Reduced premature mortality in Rwanda: lessons from success

Paul E Farmer, Cameron T Nutt, Claire M Wagner, Claude Sekabaraga, Tej Nuthulaganti, Jonathan L Weigel, Didi Bertrand Farmer, Antoinette Habinshuti, Soline Dusabeyesu Mugeni, Jean-Claude Karasi, Peter C Drobac, Paul E Farmer, Cameron T Nutt, Claire M Wagner, Claude Sekabaraga, Tej Nuthulaganti, Jonathan L Weigel, Didi Bertrand Farmer, Antoinette Habinshuti, Soline Dusabeyesu Mugeni, Jean-Claude Karasi, Peter C Drobac

Abstract

Rwanda’s approach to delivering healthcare in a setting of post-conflict poverty offers lessons for other poor countries, say Paul Farmer and colleagues

Conflict of interest statement

Competing interests: All authors have completed the ICMJE unified declaration form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: CS and JCK have worked for the Ministry of Health of Rwanda. All authors have collaborated with the Ministry of Health of Rwanda on other research initiatives. No current employee of the Rwandan Ministry of Health or other governmental entity read the manuscript prior to publication.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790745/bin/farp003186.f1_default.jpg
Fig 1 Uptake of maternal and child health interventions in Rwanda, 2000–10
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790745/bin/farp003186.f2_default.jpg
Fig 2 Mortality among children up to age 5 years, 1990-2011
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790745/bin/farp003186.f3_default.jpg
Fig 3 Global health expenditure and annual reductions in child mortality from 2000 to 2011 (includes only countries with population >500 000)

References

    1. Uvin P. Aiding violence: the development enterprise in Rwanda. Kumarian Press, 1998.
    1. World Health Organization. World Health Statistics 2012. .
    1. Ministry of Finance and Economic Planning. Vision 2020. Government of Rwanda, 2000.
    1. National Institute of Statistics of Rwanda. The third integrated household living conditions survey (EICV3). 2012. .
    1. World Bank. DataBank: world development indicators and global development finance. 2012. .
    1. National AIDS Control Commission of Rwanda. Country progress report January 2008-December 2009: United Nations General Assembly special session on HIV and AIDS, 2010. .
    1. Price JE, Leslie JA, Welsh M, Binagwaho A. Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects. AIDS Care 2009;21:608-14.
    1. Walton DA, Farmer PE, Lambert W, Léandre F, Koenig SP, Mukherjee JS. Integrated HIV prevention and care strengthens primary health care: lessons from rural Haiti. J Pub Health Policy 2004;25:137-58.
    1. World Health Organization, Joint United Nations Program on HIV/AIDS, United Nations Children’s Fund. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. 2010. .
    1. Rwanda Biomedical Center. Country progress report for Joint United Nations Program on HIV/AIDS 2012. .pdf.
    1. Ministry of Health of Rwanda. (2012). Rwanda health statistics booklet 2011. .
    1. Mugeni C. Rwanda’s community health system: from policy to action. First annual international community health summit. Kigali, Rwanda, 25 January 2011. .
    1. Rich ML, Miller AC, Niyigena P, Franke MF, Niyonzima JB, Socci A, et al. Excellent clinical outcomes and high retention in care among adults in a community-based HIV treatment program in rural Rwanda. J Acquir Immune Defic Syndr 2012;59:e35-42.
    1. Kalk A, Groos N, Karasi JC, Girrbach E. Health systems strengthening through insurance subsidies: the GFATM experience in Rwanda. Trop Med Int Health 2010;15:94-7.
    1. Lu C, Chin B, Lee J, Basinga P, Hirschhorn LR, Hill K, et al. Towards universal health coverage: an evaluation of Rwanda mutuelles in its first eight years. PLoS ONE 2012;7:e39282.
    1. Ministry of Health of Rwanda. Rwanda Community-Based Health Insurance Policy. 2010. .
    1. Basinga P, Gertler PJ, Binagwaho A, Soucat ALB, Sturdy J, Vermeersch CMJ. Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation. Lancet 2011;377:1421-8.
    1. National Institute of Statistics of Rwanda, Macro International. Rwanda demographic and health survey 2000. .
    1. National Institute of Statistics of Rwanda, Macro International. Rwanda demographic and health survey 2005. .
    1. National Institute of Statistics of Rwanda, Macro International. Rwanda interim demographic and health survey 2007-2008. .
    1. National Institute of Statistics of Rwanda, Macro International. Rwanda demographic and health survey 2010. .
    1. Ministry of Health of Rwanda. Health management information system. 2012. .
    1. Nsanzimana S, Ruton H, Lowrance DH, Cishahayo S, Nyemazi JP, Muhayimpundu R, et al. Cell phone-based and internet-based monitoring and evaluation of the national antiretroviral treatment program during rapid scale-up in Rwanda: TRACnet, 2004–2010. J Acquir Immune Defic Syndr 2012;59:e17-23.
    1. Amoroso CL, Akimana B, Wise B, Fraser HS. Using electronic medical records for HIV care in rural Rwanda. Stud Health Technol Informat 2010;160:337-41.
    1. World Health Organization. WHO-UNICEF vaccination coverage estimates time series for Rwanda. 2012. .
    1. Binagwaho A, Wagner CM, Gatera M, Karema C, Nutt CT, Ngabo F. Achieving high coverage in Rwanda’s national human papillomavirus vaccination programme. Bull World Health Organ 2012;90:623-8.
    1. Hirth JM, Tan A, Wilkinson GS, Berenson AB. Completion of the human papillomavirus vaccine series among insured females between 2006 and 2009. Cancer 2012;118:5623-9.
    1. Rwangombwa J. The struggle for ownership of assistance: health and HIV/AIDS in Rwanda. Development Outreach 2011;11:11-3. .
    1. Logie D, Rowson M, Ndagije F. Innovations in Rwanda’s health system: looking to the future. Lancet 2008;372:256-61.
    1. Porter ME, Lee S, Rhatigan J, Kim JY. Partners in Health: HIV care in Rwanda. Harvard Business School Case 709474. Harvard Business School Press, 2009.
    1. Goosby E, von Zinkernagel D, Holmes C, Haroz D, Walsh T. Raising the bar: PEPFAR and new paradigms for global health. J Acquir Immune Defic Syndr 2012;60:S158-62.
    1. Ministry of Health of Rwanda. Rwanda human resources for health program. .
    1. World Health Organization. Global tuberculosis report 2012. .
    1. World Health Organization. World malaria report 2012. .
    1. World Health Organization, United Nations Children’s Fund, United Nations Population Fund, World Bank. (2012). Trends in Maternal Mortality: 1990 to 2010. Geneva, Switzerland: World Health Organization. .
    1. United Nations Children’s Fund, World Health Organization, World Bank, United Nations Population Division. Levels and trends in child mortality. 2012. .
    1. Farmer P, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical medicine. PLoS Med 2006;3:e449.
    1. World Health Organization. Global health expenditure database. .
    1. Alsan MA, Westerhaus M, Herce M, Nakashima K, Farmer PE. Poverty, global health, and infectious disease: lessons from Haiti and Rwanda. Infect Dis Clin N Am 2011;25:611-22.
    1. Bonds MH, Dobson AP, Keenan DC. Disease ecology, biodiversity, and the latitudinal gradient in income. PLoS ONE 2012;10: e1001456.
    1. Kidder A, Bukhman G, eds. The Partners In Health Guide to chronic care integration for endemic non-communicable diseases. Rwanda edition. Cardiac, renal, diabetes, pulmonary, and palliative care. 2011. .
    1. Ministry of Health of Rwanda. District hospital action plans. 2012. .
    1. Crisafulli P, Redmond A. Rwanda, Inc.: how a devastated nation became an economic model for the developing world. Palgrave Macmillan, 2012.

Source: PubMed

3
Tilaa