Starting From Scratch: The Long Road to Rebuilding Health Care in Rwanda
By Ravi Jaipaul
How does a country rebuild an entire health care system? In April of 1994, the Rwandan Genocide spared none in a fanatical pursuit of racial purity. Entire hospitals; including Doctors, nurses and patients were killed or driven out of the country in 100 days of madness. When peace resumed, the country was left, among other deficits, without qualified health care workers.
Compounded by growing concerns of post-traumatic stress disorder, malaria and HIV/AIDS as well as reconstructing a nation decimated by war, the country was slow in addressing the concerns of health. Schools and training centers began the process of providing short-term, low-trained and overworked replacements to put a temporary band-aid on the issue. These training centers led to an undereducated and largely inefficient workforce, unable to provide the care the country needed.
Today, sixteen years later, it is easy to dismiss the Rwandan system as still being in disrepair. A World Health Organization report states that Rwanda does not have the minimum health workforce required. Estimates suggest that there are only 400 Doctors and 3,600 nurses and midwives for the largely rural population of nine million in Rwanda. Alberta and British Columbia, in comparison, share a similar population with Rwanda and have over 13,000 Doctors alone.
Infant mortality in the country remains incredibly high, as rural hospitals are crippled from the lack of resources needed to perform life saving operations and interventions. Corruption in administration continues to plague the health community, with regular investigations and firings occurring based on the grounds of financial mismanagement.
However, progress has been made on many fronts. In the national budget, health has increased to 12%, up from 4.2% in 1996. Millions of dollars in international aid is earmarked each year for global initiatives, such as eliminating malaria and prevention of HIV/AIDS. This has led to a promise of increased salaries for nurses in Rwanda; in hopes to combat the ‘brain-drain’ that continually sees professionals leave for more prosperous opportunities elsewhere. There is also a drive to use innovation to solve the accessibility issues for rural patients. Last month, the Minister of Health pledged 2500 mobile phones to Community Based Health Workers, hoping to connect patients, health care workers and communication of care through technology.
In 1996, the government introduced “Vision 2020,” a plan which aims to improve human resources for health professionals, restructure and prioritize the health budget and improve on current health statistics. As a result, 50 inadequate training centers were closed down and the Kigali Health Institute was created to train nurses and technicians for the health center in a centralized, standardized post-secondary setting.
Welcomed into the role of Nursing Lecturer at the Institute, I have first-hand witnessed the successes and struggles that exist within the educational and health care system. A lack of local staff and under-funding continue to hamper the ambitious developments of the Institute. With the new mandate in Rwanda for all institutions to teach in English, the students are struggling to master a new language, leaving a difficult language barrier for teachers to bridge. The new development of a four year Nursing program is still in it’s infancy, requiring more time to be recognized by the government as an official program and designation. At the same, Rwanda’s first Nursing degree students graduate this November, lending hopes to starting the first Masters in Nursing program next year. This would be an opportunity to retain locally trained and taught professionals.
Despite the enormous complexity that exists in reconstructing a health care system from almost nothing, there is a determination and drive by the health professionals in the country to improve the system in Rwanda. This drive, coupled with government and international initiatives has led to new hope for universal and qualified health care for all Rwandans.
Ravi Jaipaul is a University of Alberta Graduate on a six month internship in Rwanda teaching at the Kigali Health Institute through a partnership with Saint Francis Xavier University, the Coady Institute and the Canadian International Development Agency.