Talks and Lectures





Presentation to US National FACE AIDS Leadership Summit

Boston, MA, 30 September 2012 (Filmed in Kigali, Rwanda)



On 30 September, I spoke to leaders of FACE AIDS student groups at universities across the US about the continued global activist movement to fight HIV/AIDS. FACE AIDS currently works in Rwanda (among many other countries) to build awareness among youth around prevention, care, and social support for HIV/AIDS.




A Talk for Harvard University's Conference, "Universal Health Care: Challenges, Measurements, and Evaluation Strategies"

Boston, MA, 13 September 2012 (Filmed in Kigali, Rwanda)



On 13 September 2012, Harvard University hosted a conference on Universal Health Care. I participated via video-lecture and a video-Skype discussion with economists and public health professionals from around the world.



A Message to the World Cancer Leaders' Summit

Montreal, Canada, 27 August 2012 (Filmed in Brookline, MA)



On 27 August 2012, the World Cancer Congress hosted a World Cancer Leaders' Summit in Montreal Canada. As my schedule didn't allow for me to attend in person, I recorded a video message on the importance of creating a system for cancer prevention, care, and control in Rwanda. For more information on the summit, click here.

Grand Rounds at Dartmouth-Hitchcock Medical Center: "Rebuilding Rwanda's Health System: The Case for Global Health Delivery" 

Hanover, NH, 2 August 2012


Click here to watch the streamed video of this Grand Rounds


A Video Clip from Dartmouth College, "The World is a Little Village" 

Hanover, NH, 1 August 2012





On 1 August 2012, I gave a brief interview on Rwanda's new Human Resources for Health Program in collaboration with the consortium of universities in the United States.


A Talk at Dartmouth College, "Time for a Paradigm Shift in Global Health: Equity, Science, Participation, Sustainability"

Hanover, NH, 30 July 2012



On 30 July 2012, I gave a public lecture in partnership with The Center for Health Care Delivery Science at Dartmouth College on how Rwanda's experience can inform a paradigm shift in global health and why there is an urgent need for global solidarity.


Global Health Corps Fellows Orientation 2012

New Haven, CT, 10 July 2012





On Tuesday, 10 July 2012 I spoke via YouTube at the Orientation for the 2012-2013 Global Health Corps Fellows. This message can also can be applicable to students and young people interested in global health issues.





Wilton Park Conference: "The new era in HIV/AIDS treatment and prevention: science, implementation and finance"
Geneva, 27-28 June 2012



During the 2012 Wilton Park Conference titled "The new era in HIV/AIDS treatment and prevention: science, implementation and finance," I spoke via YouTube with Dr. Sabin Nsanzimana, Head of the HIV/AIDS, STIs and Other Blood Borne Infections Division in the Rwanda Biomedical Center, on Rwanda's country perspective on treatment as prevention for HIV. 



Salzburg Global Seminar - Strengthening Leadership and Policy for Improving Care in Low and Middle Income Economies
Salzburg, Austria, 25 April 2012




This week, I spoke at the Salzburg Global Seminar on "Improving Health Care in Low and Middle Income Economies." I was invited to speak on a panel during the seminar's fourth day, and discussed 
improvements in system-wide procurement and infrastructure development as an example of Rwanda's approach to quality improvement. You can view the video of my speech above, and a program description at the Salzburg Global Seminar website.



Harvard College Course Video Presentation: Health Systems Strengthening and Social Justice
Cambridge, Massachusetts, 22 November 2011



I delivered these remarks via Youtube for a course taught at Harvard College called "Case Studies in Global Health: Biosocial Perspectives." This video presentation on Tuesday, 22 November 2011 was aired in conjunction with a lecture by Partners In Health - Rwanda Country Director, and Chair of the Rwanda Biomedical Center, Dr. Peter Drobac. My video presentation and Dr. Drobac's lecture were accompanied by a discussion with Professors Paul Farmer and Arthur Kleinman.

Salzburg Global Seminar - Concluding Remarks
Salzburg, Austria, 30 September 2011


I delivered the following remarks via video-link for the concluding day of the Salzburg Global Seminar: "Innovating for Value in Health Care: Better Cross-Border Learning, Adaptation, and Adoption." 


Good morning all of you in Salzburg – I hear that you have all had a great time, and I am happy to be part of it. I have seen and heard that the presentation and ideas on innovation delivered by each of you on both individual and group level throughout the week have been tremendous. The type of community that you have created in such a short time is one that has great potential to continue in several important ways.

What I want to briefly talk about with you this morning can fit into four categories. We need to have a vision, and to know where we want to go. We need to know where we are now. We need to know how to get there, and how to achieve our mission. We need to document how we did it so that we can learn from it.

The first part is the vision – where we want to go, no matter whether other people find it too ambitious. It is our vision, and we need to stick to it. In doing so, we assure that all of our actions will be according to our own priorities. As I said earlier this week, I believe that this vision must be shared because alone we cannot accomplish much. But when everyone is together, we can design together a national strategy and plan that is country-owned and community driven because communities are part of the design from the beginning.

This participatory process brings together communities with the public and private sectors. Then it is easy to be morally sound because from the start, no one is left out and the vulnerable people are taken care of. This is the essential human rights concept behind access to care.

The second part is measurement – we need to effectively measure the health of our population, the quality of our health care system, our people’s of access to care and treatment, and the utilization of health services across our country. This is useful on the one hand to provide a baseline for evidence-based planning, but also on the other hand to set targets according to the resources that we have. I refer to financial, human, and infrastructural resources. This means that we can design results-oriented strategies and plans. If we do such assessment periodically, they will show us over time where we stand compared to our vision and our plan.

This brings me to the third category: how to reach our targets. We do this by designing good strategy, good plans of action, and by creating good tools. We reach them by thinking outside of the box – with creativity, with flexibility, by learning as we are doing, and by being always ready to question how we can do better. Innovation, of course, includes the pursuit of new partnerships, such as North-South partnerships like that between Dartmouth and Rwanda as well as South-South partnerships like that between Haiti and Rwanda.

The final part is documentation of how we build our health sector. We need to learn from our progress and more importantly, from our mistakes. To facilitate this learning, we need to conduct research for better policies, better strategies, and better ways to implement. This is implementation science, which teaches us to reduce to gap between we know from clinical research and what we actually deliver to our population.
Today, implementation science requires as much research as clinical science because improving policies, strategies, and delivery allows us to produce better health with the same resources. Sometimes, improvement of our strategies and implementation produces even more health when it is about public health by teaching us how to bring things to scale using opportunities in a synergistic way that makes the money go farther. We need to see health care delivery as a social business where the units to produce are health, enjoying life, and wealth.

Dear friends, good intentions, innovations, creativity, flexibility, and clinical science are not enough because bad planning and bad procurement can undermine health just as much as bad will, business as usual, bad clinical services, and laziness. For example, in 2008 in Rwanda, we had an argument with the Global Fund on mosquito net procurement that delayed distribution for twelve months. Because we were not allowed to use the Global Fund money before an agreement, and we were obliged to redo the entire process. In the end, the money we received was the same because we had been genuine and had indeed done the procurement honestly; yet as a result of this delay, more than 600 Rwandans died of malaria. This can be understood by health care delivery science; the Global Fund should be held responsible for system outcomes in the same way that the health professional is held responsible for the death of patients because of his or her bad practice.

Another example is the bad decision not to vaccinate Haitians against cholera during the cholera outbreak in that country because the vaccine was said to be too expensive. This decision has cost thousands upon thousands of Haitian lives. The development partners who made that decision should be held responsible for this, as it has murdered a fraction of the Haitian population. Health care delivery science teaches us how to attain the best outcomes with the resources we have while making us totally responsible for the principles upon which implement and for the results that we get from our actions.

Dear friends, thank you so much for having me, and I wish all of you a great last day in Salzburg. It has been wonderful to participate in the Salzburg Global Seminar with Al and to be with you. Be sure that I will always be available for more discussion, and you are all welcome in Rwanda. I want to reiterate my belief about how important this meeting is, and I want to thank Al for having invited me to join this huge effort to improve how we think about health care delivery. I believe that the work done during this incredible week will change the way that we view our mission as health professionals, and I am sure that the health of our patients, our economies, and our future will be improved by it. Thank you.

Salzburg Global Seminar - From HIV to HPV
Salzburg, Austria, 27 September 2011




This week, I spoke at the Salzburg Global Seminar on "Innovating for Value in Health Care Delivery: Better Cross-Border Learning, Smarter Adaptation, and Adoption." You can view the full program description here.

I was asked to present on Rwanda's experience integrating funding and programming for HIV into a comprehensive national strategic plan for quality basic health care. The talk was entitled: "From HIV to HPV: Same Principles in Building an Accessible, Affordable, and Equitable Health Care System in Rwanda." The full text of my presentation is below. 
____________________
I want to start by saying that last week I was in New York City for the United Nations High Level Meeting on Non-communicable diseases. It was intended to be a turning point in the global approach to tackling NCDs.

In that same UN hall, 10 years ago, we met about making access to HIV prevention, care and treatment services a global priority. And we all know how that the 2001 UN summit on HIV/AIDS changed the conversation about HIV around the world.

At that time, we were told that we did not have the roads, we did not have the infrastructure, we did not have the cold chain, we did not have the procurement capacity for drugs, consumable and reagents, we did not have the specialists: even not enough general practitioners and nurses as many were killed during the 1994 genocide against Tutsi. On top of all that, the so-called “experts” of health implementation said that our population was illiterate and did not wear watches to read the time to take ARVs and could not adhere to therapy. They claimed that we should concentrate on prevention and not try to introduce ARVs to save the lives of those already infected as it was too costly and dangerous for the health of the rest of the world – because they expected our people would be non-adherent, which would create deadly resistance. But what they did not account for was the cost of inaction, a cost that Rwanda did not tolerate.
Despite all of this, today, we are proud to say we now have universal coverage for antiretroviral therapy and one of the lowest prevalence rates in Africa at 2.8%.

We are also proud to say that we just completed our second dose of the HPV vaccine for girls aged 11 in Rwanda, through our national comprehensive cervical cancer prevention and screening program. The coverage rate was 95% for the first dose, and 97.4% for the second.

These two achievements, scaling up access to HIV care and launching the developing world’s first national HPV vaccination program, are not unrelated. Rwanda was able to vaccinate all of its girls aged 11 against HPV because we have strategically built upon the foundation of advances made in HIV care and treatment, among other communicable diseases.

What I will tell you this morning is how we have moved from a destroyed health sector after the war and the genocide to tackling and managing HIV and other infectious diseases; to tackling and managing non-communicable and chronic diseases while not dropping our advances in infectious disease control.
Health in Rwanda in general is understood as an important element of development. And the HIV program needs to be coherent with the overall development vision of the country. And our overall health plan is evidence-based and results-oriented, as is our HIV plan. The strategy of the health sector needs to follow national priorities, and must be linked to the national development vision (in Rwanda this is our Vision 2020 and our plan for the MDGs). The results must be monitored, and we must use these results for planning and programming. Implementation and adaptation must be results-oriented.

When a massive influx of new resources for treating HIV was made available after years of effort by activists and people living with HIV around the world, we immediately made the choice to apply for accessing these funds. We used them to save the maximum number of lives in the most sustainable manner. This meant building a system that provided the best possible care for all Rwandans.

This also was a political choice, as it used the principle of assuring that the plan left no one out of the benefits. During the assessment of our needs, in 2001, we realized that women use less health services than men. We acknowledged this disparity, and the Government issued a Ministerial instruction to assure that if one member of a family is on ART there would be no additional cost for all additional members of the family to be put on treatment. A unit cost for the family with the objective to assure women and children access prevention, care, and treatment was the first step to implement an equitable health program based on gender, age and geographic equity. This is also why we made PMTCT the key family entry point to treatment.

Furthermore, we needed to assure in the beginning that rich people would not be served and poor vulnerable be left out, as we only had drugs for 3,500 people compared to the many more in need of ARVs to survive. We assured this by putting civil society in the heart of the fight on regulation in the selection of beneficiaries in health facilities; and we put civil society in the board of coordinating bodies for the fight against HIV. While we no longer face these problems as we currently have enough drugs for all, this principle still guides us to fight discrimination and segregation.

Our strategy is based on national ownership and responsibility. We have strong national leadership. The government needs to be in the driver’s seat from A to Z, so we coordinate our development partners in committees chaired by a Rwandan civil servant. We developed national tools, which meant developing a policy, a strategy, and a plan.

Our institutions are responsible for normative functions (e.g. clinical standards, site accreditation) on performance. These are results-based contracts that do not allow delay. Once this national framework was in place – development partners had and still have a framework to integrate and to fit into. Partners align their programs to the national plan. If they don’t want to align with our plan, they can go to another country. They need to align with us also on where they are needed. Many development partners come and want to be in the city, or they go to a country and want to be by the beach to do their work – it is not a mistake. And we needed to be careful about this type of coordination too.

To assure the alignment of partners, we need a participatory process. Partners need to participate in the design of the policies, strategies, and plans; and to be together with us in achieving it all. They also need to sign their commitment of clear actions to be taken to support the process and clear indicators to be rigorously evaluated over time. This has allowed us to succeed with innovative approaches including our common basket of procurement for ARV and consumable procurement and activities.

We assure also an equitable geographic coverage through strong coordination of our partners and with the political will to move resources out from the capital city. Another strategy we promote to assist with equitable distribution of human resources is performance-based financing to keep nurses and doctors in remote areas, and to increase the quality of the care they provide.

The other tool developed was the community-based health insurance (called mutuelles de sante) for eliminating financial barriers to basic health care.  One pillar of our strategy is to provide systematic health insurance for civil servants through a program called RAMA. For the rest of the population, we began mutuelles. This health insurance scheme aims to protect every Rwandan citizen from all common diseases. Since some very poor people cannot even afford the 2 USD co-pay per year, there is free health insurance for the poorest that is paid by the government.

All this is done to protect people living with HIV as well as those who are HIV free against the most common diseases. Because it is stupid to save a child on antiretroviral therapy for more than one hundred dollars a year and then to lose that child for lack of five dollars to treat diarrhoea or malaria, or to improve only the life of a small portion of our people.

Paying for mutuelles for the poorest provided the opportunity to show to those not covered by the government (those who are not rich and who have limited financial capacity) that the poorest people with mutuelles have better access to care than them. The result is that last year 98% of Rwandans had health insurance. We created the demand and a new mentality among the rural population, who saw people poorer than themselves having access to health care; it created a revolutionary demand for pre-payment in a country where paying prior to needing care no longer existed.

In the area of capacity building we accomplished many goals that improve the health of all Rwandans, including the training of health staff at different levels and providing solar panels, computers, ambulances to the health centres. “AIDS money” has allowed the country to train health workers and to improve overall care. We have used it to provide incentives to improve human resources, allowing health workers to serve the poor.  When you train a lab technician for HIV testing, you also train him/her to test for syphilis, other diseases and even pregnancies. The lab infrastructure and microscope he uses serves all diseases. Almost half HIV/AIDS funds in Rwanda were directed to strengthen the general health system and to support non-health, multi-sector development. 

Plans need to be community-driven if we want to solve the real problems at the community level. Integration of HIV and AIDS programs needs to be part of a larger strategy for economic development and poverty reduction for the achievement of MDGs, because HIV is a disease of poverty. Let me make it clear that I believe that this notion of health as a basic right is critical, and that this right must be protected and promoted by everyone.

We must have zero tolerance for vertical programs. This means we must consider an individual as a whole, not tackling one disease but all the public health issues by using the same structure in services for the same communities with the same health workers.

Here is a concrete example of how with “AIDS exceptionalism” we strengthen the entire health system: to provide ARV services, we need to be able to test for VCT and PMTCT first to know if a person or pregnant women is HIV-positive. That means we need a laboratory for the test. Before building or improving an existing laboratory, we need to provide common basic care to the clients of the sites where HIV treatment will be given. That means basic care for all, not only for PLWHA, because there is no site aimed only at HIV but rather comprehensive health facilities that treat the entire population for all diseases. Integration of HIV services in the health system is a prerequisite to provide ARVs in a safe manner while taking into consideration the needs of the entire population.

In Rwanda, we have always managed to use the recent influx of AIDS money to strengthen all sectors of the health system. We know that HIV is a cross-cutting issue if ever there was one. Within the health sector, AIDS money was used to rehabilitate or build from scratch infrastructures such as health centers, delivery wards, laboratories, and consultation facilities. We have bought materials for communications, including telephones, computers, and ambulances.

Another key requirement for building a system is ensuring accountability from both sides, including countries and donors, through enforcement of transparency and anti-corruption measures. The greatest challenge Rwanda and many other African countries face is that the health sector is largely externally financed. We have solved that partially by making the funds country driven and directed them to meet community-defined needs.

Many interventions remain under-funded, however, such as programs to address the link between food insecurity and health. Sustainability issues for interventions like ARV therapy remain beyond the financial means of most developing countries. We face the challenge of maintaining balance between our investments by addressing the human resources deficit while providing necessary services today. Development requires long-term support, and we do face difficulties in firming up long-term donor commitments to projects focused on health systems strengthening. Partners must bring a spirit to plan for achievement and results, not simply a limited and arbitrary timeframe – what is not achieved in a sustainable fashion is lost.

While we face significant challenges, we also have a lot of opportunities. These include clear political and technical vision, strong government leadership, broad community and civil society participation, goodwill from all partners that results in global solidarity put into action, strong foundational programs on which to build, and motivated teams of health workers with the right skills.

By dedicating ourselves to making the new resources for HIV work to meet our vision, we have seen remarkable progress in the health of our population. Over the last five years, malaria morbidity has been reduced by 60% and under-five mortality has dropped by 50%. We have increased the proportion of infants receiving all basic WHO recommended immunizations from 75% to over 90%. Maternal mortality has dropped by nearly two-thirds. 98% of Rwanda’s 11 million people have health insurance. We have 45,000 community health workers and have successfully implemented our performance-based approach in the health sector.

So, on the shoulders of these advancements, we decided to tackle non-communicable diseases, which we saw as an important investment. The fight needed to start somewhere, and it is clear that for women we can mitigate cervical cancer with a vaccine, and breast cancer with self-detection or clinical detection.
This is the place our government wanted to start. So on 26 and 27 April 2011, 128,000 young Rwandan girls received their first shot of Gardasil – with no out-of-pocket payment – and Rwanda became the world’s first low-income country with a national HPV vaccine program.

Several early decisions were crucial to the success of our HPV vaccine initiative. First, we decided to vaccinate the girls at age 11 because at this age they are ready for messages on reproductive health. We decided to vaccinate them in schools because fully 96% of girls in Rwanda go to school. Accordingly, we also decided to widen our technical working group on vaccinations to include the Ministries of Education and Gender and Family Promotion, the Center for Treatment and Research on AIDS, Tuberculosis, Malaria, and Other Epidemics (TRAC Plus), and health workers engaged in the provision of cancer care. At the same time, around Rwanda there was a sensitization campaign undertaken months in advance of the HPV vaccination. Many were involved in this, including health care professionals, local government officials, clergy, and the First Lady.

Second, the committee decided on a multi-phased vaccination strategy spanning three years. It started for girls in primary 6 this year. After this first year, we will catch up with two years of also vaccinating girls in the second year of secondary school to assure that all girls aged 14 today are vaccinated. After the third year, we will continue to vaccinate only in primary 6.

Looking at the central considerations of our decision to roll out the HPV vaccine, it is clear that an effective HPV vaccine program has to build on a national vaccination program. The HPV vaccine in Rwanda is also based on public private partnership with Merck, which we see in reality as a public private community partnership, since our community health workers have helped us to identify the children that were not at school on the day of the vaccine. When you vaccinate at school, universal access to education is key to health equity.

I should note that the same accusations made against antiretroviral therapy and MDR-TB, as Jim Kim and Jaime Bayona mentioned to you yesterday, were repeated against our HPV vaccine program. Researchers said that it was too expensive for Africa and that the HPV vaccine would take away from other vaccination programs (which have nearly universal coverage in Rwanda already). Also, they alleged that Africa’s high HIV prevalence would make the vaccine dangerous. But what they did not consider again was the cost of inaction and the danger to women who would die of cervical cancer without the vaccine. Rwanda and leaders in the health sector would not tolerate this cost. 

The HPV vaccine in Rwanda relied heavily on government leadership and support as well as a community health system that reaches all rural and urban persons. To provide timely quality services without stock-out, the supply chain, distribution systems and the cold chain have to be in place and monitored extremely carefully.

Integration was and is key to our approach to non-communicable diseases. Detection should be integrated with family planning, with life skills, with economic development. The point is to be cost-effective while providing health care in an equitable manner that ensures accessibility and affordability to all individuals.
Historically, there has always been a 15-20 year lag between the introduction of a vaccine in rich countries and in poor countries. But in Rwanda, thanks to the good partnerships we have, and our human rights-based approach to development, we shortened that lag time in delivering the HPV vaccine to less than 2 years. This is something that can and should be done in many other poor countries – those who bear the brunt of the burden of disease yet are generally the last beneficiaries of advances in science and medicine.

Rwanda’s richest resource is its population. For this reason, all of the policies and strategies in our health sector are rooted in the pursuit of health equity and social justice. These advances in combatting communicable diseases and strengthening the health system have led to increased life expectancy, which now exceeds 50 years and has led to an increase in the prevalence of NCDs.  This is an opportunity and a challenge, reflecting both our progress and the immense mountains we still have to climb to provide the necessary new services to our population.

I hope I have illustrated the principles we followed in Rwanda to create a successful program. Fighting diseases needs to start by good policies, strategies, and plans and needs to be integrated across sectors with the goal of strengthening the entire health system. Thank you very much, and I look forward to talking further. 


Global Health Principles: A focus on Health System Strengthening
Cambridge, 7 April 2011

This talk was given to undergraduates and graduate students at Harvard University, and hosted by the Harvard Institute for Global Health in Cambridge, MA. Prior to a Question and Answer session, I spoke to the students about how it is important to develop a health care system based around national programs and ownership. I discussed the example of HIV programs, the fight against cancer, care of people living with handicaps, and issues of human resources for health including professionals and community health workers. Students posed terrific questions about accountability, national ownership and challenges to scale-up.

Global Health Financing, Panel at Harvard Kennedy School
Cambridge, 7 April 2011
A panel hosted by the Harvard Kennedy School; the Program in Global Public Policy and Social Change, in the Department of Global Health and Social Medicine of Harvard Medical School; the Fran├žois-Xavier Bagnoud Center for Health and Human Rights, of Harvard University; and Partners In Health.  Several panelists participated in a discussion concerning the payment for health services and access to essential services in resource-limited settings. Dr. Binagwaho spoke on the panel with other scholars including Paul Farmer, Kolokotrones University Professor, Harvard University; Cristian Baeza, Director for Health, Nutrition and Population, Human Development Network, World Bank; Robert Yates, Senior Health Advisor, DFID; and S.A.S. Kargbo, the Director of Reproductive and Child Health in the Ministry of Health in Sierra Leone.  Each explained different models of health care financing and payment for services in various countries in Africa and other parts of the world. Dr. Binagwaho insisted on home grown solutions to payment schemes and on the sustainability of financing. After the panelists shared their views on payment for health care (e.g. individual payer, insurance provider, government as the payer), there was a designated period of Question and Answer with the audience. To conclude the event, the panelists agreed on the need for universal access to basic care with a shared understanding of health care as a human right.

UNAIDS- Civil Society Hearing
New York, 8 April 2011
Ten years after UNGASS - what are the lessons we have learned, and what is next?


Global Health Delivery: Challenges and Opportunities for Advancing Excellence and Equity

Boston, 4-5 April 2011



Panel titled "Framing Priorities in Global Health".

Panel titled "Evidence to Policy: Translating Effective Delivery Strategies into Policy".
Innovations to Improve the Quality of Health Care in Resource-Limited Settings
Boston, 31 March 2011
Lecture given in Boston, MA on 31 March 2011 on Innovations to Improve the Quality of Health Care
This lecture concerned innovations to advance the quality of health care in resource-limited settings with a focus on current programs and projected opportunities for improvement. In order to reach the Millennium Development Goals, especially those for health, countries must invest in innovations - both technological and political. We must agree that the responsibility to provide health care belongs to all people including the Government, the private sector and the general population. Improving access to prevention, care and treatment especially for those who are most vulnerable such as women and children, we need to have targeted innovative actions. Generally speaking, the world has come far since the MDGs were set in 2000. And yet we have a big push ahead of us. In order to advance as quickly as we need to - a big shift toward technology and communication must be made. 

If health care is taken as a basic human right - something I believe strongly - these innovations must reach all persons within a country, with a focus on those who are most vulnerable. In Rwanda, there are four examples of such innovation: (1) the new non-surgical male circumcision device that does not require a sterile environment, PrePex; (2) the alert system called Rapid SMS whereby community health workers can alert the district and central levels of, for example, a woman who needs an ambulance to take her to the hospital to give birth simply by sending an SMS; (3) mUbuzima, another cell phone technology that allows the community to send a set series of indicators on the MDGs within their communities; (4) and the system of governance in Rwanda wherein the population is given a strong voice in policy, action and major decisions.

With innovative tools and new ways of managing them with enhanced ownership and accountability, countries will be able to accelerate providing access to health services for all.


The Cycle of Poverty and HIV Infection
Boston, 8 July 2010

With Dr. Paul Farmer giving a lecture in the Harvard Medical School Course: Introduction to Social Medicine
This lecture explores the role poverty plays in preventing access to health care and discusses the vicious cycle of poverty and HIV infection. This is well illustrated by maps by of HIV distribution and poverty distribution worldwide.

Countries have to break the cycle of disease and poverty in order to achieve good health. The fight against HIV is one of the clearest examples of how the lack of access to care and treatment is a death sentence for the poor. And, beyond the affects of HIV/AIDS, a poor country in sub-Saharan Africa will not be able to reach development goals efficaciously without addressing the burden of other infectious diseases like malaria. Malaria claims millions of deaths in addition to debilitating tens of millions through chronic anemia. There is a need to promote prevention and, at the same time, improve case finding and treatment at the community level. This will lower the number of patients hospitalized for malaria and thus lower absenteeism among workers and students.

To fight HIV infection and malaria we need to link improvement in both prevention and care. We have to avoid choosing between one approach or the other given that both prevention and care are vital. Why does Africa face the vicious cycle of disease? By losing skilled people due to diseases, including doctors and nurses, rates of death among the population from other common diseases will rise since fewer professionals would be there to treat them.

In hospitals, beds occupied by those suffering from HIV-related diseases are limiting the space for patients sick with other treatable diseases. Thus, we see that AIDS kills even non-HIV infected patients because of lack of heath practitioners and lack of hospital spaces. In the education sector, the lack of teachers decreases the quality of education for the next generation (and a loss of investment for governments that have disbursed funds to trained teachers).

Most importantly, parents are dying in their productive and reproductive years and leaving orphans behind. As it is in the tradition, extended families and communities struggle to absorb these orphans.  T times there have been no parents left and children without adults alive at home struggled to organize themselves into new families. But extended families, and even moreso child-headed households, cannot afford school and health care for their children, brothers, and sisters without solidarity—locally and nationally and internationally. The orphaning of all of these children makes people even poorer and more vulnerable. Without appropriate action we have feared that Africa would become more and more poor, with diminished capacity to defeat poverty.

So, thinking beyond the examples of AIDS and malaria, what is needed to break the cycle of disease and poverty? Good health increases production capacity, which in turn leads to economic growth and poverty reduction. This leads to better health for the overall population as they have more money to pay for health services.

Taking examples of Rwanda, this lecture indicated the importance of developing a national policy framework, coordinating partners, proactively promoting gender-equity, mobilizing funds, integrating vertical programs in public health facilities, assuring sustainability and breaking down geographic and financial barriers.

We cannot ensure the basic human right of access to care for all without this battle. In breaking the vicious cycle of poverty, no one is exempt: no government, no sector, no agency, no NGO, no part of civil society, no multilateral organization, no individual – no expert, no scientist, no public health professional. All must join the fight.





Health and Human Rights: Creating an Open Forum to advance Global Health and Social Justice
Wednesday, September 17th, 2008
Human Rights Journal Launch - Part 1
Human Rights Journal Launch - Part 2

The Right to Health and the Right to Information are linked. Open Access Journals are good entry point to access to information and improve access to health care.

Rwanda’s history, and particularly, before 1994, the role of state-controlled radio stations in the genocide, had demonstrated that the right to information was critical to protecting individuals. The Rwandan government sees Information and Communication Technology as a top priority, and is working tirelessly to increase Internet access nationally.

This lecture reflected also on the irony of research done in developing countries that can’t never been available to the study subjects, without them paying for it. This is why the efforts of open access Journal in promoting access to a wider audience should be applauded as it increases access to education, information, and health all necessary for fighting against the cycle of poverty.