Rwanda’s Come-Back

By Enya O’Riordan

Last week, Harvard’s World Health News featured an article pulled from The Atlantic with the lead stating, “Over the last decade in Rwanda, deaths from HIV, TB, and malaria dropped by 80 percent, maternal mortality dropped by 60 percent, life expectancy doubled – all at an average health care cost of $55 per person per year.”  This is astounding news coming from the sub-Saharan nation, whose name is still synonymous with the devastating 1994 genocide that killed nearly 1 million people.  Following the genocide Rwanda was essentially left with a “clean slate[1]” on which it has built an incredible primary health care system, as well as instituted a program of universal healthcare with a focus on vulnerable populations.  As the author correctly points out, “for Rwanda, health equity is both a matter of ethics and epidemiology.”  This surge in availability and quality of medical care has also pulled thousands of Rwandans out of extreme poverty, and tripled the GDP per capita over the last decade.

What I found most interesting about this article was the subtle critique of rich nations and their lack of commitment to Rwanda following the genocide.  According to the article, in the years following the genocide Rwanda received the least health aid in all of Sub-Saharan Africa because the international community essentially considered it to be a “lost cause.”  While this realization is disheartening and ill-received by the reader, the recovery that Rwanda has made inspires much hope for other poor countries that have simply been written off as unsalvageable.  Though Rwanda’s health system is still very dependent on foreign aid and the work of non-governmental organizations, their work is highly monitored for transparency and accountability standards, no doubt as a result of resentment and general suspicion of aid institutions.  Rwanda’s Vision 2020 plan, to become a middle-income country by 2020, is a reflection of the dedication of countless officials and institutions within the nation itself to rebuild after catastrophic loss and even compete with the world’s leading developing countries.

The hundreds of thousands of deaths that occurred during the Rwanda genocide were broadcast across the world for months, as the international community stood by the sidelines with little intervention, but is there some justification for the lack of dedication to the Rwandan government?  In many African nations, international aid ends up in the pockets of corrupt government officials and does nothing to help civilians, and there has been plenty of suspicion on corruption within the Rwandan government.  Today Rwanda relies heavily on aid from the United Kingdom: they plan to give £270 million to the Rwanda government over the next three years to spend as they see fit. Meanwhile, the UN has openly and repeatedly accused the Rwandan Government of funding and arming a rebel forcing in neighboring Congo, with evidence that the British government has said “will necessarily be a key factor in future aid decisions to the Government of Rwanda.”  While the Rwandan government continues to heavily rely on foreign aid, for the United Kingdom and other nations, the corruption is an important aspect to consider in continuing helping Rwanda to re-build.

Reading about the miraculous road to recovery in Rwanda has definitely given me a different perspective of the commitment, or sometimes rather lack thereof, of the international community to help the world’s most disadvantaged peoples live the life of dignity that each human being deserves.  I recently read a CNN article about the 10-year anniversary of the SARS epidemic in Hong Kong, which said “it was rapidly contained… as a result of an unprecedented level of international cooperation designed to prevent it from becoming established in people.”  While Rwanda is well on its way to meet most of the Millennium Development Goals, it is such a shame that it has not received consideration from international officials until this report.  Yet for many African countries, the depths of poverty that continue to grip so many should not simply be considered a “cause”: like the SARS epidemic, it is a human emergency that should be an immediate concern of the entire planet.

Reference:

1. Emery, Neal. 2013. “Rwanda’s Historic Health Recovery: What the U.S. Might Learn”. The Atlantic. Available from http://www.theatlantic.com/health/archive/2013/02/rwandas-historic-health-recovery-what-the-us-might-learn/273226/