Management

Rwanda's Historic Health Recovery: What the U.S. Might Learn

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.

February 20, 2013

Management Matters

By Neal Emery

The Atlantic

Amidst the barrage of stories about failing states and civil wars that characterize the dour American media coverage of the developing world, the reinvention of Rwanda offers hope. Since the genocide with which its name is still synonymous in the United States, Rwanda has doubled its life expectancy and now offers a replicable model for delivery of high quality health care with limited resources.

Dr. Paul Farmer, Chair of the Department of Global Health and Social Medicine at Harvard Medical School and co-founder of Partners In Health, says that, "Rwanda has shown on a national level that you can break the cycle of poverty and disease."

In the wake of the genocide that killed nearly one million people in 1994, such a turnaround seemed nearly impossible. Rwanda was a failed state mired in poverty and chaos. The genocide decimated Rwanda's health facilities and workforce, allowing infectious diseases to run rampant and more than one in four children to die before their fifth birthday. Normally in such situations, economic development stagnates because disease cripples workers and the national economy, leaving the country too poor to effectively reduce the burden of disease. With a life expectancy of only 30 the year after the genocide, Rwanda looked poised to follow this pattern.

Over the last ten years, Rwanda's health system development has led to the most dramatic improvements of health in history. Rwanda is the only country in sub-Saharan Africa on track to meet most of the Millennium Development Goals. Deaths from HIV, TB, and malaria have each dropped by roughly 80 percent over the last decade and the maternal mortality ratio dropped by60 percent over the same period. Even as the population has increased by 35 percent since 2000, the number of annual child deaths has fallen by 63 percent. In turn, these advances bolstered Rwanda's economic growth: GDP per person tripled to $580, and millions lifted themselves from poverty over the last decade.