Rwanda 20 years on: investing in life.
Two decades ago, the genocide against the Tutsis in Rwanda led to the deaths of 1 million people, and the displacement of millions more. Injury and trauma were followed by the effects of a devastated health system and economy. In the years that followed, a new course set by a new government set into motion equity-oriented national policies focusing on social cohesion and people-centred development. Premature mortality rates have fallen precipitously in recent years, and life expectancy has doubled since the mid-1990s. Here we reflect on the lessons learned in rebuilding Rwanda's health sector during the past two decades, as the country now prepares itself to take on new challenges in health-care delivery.
Ministry of Health, Government of Rwanda, Kigali, Rwanda. Electronic address: agnes_binagwaho@hms.harvard.edu.
Agnes
A
Binagwaho
Harvard Medical School, Boston, MA, USA.
Paul E
PE
Farmer
Rwanda Biomedical Center, Kigali, Rwanda.
Sabin
S
Nsanzimana
Rwanda Biomedical Center, Kigali, Rwanda.
Corine
C
Karema
Rwanda Biomedical Center, Kigali, Rwanda.
Michel
M
Gasana
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Jean
J
de Dieu Ngirabega
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Fidele
F
Ngabo
Global Health Delivery Partnership, Boston, MA, USA.
Claire M
CM
Wagner
Dartmouth Center for Health Care Delivery Science, Hanover, NH, USA.
Cameron T
CT
Nutt
Rwanda Biomedical Center, Kigali, Rwanda.
Thierry
T
Nyatanyi
Rwanda Biomedical Center, Kigali, Rwanda.
Maurice
M
Gatera
Rwanda Biomedical Center, Kigali, Rwanda.
Yvonne
Y
Kayiteshonga
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Cathy
C
Mugeni
Rwanda Biomedical Center, Kigali, Rwanda.
Placidie
P
Mugwaneza
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Joseph
J
Shema
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Parfait
P
Uwaliraye
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Erick
E
Gaju
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Marie Aimee
MA
Muhimpundu
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Theophile
T
Dushime
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Florent
F
Senyana
Rwanda Biomedical Center, Kigali, Rwanda.
Jean Baptiste
JB
Mazarati
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Celsa Muzayire
CM
Gaju
Kigali University Teaching Hospital, Kigali, Rwanda.
Lisine
L
Tuyisenge
Rwanda Biomedical Center, Kigali, Rwanda.
Vincent
V
Mutabazi
University of Rwanda School of Medicine, Butare, Rwanda.
Patrick
P
Kyamanywa
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Vincent
V
Rusanganwa
Rwanda Biomedical Center, Kigali, Rwanda.
Jean Pierre
JP
Nyemazi
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Agathe
A
Umutoni
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Ida
I
Kankindi
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Christian
C
Ntizimira
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Hinda
H
Ruton
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Nathan
N
Mugume
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Denis
D
Nkunda
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Espérance
E
Ndenga
Ministry of Health, Government of Rwanda, Kigali, Rwanda.
Joel M
JM
Mubiligi
University of Rwanda School of Public Health, Kigali, Rwanda.
Jean Baptiste
JB
Kakoma
Project San Francisco, Kigali, Rwanda.
Etienne
E
Karita
Quality and Equity HealthCare-Social Health Enterprise, Kigali, Rwanda.
Claude
C
Sekabaraga
University of Rwanda School of Medicine, Butare, Rwanda.
Emmanuel
E
Rusingiza
Partners In Health, Boston, MA, USA.
Michael L
ML
Rich
Harvard Medical School, Boston, MA, USA.
Joia S
JS
Mukherjee
Brigham and Women's Hospital, Boston, MA, USA.
Joseph
J
Rhatigan
Brigham and Women's Hospital, Boston, MA, USA.
Corrado
C
Cancedda
Partners In Health, Boston, MA, USA.
Didi
D
Bertrand-Farmer
Harvard Medical School, Boston, MA, USA.
Gene
G
Bukhman
Brigham and Women's Hospital, Boston, MA, USA.
Sara N
SN
Stulac
Brigham and Women's Hospital, Boston, MA, USA.
Neo M
NM
Tapela
Harvard Medical School, Boston, MA, USA.
Cassia
C
van der Hoof Holstein
Dana-Farber Cancer Institute, Boston, MA, USA.
Lawrence N
LN
Shulman
Partners In Health, Boston, MA, USA.
Antoinette
A
Habinshuti
Harvard Medical School, Boston, MA, USA.
Matthew H
MH
Bonds
Harvard Medical School, Boston, MA, USA.
Michael S
MS
Wilkes
Harvard Medical School, Boston, MA, USA.
Chunling
C
Lu
Harvard Medical School, Boston, MA, USA.
Mary C
MC
Smith-Fawzi
Brigham and Women's Hospital, Boston, MA, USA.
JaBaris D
JD
Swain
MASS Design Group, Boston, MA, USA.
Michael P
MP
Murphy
MASS Design Group, Boston, MA, USA.
Alan
A
Ricks
Seed Global Health, Boston, MA, USA.
Vanessa B
VB
Kerry
Global Health Corps, New York, NY, USA.
Barbara P
BP
Bush
Bridge2Rwanda Scholars, Kigali, Rwanda.
Richard W
RW
Siegler
The Strongheart Group, Austin, TX, USA.
Cori S
CS
Stern
Clinton Health Access Initiative, Boston, MA, USA.
Anne
A
Sliney
Clinton Health Access Initiative, Boston, MA, USA.
Tej
T
Nuthulaganti
Clinton Health Access Initiative, Boston, MA, USA.
Injonge
I
Karangwa
UNAIDS, Geneva, Switzerland.
Elisabetta
E
Pegurri
Partners In Health, Boston, MA, USA.
Ophelia
O
Dahl
Partners In Health, Boston, MA, USA.
Peter C
PC
Drobac
D002648:Child; D046688:Child Mortality; D003695:Delivery of Health Care / Q000458:organization & administration*; D063365:Genocide; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D006291:Health Policy; D006801:Humans; D012432:Rwanda / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000401:mortality; D014857:Warfare