we have been able to increase life expectancy from around 30 years in 1994 to 55 today. This transition has its own dynamics and we are now staring at the emergence of new chronic diseases that are not the result of any new epidemic but because the population is aging. It is evidence of our success against infectious diseases.

All people who need HIV treatment are on treatment. We have managed to control malaria and Tuberculosis. But going forward we now need specialists to deal with the emerging health problems related to age and consumption. We need to deal with heart diseases and chronic diseases such as cancer. We also need to improve child mortality by improving neonatology because the rate of death of neonates is what pulled down our child mortality indicators.

So we decided to create a program that brings to Rwanda around 100 Americans from the best universities every year, to teach, to mentor, bedside and also transfer clinical skills to Rwandan professionals at the level of post-graduate. Through this we hope to produce 500 specialists and sub specialists. Through this program we are going to be able to staff every district hospital with one gynecologist one pediatrician, one internist, one anesthetist and one surgeon.  We shall also have the capacity to treat our population for cancer and other diseases that need specialized care. This is not going to be done overnight; it is a seven year program that brings together all the partners working in education around the program. We are stopping petty training and focusing on good sustainable academic training.

This program will reinforce our universities to provide teaching and at the end of the day we are going to have a very skilled workforce in the health sector.

Decentralization

We are making great progress in management of the sector. Management at the central level has been very good and certified by various audits. 

We are now actively supporting the decentralized sector with the people we have trained and mentored. We are now going to move to the district level deploying people with skills in monitoring and evaluation of health programs. They also have skills in in-service training, supervision etc. Those people are now well trained and functional and we are going to base them in districts where they will be at the service of the districts. The Director of a hospital will report to the Director of health and to the Vice mayor. By decentralizing the audit function to the district and having these highly skilled people distributed equitably across the entire country, we are going to see even better management of the health sector.

This is a big move towards ownership of the sector by the districts. Because it is not fair to decentralize tasks without decentralizing the capacity to do that, we are confident they will transfer this knowledge and capacity since they have been doing it well at the central level.

2013 targets

Customer care and putting in practice the knowledge we have acquired through various programs such as HRH (Human Resources for Health) is our collective target for 2013. Our workforce is skilled and knowledgeable and what we need is to marry knowledge with practice. Health workers need to know that they need to care and apply their knowledge with customer care in mind.