The example of Rwanda

Much more than just primary health care

Rwanda has made considerable progress in the fight against some of the most serious infections, particularly impressive in the case of AIDS, with the number of children infected via their mothers down in the last four years from 11.4% (2005) to 4.1% (2009). It is expected that this rate will soon fall to 2%, as in the developed nations, and the aim is for this method of transmission to disappear completely by 2012, thanks to special antiretroviral treatment and the setting up of centres for the prevention of mother-to-child transmission (PMTCT). 

This success is been achieved thanks to a significant increase in the number of hospitals and health centres, but also to a continuous awareness-raising campaign in schools, the press, the arts and "advertising"  communications, principally in the Kinyarwanda language. In general terms, the Rwandan state guarantees more than simply primary health care to the whole of its population. Women are encouraged to give birth in health centres, which have been set up all over the country. While five years ago, they only did so in 5% of cases, the proportion today is approaching 65%. Between the years 2000 and 2008, the maternal mortality rate has fallen from 1,071 per 100,000 to 750. 

As regards other forms of health care, participation in government health schemes is limited. In a country where 80% of the population lives on less than two dollars a day, many people are unable to contribute.  A kind of mutual health insurance for the poor has been set up, and it is working well, in part due to foreign aid. 

The level of primary health care provided to its citizens by the Rwandan state is constantly improving. The neuropsychiatric hospital at Ndera, for example, is conducting, with impressive results, a pilot project combining HIV screening with the treatment of mental illnesses, which may be exacerbated by AIDS, as well as being a risk factor as regards infection with the virus. 

Integration of traditional medicine

In 2010, Rwanda was the host of the African Traditional Medicine Day, which aimed to carry out an assessment of the progress made during the first decade of the millennium and to make a plea for further research in this area, in order to improve its integration into modern medicine. 

Paradoxically, traditional medicine is officially a new field of medicine in Africa, given that its recognition in a declaration of African heads of state and the accompanying strategy only go back about ten years. It is expected that the body of traditional practitioners will undergo some restructuring, which will make it easier for them to adapt their products to existing norms and so to compete more effectively with so-called modern products. In other words, the aim is to follow the example set by China or India. 

The Rwandan health authorities intend to invest in research on medicines originating in traditional medicine, and have decided that little by little these will come to form part of the primary health care guaranteed by the state. The (Rwandan) Institute of Scientific and Technological Research was actively involved in the organization of the event, and the WHO also played its part. 

Hegel Goutier