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NEW THIS MONDAY: REDUCED PREMATURE MORTALITY IN RWANDA: LESSONS FROM SUCCESS

Saturday, 27th of July 2013

• REDUCED PREMATURE MORTALITY IN RWANDA: LESSONS FROM SUCCESS

Conclusion below; full text with figures is at http://www.bmj.com/content/346/bmj.f65?view=long&pmid=23335479

During the 2011 United Nations high level meeting on non-communicable diseases, Rwandas minister of health, Agnes Binagwaho, reminded the assembly that prioritising equity in the health sector is “not only a moral imperative but also an epidemiological and economic imperative if we want to grow as a nation.”

Certainly, Rwanda will face great challenges if it is to meet its goal of becoming independent of aid by 2020: nearly half of its health sector budget was externally financed in 2010.37 Even if Rwanda sustains its impressive pace of economic growth in the coming decade (and many believe it is well positioned to do so),43 redistributive funding mechanisms such as PEPFAR and the Global Fund will continue to have a crucial role in the future success of global health initiatives.

But the challenges ahead do not diminish the present successes or dilute the lessons learnt (box 2). The impressive reduction in premature mortality speaks for itself. Linking sound analysis to a collaborative approach to strengthening health systems, Rwanda has instituted policies that have produced remarkable outcomes. This has occurred in concert with economic growth. Although the term “local ownership” is often invoked in development circles, it is rare to see it implemented successfully. The lessons from Rwandas success should inform the work of those around the world who seek to deliver on the commitment of comprehensive and equitable healthcare for all.

Box 2: Lessons from Rwanda: strategies for strengthening comprehensive health systems

National leadership—High level political commitment to equity and to service delivery as well as a clear plan for action

Health systems approach—Harnessing funding for disease specific or other “vertical” programmes to build and strengthen platforms for integrated service delivery

Country ownership—Health system spending managed by or in partnership with national and local government

Community based care—For example, using community health workers to increase the effectiveness and efficiency of care delivery, especially for chronic diseases

Evidence based policy making—A critical “feedback loop” linking research to service and training to promote accountability and improve the quality of care

Cross-sector collaboration—Strengthening health systems with partnerships between the public and private sectors and also across sectors and ministries