The Equity Imperative


“There is no correlation between money and what you can offer your people,” said Rwandan Minister of Health Agnes Binagwaho. “Money is not the obstacle; your vision is the obstacle.”

Paul Farmer, MD, PhD, Chief of the Division of Global Health Equity at BWH, introduced Binagwaho to the audience gathered on July 23 at Harvard School of Public Health. Binagwaho was a guest speaker at Harvard’s Global Health Effectiveness Program, which is co-directed by Joseph Rhatigan, MD and Rebecca Weintraub, MD, both Associate Physicians in BWH’s Division of Global Health Equity.

Over the next two hours, Binagwaho shared how reforms in Rwanda’s health care sector had produced stunning results: Despite a GDP of less than $1000 per capita, life expectancy in Rwanda has doubled since 2004. Continue reading “The Equity Imperative”

A Paradigm Shift in Global Health Partnerships


The impact of the Human Resources for Health (HRH) program on Rwanda isn’t simply improving health in the African country. It’s changing everything.

“This program is a way that we can reverse the injustice of poverty,” said Dr. Agnes Binagwaho, minister of Health in Rwanda, of HRH’s long-term impact.

The seven-year HRH program is a partnership between the Rwandan government and universities and hospitals in the U.S. that strives to achieve one goal: to help Rwanda develop a high-quality and sustainable health care system. The program enables Rwanda to train and educate its health care workforce, care for the country’s patients and, as an indirect result, bring new businesses to the country that will stimulate economic growth.

During her visit to BWH last week, Binagwaho presented with BWH President Betsy Nabel, MD, about Rwanda’s health care needs and HRH’s first year of progress to a packed Bornstein Amphitheater. Binagwaho likened her country’s challenge in developing its own health care workforce to a classic “chicken and egg” conundrum.

“How can we produce these professions we need when we don’t have the people to train them?” she asked. “So we thought about creating partnerships with universities and hospitals like the Brigham. Let’s borrow ‘chickens’ from the United States to produce ‘eggs’ for Rwanda. This is a way to bring more justice by improving access to care.”

HRH launched last fall, with 97 faculty members—nine of whom are BWH physicians—participating from 23 universities in the U.S., including Harvard Medical School. The faculty members are focused on educating and training the next generation of doctors, nurses, midwives and other health care professionals.

When the program concludes in 2019, Rwanda’s workforce should be sustainable without foreign aid. In its first year, HRH is focusing on educating professionals in five specialties: gynecology, internal medicine, surgery, pediatrics and anesthesiology. After two years, the program will begin to focus on building subspecialties, such as pediatric surgery.

The needs in Rwanda are staggering. The country currently has six physicians per 100,000 people. By comparison, Boston alone boasts 1,053 physicians per 100,000 people. There isn’t a single cardiac surgeon, pathologist or cancer specialist in the country. HRH works to strengthen these and other specialty fields with critical shortages.

Led by co-investigators Robert Riviello, MD, and Corrado Cancedda, MD, HRH also builds upon the existing partnerships that many BWHers have already formed in Rwanda, including those through the Division of Global Health Equity, Partners In Health, the Center for Surgery and Public Health and the BWH-led Team Heart (see related story). While the HRH model builds on these programs and efforts, it also raises existing collaborations to an academic level to ensure Rwanda can educate the next generation of health care professionals and build a sustainable health care system.

“This is a wonderful partnership,” Nabel said. “I believe that reciprocity is the prize at the end of the day. We benefit from learning from one another and growing through this experience.”