As Kenya grapples with a dilapidated public health insurance system, Rwanda continues to make steady strides in leading the continent with health innovation and public health strategies that many countries worldwide could emulate to realise resilient health systems for their citizens.
Speaking during the opening session of the sixth Africa Health Agenda International Conference in Kigali, Rwanda Health Minister, Dr Sabin Nsanzimana, did not hesitate to showcase his country’s strategies that have helped ensure its people’s health is covered.
Dr Nsazimana said that even though countries in Africa might be facing funding challenges in health, it was time for them to take up and own the challenge, to ensure that their population’s health is their full responsibility.
“The centre must hold because we don't have another choice. This is our health, this is our systems, and we can't go back. So we have only one option, and that is our determination. That is our strength, that we are going even to think beyond the traditional ways and we're going to own our systems, our health, because we can't delegate to someone else, and that someone else pulls out overnight, and we were panicking. We should own it and even run it better than we have done before. That should be our goal,” he said.
Rwanda showcased their medical and health prowess mid-last year when it had its first-ever outbreak of the Marburg disease which the World Health Organisation (WHO) says kills half of those infected.
With Dr Nsazimana’s leadership, the country was able to contain the disease within a record 42 days, only recording a 23 per cent death rate, which was the lowest ever recorded in any Marburg outbreak.
This, he says, always comes down to how countries can simplify their needs and work within their means, with dedication and determination to solve their health problems in their systems.
“That is the simplicity of our system, the adaptability of our system to our needs. We don't want to do things as it has been designed, sometimes in the past. We have to look at what our health problems are: we have malaria, we have teenage pregnancy, we have stunting, these are the big issues our systems are dealing with; and address them with our local solutions, and within the means,” he said.
The Minister received accolades from the Africa CDC when Dr Claudia Shilumani, the Director of External Relations and Strategic Management at Africa Centre for Disease Control (CDC) began her speech by congratulating him on how he handled the outbreak and saved the whole continent from it.
“I am glad to start by congratulating the Minister for really doing a fantastic job in controlling Marburg in Rwanda and saving, literally, the whole continent and all of us from getting this problem becoming ours,” she said.
Dr Shilumani went ahead to say that last year alone, the Africa CDC was monitoring 243 health threats on the continent, and the number is already at 84 this year alone, as of last week, meaning that health systems on the continent need to be strengthened.
“We need to brace ourselves for what is going to come. And that means we need strong partnerships so we don’t walk this journey alone. Rwanda has made significant progress in a short space of time, just as Ethiopia has as well. Those examples need to remain our examples and we don’t need to go and learn outside of Africa,” she said.
He maintained that African countries, just like Rwanda, need to invest in people in the health system, who are one of the five most important pillars of their health system, and this means training medical workers so they put in their energy in ensuring success.
He gave an example of the number of surgeons being 162 in Rwanda, out of the 1000 they need, and so there is a huge gap, but that does not mean they need to give up.
“We need people all across our systems, and we need to invest in those people, including community health workers, nurses, doctors, leaders, hospital managers, finance experts, researchers, and even the lab scientists, who will help us to know if there's a threat to our system. So that remains a priority,” he said.
Another pillar that the country is investing in and that the region needs to emulate is the infrastructure, because, according to Dr Nsazimana, “people without infrastructure, or a space where they work and operate, then you miss an important pillar. So we need to continue to build infrastructure from small clinics for community health workers who are treating from the household, the small clinics of two blocks to a few square meters, to big hospitals, because Africa needs also that standard that's quite okay”.
According to the Minister, his country has also largely invested in equipment as another important factor for a good health system because a good doctor, and a good hospital doesn't mean good care.
He said that the continent needs to acquire good advanced technology which should also be the latest and preferably be developed by our young people.
“We need to also adapt our system and our governance to what we need, and even make it simple and cheaper, because it's not about how much you invest, it's more about how do you invest and what are the results and impact you have. That brings in the data systems, the monitoring and channeling the money where you really need it, and removing it where you don't."
He gave an example of an exercise they carried out recently where they were supposed to train surgeons and midwives but a donor had cut funding overnight.
They sat among themselves and sought to see what money they had and what to prioritise.
“Surprisingly, I mean, it's not a secret and it's not unique to Rwanda only, but we looked across projects active in the health sector, and we found more than five billion Francs, that is more than $5 million in short-term trainings and workshops.
These trainings are supposed to be training people, and on the other side, we have people who have been trained to take care of our lives in the long term that are not funded for them to finish their programs. So do we need to keep these short-term trainings, or do we fund these long term so that we don’t need to fund these weekly programmes that people can read on their phones online,” he said.
