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Vol. LXVII, No. 18
August 28, 2015
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An African Success Story
Rwandan Health Minister Attributes Nationís Progress to Research, Resilience

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Dr. Agnes Binagwaho gives the 2015 Barmes Lecture. She has led Rwanda through remarkable health gains.

Dr. Agnes Binagwaho gives the 2015 Barmes Lecture. She has led Rwanda through remarkable health gains.

Not long ago, Rwanda had one of the lowest life expectancy rates in the world. Today, this small, rural African country—slightly smaller than the state of Maryland but with nearly double the population—boasts an impressive health record that could be the envy of even the most developed nations. And, all of these remarkable health achievements occurred during the last 2 decades, after genocide ravaged the nation in 1994.

In the past 20 years, life expectancy in Rwanda nearly doubled, maternal mortality dropped by three-quarters and under-5 child mortality decreased by two-thirds. The prevalence of HIV has dropped dramatically, while most who are living with HIV are receiving treatment. Today, more than 90 percent of Rwandans have health insurance coverage. Rwanda also is making great strides in screening and treatment for cancer and non-communicable diseases.

Continued...

Rwanda’s minister of health, Dr. Agnes Binagwaho, credits these successes to scientific research, cost-effective reforms and a commitment to creating an inclusive health care system.

“We created a system where we don’t want anyone to be left out,” Binagwaho told a packed Masur Auditorium audience at the annual David E. Barmes Global Health Lecture on July 29.

In fact, those benefitting the most from Rwanda’s health interventions are the poorest citizens living in rural areas.

“We focus on the community and target the most vulnerable because when we have them in the loop, we have everybody,” Binagwaho said. “I say to myself, ‘If we create a system where the grandchild of the most vulnerable mammy in Rwanda is safe, my grandchild is safe.’”

One notable achievement is Rwanda’s focus on childhood vaccinations. Since 2011, more than 90 percent of all Rwandan children are vaccinated against 10 diseases including polio, measles, tuberculosis, tetanus and whooping cough. And, more than 90 percent of teenage girls receive the HPV vaccine—first developed and tested at NIH’s Clinical Center—which can help prevent cervical cancer.

“We’re very proud to be the country that has shown the world that the HPV vaccine can be used safely, rationally and [be] well implemented [even in a lower income country],” Binagwaho said.

NIH director Dr. Francis Collins (l) shares a light moment with the guest Barmes lecturer prior to the start of her talk. Binagwaho said, “If in my country we have reached [certain health milestones], it’s because we have put research at the forefront of evidence-based decisions.”

NIH director Dr. Francis Collins (l) shares a light moment with the guest Barmes lecturer prior to the start of her talk.




Binagwaho said, “If in my country we have reached [certain health milestones], it’s because we have put research at the forefront of evidence-based decisions.”

Photos: Bill Branson

The momentum in Rwanda’s health sector is made possible by a common national vision. The minister lauded her country’s cooperation on health policies across all sectors of government. She said Rwandan government officials recognize that inaction results in losses of medical services and lives and that a healthy workforce generates economic growth.

“We have to be vigilant on how we are interacting with the population because we cannot research there in our silo,” Binagwaho said. “We are interacting with and influencing the world. And if in my country we have reached [certain health milestones], it’s because we have put research at the forefront of evidence-based decisions.”

Binagwaho emphasized homegrown solutions that involve all stakeholders.

Several years ago, the Rwandan Ministry of Health and Harvard University teamed up on a program to educate Rwandan leaders in implementation science and service delivery, she said. This initiative inspired the creation of a new educational opportunity in Rwanda to train future leaders in clinical care, planning and program implementation: the University of Global Health Equity. It’s owned by Partners in Health, a non-profit organization that is affiliated with Harvard University and co-funded by the Gates and Cummings foundations.

“We want academics to enter into politics,” she said, noting that, since 2008, everyone working in the Ministry of Health has at least one advanced degree.

But even with all of the important information out there, many researchers in low-income countries can’t afford to pay to access it. Binagwaho said she now only publishes on open source so anyone can afford to use and share her research. She called on scientists to make sure their data is accurate, ethical and transparent and advocated for expanded access to research for all.

“We should do research in a more participatory manner,” Binagwaho said. “We have so much to tell the world and we have so much to learn from the world—we need to create that partnership.”


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