Can Rwanda be the blueprint for delivering primary health care?
As Rwanda’s case demonstrates, it is possible for even a low-income country to provide publicly financed, quality health services to all
Githinji Gitahi is Group CEO of Amref Health Africa and Global Co-Chair of UHC2030.
Twenty years ago, I was a young doctor trying to make a difference in my local community in Nairobi, Kenya. Back then, child mortality rates were much higher, and it was not uncommon for children to die because of lack of access to basic immunisations, medicines or procedures. The child mortality rate in sub-Saharan Africa has dropped by more than 50 percent since 2000, and nothing has been more gratifying than seeing those numbers reflected in the lives of healthier children in my own community – and across the continent.
Improvements in primary health care over the past two decades have been key to this progress, but this trend is far from universal. While some countries, such as Rwanda, Ghana and Ethiopia, have made impressive strides in strengthening health systems and expanding coverage, others, such as Equatorial Guinea and South Sudan, have fallen behind. There is a great deal that we can learn from countries like Rwanda that have been prioritising primary health care to achieve quality, affordable health coverage for all their citizens.
Rwanda has made primary health care a cornerstone of its expansion of health services – as a matter of principle, but also of economic necessity. After all, approximately 90 percent of a person’s health care needs across his or her lifetime can be covered by primary health care, which is much more cost-effective than hospital-based care. Primary health care is where people turn for routine check-ups, where children access immunisation, where mothers receive prenatal and postnatal care, and where signs and symptoms for illnesses can be caught before they evolve into life-threatening conditions. Rwanda’s primary health care system also integrates services to address the leading causes of mortality in the country, which has led to drastic reductions in deaths from diseases like HIV, tuberculosis and malaria over the past several years.
Rwanda’s recognition of health care as a means to treat all people with dignity and also improve productivity is part of a growing global movement. In 1978, in Almaty, Kazakhstan, health experts and world leaders made a commitment to promote access to health care in their countries with the ground-breaking Declaration of Alma-Ata, reaffirming the principle that health is a fundamental human right. This October – 40 years later – world leaders have come together once again in Kazakhstan for the Global Conference on Primary Health Careto endorse a new declaration, emphasising the critical role that primary health care plays in improving lives around the world.
As we reflect on these commitments and the remarkable progress that countries like Rwanda have made, we must also remember that much remains to be done – locally, regionally and globally. Countries from the US to India to South Africa can learn from Rwanda’s dramatic progress toward ensuring primary health care services reach the poorest and most marginalized – from funding and supporting health workers to political will at the highest levels of government to drive reforms. Rwanda will showcase its health systems roadmap at the Africa Health (AHAIC) 2019 global summit next March, so that other countries can learn from it how to build a health system that is fit for purpose to deal with the ongoing threat of pandemic outbreaks, growing drug resistance, and the increasing burden of cancer, diabetes, and other chronic diseases.
As Rwanda’s case demonstrates, it is possible for even a low-income country to provide publicly financed, quality health services to all, especially if those services are delivered through primary care. Achieving universal health coverage in Africa is an ambitious goal, but it is not an impossible one – the time to roll up our sleeves and get to work is now.