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Rwandan Parliament Seeks to Increase Maternity Coverage

Maternity coverageIn March, the Government of Rwanda approved a bill granting mothers full compensation while on a 12-week maternity leave. If implemented, the Maternity Leave Benefits Scheme would increase maternity coverage by 80 percent for the second half of their leave from the workplace.

Throughout the spring, the bill moved through parliament but was temporarily tabled in the House because of other pressing issues. Members of parliament are set to discuss this important legislation in the next few weeks, though, according to an article in Equal Times.

Because of the current system, many Rwandan women on maternity leave return to the workplace after just six weeks because they cannot afford to lose 80 percent of their compensation for that time.

Minister of Finance and Economic Planning Claver Gatete said that the current plan is not conducive to supporting a mother and her child both socially and financially.

The new legislation will have employers compensating mothers for the first six weeks and a social security fund covering compensation for the second six weeks. As an insurance scheme rather than a government fund, the additional compensation will come from a new income tax.

Public and private sector employees will make a 0.6 percent contribution of their salary to the insurance scheme in order to cover the costs of this fund. Contributions are set to be taken through the existing Rwanda Social Security Board, but the scheme funds are set to be distinct from other social security funds.

There is widespread support throughout Rwanda for this legislation, many calling this bill “long overdue.” Dominique Bicamumpaka, president of the Congrés du Travail et de la Fraternité — Rwanda (CONTRAF) was quoted in Equal Times, explaining her and other campaigners’ support for this legislation.

“[CONTRAF was] involved in the whole process and we encourage all the citizens to embrace this new initiative wholeheartedly because when a woman gives birth, it is not only for the family but also for the society,” she said.

If adopted, this bill will improve living conditions for mothers and their newborns, while also giving mothers more value and credibility in Rwandan society.

Many Rwandans consider this legislation a major step toward improving working conditions for women throughout the country. However, advocates such as Andre Mutsindashyaka, secretary general of the Rwanda Extractive Industry Workers Union, hope that this is just the first step of many other adjustments in making the workplace more mother-friendly.

“We are trying to make it easier for mothers, especially that nursing, by finding ways how they can work but also look after their babies,” he was quoted in Equal Times.

“So far, there is a plan that we hope to launch in five years, which will see each office have a daycare centre where mothers can breastfeed their babies. So far, some places like [the Rwandan Tea Authority] are providing [daycare facilities] and we hope that eventually, every office can do the same.”

– Arin Kerstein
Photo: Flickr

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Deworming Rwanda

Deworming campaign Improving School Attendance in Rwanda
Unquestionably, one of the most effective weapons fighting global poverty today is education, and in Rwanda, a small country in central eastern Africa, it’s essential. Absence is commonplace however, with children suffering from abdominal pain, diarrhea and nausea. Attendance in school is difficult for children with soil-transmitted helminth infections.

In collaboration with Ministries of Health, a campaign to combat the disease was launched by the World Health Organization (WHO) and has shown success in getting students back in school.

According to WHO, soil-transmitted helminth infections are among the most common infections worldwide and affect the poorest and most deprived communities. They are transmitted by eggs present in human feces, which contaminate soil in areas where sanitation is poor. The disease is easily contracted by walking barefoot on contaminated soil or eating contaminated food.

The main species that infect people are the roundworm (Ascaris lumbricoides), the whipworm (Trichuris trichiura) and the hookworms (Necator americanus and Ancylostoma duodenale).

Soil-transmitted helminth causes a spectrum of health problems, from the indiscernible to the severe, which can includ abdominal pain, diarrhea, blood and protein loss, rectal prolapse and physical and mental retardation. The severity of infection is directly related to the worm burden.

The disease, one of the most common parasitic ailments in the world, affects approximately 2 billion people, nearly two thirds of the world’s population, and it is estimated that 4 billion others are at risk.

In Rwanda, illnesses can be extraordinarily bad. According to WHO, ninety-five percent of school aged children living in the Musanze District were suffering in 2007, one of the highest rates in the country.

There, soil-transmitted helminth is contracted mainly from dirty water, fetched from nearby Lake Ruhondo and those who use the stagnant water from the former banks of the Mukungwa River. Open defecation is still practiced in the area and sanitation is almost non-existent.

In 2007, whole families were getting sick. Parents stayed home caring for sick children, which prevented them from being able to work, and children were too sick to go to school or earn a menial income raising livestock or growing vegetables.

Worldwide, the WHO has been working tirelessly to control the spread of soil-transmitted helminth by facilitating wider access to preventive medicine such as albendazole and mebendazole. According to Dr. Antonio Montresor, Medical Officer for WHO in the Department of Control of Neglected Tropical Diseases, the deworming campaign reached more than 395 million children in 2014, making it one of the largest global public health interventions.

In the Musanze District of Rwanda, the WHO provides the necessary medications to local schools, which are then disseminated to the population. Since the program started, the rate of children with intestinal worms has been reduced by nearly 20 percent.

Education is essential in alleviating global poverty. Every day a child is absent from class, the likelihood they can break the endless cycle disappears a little more. The WHO is striving to keep students in school and families healthy, making a chance to prosper a reality.

– Jason Zimmerman

Sources: WHO 1, WHO 2
Photo: TheGuardian

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Interview with Mardge Cohen, Co-Founder of WE-ACTx

Interview With Mardge Cohen, Co-Founder of WE-ACTxWomen’s Equity in Access to Care & Treatment, or WE-ACTx, aims to provide the women and children of Rwanda with proper access to healthcare and treatment. Nearly 10 years after the Rwandan Genocide, this HIV/AIDS initiative brought much needed aid to communities of women and children in Kigali. Now, more than 12 years later, the organization continues its work, offering not only clinical care and mental health services for people infected with HIV/AIDS, but also youth programs and support with income generation—aimed at addressing both poverty and malnutrition.

I caught up with Mardge Cohen, co-founder of WE-ACTx, and spoke a bit about the organization’s origins, progress and successes, which have allowed this quite exceptional organization to thrive among the people of Kigali, Rwanda.

Tell me, how did WE-ACTx begin?

“The organization was started in 2004. We went to Rwanda because one of the other people who formed the organization, named Anne-Christine d’Adesky, a journalist, had been writing a book about HIV and women. She had been to Rwanda and these heads of associations talked to her about how the women of Rwanda, who had been raped during the genocide and were then infected with HIV, were not getting access to medicines for HIV. But the men who raped them, who were in jail, were getting medicines for their HIV. These women thought that was very unfair, and they asked Anne-Christine to bring a bunch of physicians and advocates to help fast-track medicine for these women because they were getting very sick and dying.

The genocide was in 1994 and this was in 2004, and it takes about a decade, 10 years, after you’re infected with HIV to become very sick. The women were just getting sick and the leaders of these associations wanted to do something about it.”

Do you feel that these at risk populations of Rwanda are ignored by the government, or were ignored?

“In 2004, nobody was getting medications for HIV. It was before PEPFAR (The U.S. President’s Emergency Plan for AIDS Relief). It was before the global fund. It was at a time… you know I’d been working on HIV since 1987, and people were saying things about Africa: ‘Well, we’ll just give them medication for pneumonia, for prophylaxis. We can’t afford… and the people in Africa wouldn’t know how to manage, there isn’t a good enough infrastructure to manage the antiretroviral therapy, so we’ll just ride them off.’ And they were going to ride them off. You know, right now there are 36 million people living with HIV worldwide and 26 million of them are in Africa, and most of them are in Sub-Saharan Africa.

That’s an enormous number of people that people were thinking of just riding off, so the governments of those countries in Africa really had no wherewithal to actually help people. The drugs weren’t there. They weren’t letting the drugs get there, so my feeling is my experience in Rwanda was in fact the government seriously wanted to help people. Once medication became available, they figured out ways to actually control the dispersal of the medicine so that it got out to people, and they tested everybody. I was aware of some countries where tests got outdated, expired, in garages and never got to people—that’s not what happened in Rwanda. In Rwanda, they really tried.”

You didn’t face much resistance from the government?

“Well, our approach was a little bit different from the government’s because our approach was very women-centered and youth-centered, and their approach was more decentralized… sort of a public health model where people would just go to the nearest clinic to where they lived. Everybody would sort of be engaged in the healthcare system that way, but because HIV comes with a lot of stigma people didn’t really want to go to clinics near where they lived. Women sort of liked the idea of going to a place that cared about women and worried about their emotional reaction to HIV, gender-based violence and helping them try to become productive members of society—not just worrying about HIV as it affected the baby or the husband, but rather cared about them as real people. So, people wanted to come to our program even though it may not have been a neighborhood clinic.

That was a little bit problematic for the Rwandan government. They didn’t like that so much, but they then saw that we did very well with connecting women to care and having people with very good retention rates and adherence to medication. Then, after a while, we had a lot of good youth programming because we had so many women who they had kids—a lot of attention to youth friendly programs. Then we got on better with the Rwandan government public health system and now we’re in very good shape. We do a research program with their principal investigators, and we’re principal investigators; It’s much more collegial.”

What did you have to do to overcome cultural differences? I know that specifically in Rwanda, people don’t very much like to talk about things involving sex.

“So, there was a pretty big public health campaign to get people tested. And, you know, in Africa it’s said that one of the major risk factors for a woman having HIV was being in a monogamous relationship with her husband. It’s just that he probably is not in a monogamous relationship with her. Women who had done everything they were supposed to do, get married, have children, they were at risk for HIV. As a result, we didn’t really have to have that many difficult conversations with them, but they were reticent to talk about things… but after a while, we used a model of peer advocacy.

We found some Rwandan women who were HIV-infected who were sort of a bit more leader-ish and wanted to sort of help other women. We utilized them to help us understand what the cultural differences were and for them to sort of share with the other women what efficacy the drug we had and the approach we were taking. That really, really helps—a peer model really got through some of those cultural differences. I think one of the things that I learned was that you have to be very patient; I’m a very impatient person and things are very slow, and change happens over a long period of time. It’s not quick. There was a lot of stigma related to HIV and there still is because we went there 11 years ago and now its 2015 but there’s still a lot of stigma.”

Did you do some advocacy in the community to try to change that perception?

“We did, especially if there were kids in schools or if there were neighborhoods that were giving people a hard time or landlords who kicked people out of their homes. We did legal training of advocates to sort of have the people… you see, there aren’t that many lawyers in Rwanda and the case loads that they have are so great that there’s sort of a paralegal system and we try to train our patients—a significant number of them—to participate that way in dealing with those issues. That sort of helped. We also tried to provide a very joyous atmosphere for the children because their lives are pretty rough, and every year we have this thing called ‘Day of the African Child’—a big party for all the families, like 1,200-1,400 people come and have a big party and its just to celebrate that they’re alive. Those kind of thing help the parents and the patients realize that we were not trying to get away with anything or do anything bad, but really just trying to provide a better quality of life for people who are HIV-infected.”

Was it a bit difficult to break into the community in Kigali?

“Well, luckily, these groups—these women’s groups, these leaders who had spoken to my friend Anne-Christine d’Adesky—they were still there. Initially, it started with 5 groups, and they called us in and told us where to go and they told us what to do, so I never felt like I was . . . bringing our stuff and putting it on people in Rwanda. I felt that the Rwandans had called us in. I thought that we were very lucky to have that approach, and they told us what they wanted from us. That made it, I think, a good way to be in another culture, in another country, and we’ve maintained that. We have partner association meetings four times a year where we review what’s going. We didn’t have to put up a shingle and hope people would come. Basically, those associations keep bringing their members to us, so I think it a pretty good model for being connected to community groups. You know, AIDS groups, women groups, local groups, service groups…

Then there’s the issue of the genocide and I think those are some of the lessons we learned, too. In some of the groups, people didn’t always want to work together, and we had a sort of… We didn’t understand that, or we didn’t think of that as behind some of the problems that we encountered, but it sometimes was. But now, the staff is sort of mixed grouping and everybody have bought into the mission to provide good HIV care for children, women, their partners and their families. And I think everybody does the best they can to make that happen.”

Do you feel that a substantial amount of progress has been made?

“Oh yeah! I mean, HIV is a deadly disease. We now have about 2,600 people—I’d say 90 percent—of those over 25 adhere wonderfully to their medicines and are doing great. A small percentage need a lot more help to take their medicine and keep doing well. The younger people, who have had the disease longer because most of them were born with it, have sometimes become resistant to some of the medicine. So, we have to put them on more complicated regimens.

Some of the good medicines we have in this country are not readily available there. When I first started that was true. Then for a while, the medicines we had in Rwanda and the medicines we had in the U.S. were the same. Now the U.S. is way, way passed Rwanda and a lot of countries in Africa and Latin America. They don’t have the medicines we have, which are really excellent medications. So, that’s a problem, but there is generally progress. I watched, at this ‘Day of the African Child,’ I watched kids who I knew when they were 10 who are now 21 years of age, and they’re confident, they’re strong, they’re going to university—it’s amazing! It’s an enormous amount of progress!”

Was the genocide the main reason why you chose to work in Rwanda?

“It was more HIV, but in the context of the genocide. I had an interest in intimate partner violence because I had seen a lot of that in the care I gave women in Chicago who were HIV infected. We’ve done studies, and there’s just high prevalence of gender-based violence, like 62 percent lifetime—here [in the U.S.]—experience with either sexual, physical, or emotional abuse. Then, we looked at it in Rwanda, in our clinic, post-genocide, and it was 62 percent also. It was the same in both countries—you know poor population, difficult situation of sexually transmitted disease where people go off to try to make a living somewhere else… In the U.S. there was lot of drug use and a lot of difficult relationships with partners. There had been issues [in Rwanda]—people had lost partners during the genocide, people had been raped during the genocide. I was interested in Rwanda because my friend had been here and we had been asked to go, but I thought that because of everything that I had learned related to women with HIV and their experiences, it would be useful in this ultimate experience of gender-based violence, which was the genocide, where about a quarter of a million women were raped. So it was sort of both things.”

What do you think the main difference is between the government in Rwanda and in a country like Zimbabwe, which has seen a lot of resistance to NGOs that are trying to come into the country trying to help people with HIV?

“I think Rwanda sort of benefited post-genocide and by the 2001-2003 people coming in. A lot of Western and European countries that felt so guilty of not helping during the genocide were now giving lots of money. At the same time, there was lots of money going into HIV in a lot of countries, but the difference was that . . . there was money straight to the government and there was NGOs’ money, but what Rwanda did—very importantly—was it controlled the NGOs a lot, or tried to. There was a very strong government presence… very strong. One can’t write anything related to Rwanda without mentioning how wonderful the Rwandan government is. One can’t really be there without somehow being acknowledged by or understand the relationship with the Rwandan government, but its not just that; It’s that there was a lot of government will in Rwanda to do well in terms of the HIV epidemic, and in some sense, I think they wanted to be a poster-child for being able to distribute medicines well and lower the prevalence as opposed to be known for the genocide. It was a way to sort of make history—current history—much more positive as a country. And they were one of the best at utilizing the many millions of dollars that were given to them to help with the HIV epidemic. I think it was disproportionately more than what other countries got, but they utilized it extremely well. The other countries who maybe should have gotten more never used it well, often. There wasn’t the same governmental will, which I think you need.

It’s not just an issue of, are the NGOs disorganized? are they sort of stepping all over each other? and are they not doing what’s right? There are those issues, which I did see a bit in Rwanda and I had seen in a lot of other countries, but what I didn’t see in Rwanda was a government that wasn’t taking the epidemic seriously. They really put energy and resources… they used the resources they got to have a very strong public health system which helped HIV and other things along the way. It really addressed maternal mortality, infant mortality… When I started in Rwanda there were 30 doctors for 10 million people, and now there are so many more physicians and nurses who are trained related to HIV. And I think it’s an issue not just of the government’s relationship to NGOs, but of the government itself, having a strong presence related to the problems that the society is facing. I think that’s different from Zimbabwe and other countries.”

What do you think is lacking in terms of support for NGOs that do the same work that you do?

“Well, we have to do a lot of fundraising and I mean that is hard . . . that is one of our issues and it is a lot of work to raise money. I think what we do is really deliver the product we say we’re going to deliver, and I think that’s why we’ve been successful so far in our fundraising. We’ve been sustained for 11 years, so that speaks to our success in itself.

What I think we did that was good is that right now in Rwanda there is a local NGO called WE-ACT for Hope. It’s all Rwandan-run and they now manage the entire clinic, so our job is to fundraise a certain amount that we commit to, along with a few other groups that they get money from, and we do a lot of guidance related to program and other things, research… but they’re responsible—they are running the show. I think if you have local folks running the show, not just in a body, but rather the responsibility of a true locally credentialed NGO, which is also what Rwanda encourages, that’s a good way to go!”

– Jaime Longoria

Sources: Mother Jones, WE ACTx
Photo: WE ACT

Rwanda Calls to End Tied Aid from Donors

Rwanda Calls to End Tied Aid from Donors
In 2011, Rwanda led a coalition of African countries through negotiations that pushed for ending tied aid from donor countries. Tied aid can increase the cost of a development project 15 to 30 percent and often delays the time it takes to receive aid.

Since the Millennium Development Goals (MDGs) end at the end of 2015, Rwanda has reiterated their position to untie aid for the new set of 17 Sustainable Development Goals (SDGs) in order to take more effective action to achieve the new goals.

“We want to discuss how to finance SDGs but we want to change the way things are done because donors can promise us the money but you cannot use it because of the conditions and strings attached,” says Claver Gatete, Rwanda’s Finance and Economic Planning minister.

Rwanda has successfully achieved all of their MDGs except improving nutrition, making it one of five countries to do so in Africa. However, many of the issues surrounding tied aid in Rwanda deals with homosexual rights, which Rwanda argues is unfair to their culture.

The European Network on Debt and Development released a statement in 2013 that 20 percent of bilateral aid is tied. In return, the tied aid reduces spending power by 15 to 40 percent.

One way countries will tie aid is by controlling how a country spends the money, often forcing them to buy products such as food from the donor country. Therefore, instead of being able to purchase food from local markets in order to reach more of the population in a short time frame, the country may have to wait weeks or months to receive food items.

The World Bank and the IMF often tie their aid for Structural Adjustment Programs (SAPs) and the average loan comes with 67 conditions. SAPs can hurt a country economically because many of the conditions set force countries to lay off public workers and privatize more industries, resulting in a higher unemployment rate and public dissatisfaction.

By untying aid, it would increase its effectiveness and improve the rights of recipient countries to determine their own development course.

Goal 17 of the SDGs states, “Strengthen the means of implementation and revitalize the global partnership for sustainable development.” One way to improve implementation to achieve sustainable development is by allowing more autonomy for recipient countries to control their own development programs.

– Donald Gering

Sources: All Africa, The Guardian, OECD, UN, UNA
Photo: Pixabay

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3 Lessons Learned about Eye Care in Rwanda

Eye Care in Rwanda

Rwanda is one African country poised to dramatically improve visual healthcare for its citizens. Since the 1990s, it has improved its mortality rate caused by infectious diseases, doubled its life expectancy and experienced significant economic development. Rwanda created a national vision plan in 2002 when it signed the World Health Organization’s  VISION 2020 initiative. The aim of the initiative is to eradicate preventable and treatable blindness by raising awareness, securing resources and facilitating the planning and implementation of the initiative.

Of the 285 million people in the world who are visually impaired, 87% live in low- and middle-income areas. With 32,700 per million people living with visual impairments, Africa is one of those areas. Still, almost 80% of visual impairments—that often lead to blindness if untreated, such as cataracts, glaucoma, trachoma as well as refractive error (myopia, hyperopia, presbyopia and astigmatism)—can be prevented or treated. If not, blindness throughout the world will double by 2020, and the developing countries will shoulder the burden, according to WHO.

Visual impairments reduce the quality of life and people’s productivity. Eye care is part of a comprehensive primary healthcare plan that helps to reduce injuries, and improve educational outcomes and access to employment opportunities. All these improvements contribute to economic growth and development.

Recently, WHO examined the national plan for eye care in Rwanda, focusing on progress made, as well as current and future needs. The result was a reflection of three lessons learned.

First Lesson: A single national plan optimizes the provision of eye care.

The Ministry of Health coordinates all partners’ efforts to align with the national vision plan. The Ministry makes certain that providers complement each other’s resources and strengths. International nonprofit partners coordinate with each other and private eye care clinics and hospitals to ensure accessibility to a variety of services across the country.

Some of the work that the nonprofit partners provide is funding for disease burden studies, building eye care clinics, supporting scholarships to train eye care specialists and standardizing the eye care curriculum for nurses.

Examples of coordination of services include:

  • Vision for a Nation, a U.K. charity, provides low-cost or free eye glasses to those in need.
  • The Fred Hollows Foundation, an Australian charity, began working in 2004 in the Western Province of Rwanda when the only other available eye care service was a mobile service.
  • The Christoffel Blinden Mission, headquartered in Germany, locates their services in the Southern Province of Rwanda, and among other services, performs specialized pediatric surgery.

Second Lesson: Better access to primary eye care and vision insurance has increased the demand for more advanced eye care at the secondary and tertiary levels.

Most of the population is currently enrolled in the Rwanda Community Based Health Insurance Policy set up in 2010. This policy provides affordable eye care and reimbursement for consumable products.

As Rwandans benefit from accessible primary eye care through insurance, awareness of further eye care needs to grow. Now, there are more instances of cataract operations and treatment for glaucoma.

Treatment for eye diseases, such as trachoma, has risen dramatically in the last five years. In 2009, treatment for eye diseases was not among the top ten reasons for seeking eye care. In 2014, it was the second leading cause of treatment.

Third Lesson: A comprehensive strategy, one that includes prevention of eye disease and a supply chain of glasses and lenses, is still needed.

Rural areas are still underserved. Almost 50% of the population lives in rural areas of poverty and are unable to afford private eye care services. In any case, rural areas still do not have adequate eye care services as most eye care resources are situated in the capital of Kigali. Another startling fact is that for the 10.5 million people in Rwanda, there are only 18 ophthalmologists and most of them live in the capital.

Task shifting is one solution to the lack of trained professionals through the Rwandan three-year ophthalmic technician training course, but more trained eye care professionals will be needed.

The demand for eye care services may be increasing not only due to more awareness and accessibility to services but also due to an aging population, as the life expectancy doubled since the 1990s to age 63. Among the eye problems associated with age is presbyopia, which usually requires prescription lenses such as bifocals.

WHO feels confident that these lessons learned will provide a basis to overcome barriers to progress and continue to improve the planning, implementation and provision of services to meet the eye care needs of the people of Rwanda.

– Janet Quinn

Sources: WHO 1, WHO 2, WHO 3, Vision for a Nation, CBM, Hollows
Photo: The Fred Hollows Foundation

Is Progress in Rwanda a Development Success?

progress_in_rwanda
Two decades after one of the fastest and most brutal genocides in history, Rwandans are healthier and wealthier than ever before. Education is at an all-time high, corruption at a low and investors are flocking to the country. Despite this amazing progress in Rwanda, some experts are hesitant to call the country a total development success just yet.

The Rwandan genocide of the 90s shook the country to its core. The population, especially the Tutsi minority, is still dealing with the aftershocks of the violence. In particular, concepts like political competition and unregulated free speech are regarded warily at best. Many feel that allowing these would open a back door into the country for the génocidaires who fled Rwanda and have yet to repent. The memory of the genocide is fresh enough in many minds to keep the political discourse severely stilted.

Still, despite the hesitance Rwandan politics show in internal discussion, nobody could argue that Rwanda has trouble standing up for itself to aid providers. In 2011, 20 percent of gross national income was foreign aid, mostly aimed at the still significant portion of Rwanda’s population that lives on less than $1.25 a day.

Richard Manning, the former head of the Organization for Economic Cooperation and Development’s development assistance committee, says that’s no bad thing. “My thesis for a long time has been that no country will develop successfully unless it is prepared to say no to donors,” Manning said. “Just because you are dependent on aid doesn’t mean you have to have a dependent mentality. I think that’s the crucial thing. It’s very clear that the Rwandan government, whether you like it or not, has a very clear view on how Rwanda should develop, and it expects donors to fit into that.”

A major driving force behind Rwanda’s rapid progress is the current president, Paul Kagame. His ethnically Tutsi militia put a stop to the genocide of Tutsis at the hands of the Hutu majority in 1994. He established a democratic government while avoiding many of the pitfalls recovering democracies stumble into and he oversaw the trials of guilty parties mostly without creating new injustices.

However, Mr. Kagame is not perfect. Despite a decades-long career, he has not come up with a clear successor. Instead, he seems to have driven away or removed every candidate for office that is not him. He “won” his last election with 93 percent of the vote and will not be up for re-election until 2017. According to the constitution he helped draft, he is not eligible to run in the 2017 election, but his administration is already starting to make a path for the removal of term limits.

Rwanda’s recovery has made it a role model for other developing nations, especially those recovering from violent conflict. Unfortunately, it would be very easy to look at Rwanda’s experience and see that tight political control is a key part of development. At best, a less-than-capable leader could hold back a country’s development with this interpretation. At worst, it leads war-torn countries right back to where they started.

– Marina Middleton

Sources: USAID, African Economic Outlook, Forbes, The Guardian, The Economist 1, The Economist 2
Photo: Flickr

How Rwanda Reduced Its Child Mortality Rate

Child_Mortality_Rate
In 2000, the United Nations came up with the Millennium Development Goals, a list of things the world wanted to accomplish in impoverished countries by the year 2015. Rwanda in particular has been reported to have reached one of these goals: reducing child mortality by two-thirds. In 2000, when the goal was made, 90 children died before age five in every 1,000 live births. Now, the average is 46—the equivalent of 17,000 fewer deaths per day.

Rwandans can now say they have the highest average annual reduction of child mortality rates in comparison to other countries who are striving to reach the same goal. It is believed that in total, 590,000 children have been saved since the MDGs initiative was implemented. UNICEF has regarded this accomplishment as “one of the most significant achievements in human history.”

In order to see how this goal was met, BBC News spoke with public health researcher Claire Wagner, Jose Manuel Roche of Save the Children U.K., Randy Wilson of Management Science for Health and Dr. Fidele Ngabo, who is the head of the division for maternity, child and community health in Rwanda.

Dr. Ngabo believes that training and hiring more health workers played a significant role in reducing the rate of child mortality. “We had four top killers – malaria, diarrhea, pneumonia, and malnutrition – diseases which can be treated by simple intervention,” Ngabo explained. “So we selected 45,000 community health workers at each village so when the children are sick, instead of spending one or two hours going to a health facility, the community health workers can give the treatment in less than 10 minutes.”

Wilson hopes that his company’s introduction of a text-message system called “RapidSMS” also helped reduce the rate of child and maternal deaths. Doctors were trained to use the text-messaging system to communicate quickly and efficiently about their patients so that actions can be decided on immediately if needed. Reducing delays in treatment reduces preventable deaths.

Wagner, who works for Rwanda’s Minister for Health Dr. Agnes Binagwaho, credits Dr. Binagwaho for working hard to save lives.

“Fifteen years ago when Rwanda actually launched its community-based health insurance program, it gave the first health insurance to Rwanda’s poorest million inhabitants, which is a signal to the world that this is going to be a new health sector that is focused on local ownership of the country’s future. Ninety-eight percent of Rwandans are now covered,” said Wagner. “The minister will always say that ‘if you give me a penny to help my grandmother, I’ll make sure that it also works for my granddaughter.’ She ensures that all of the investments that are coming in should go to build a strong health system.”

This accomplishment is excellent news for Rwanda, and hopefully other countries will follow suit and take similar actions to reach the MDGs.

– Melissa Binns
Sources: BBC, United Nations
Photo: Flickr

Rwanda’s Female Entrepreneurs Make Progress

Rwandas_female_entrepreneurs
The U.S. African Development Foundation (USADF) has made it possible for women to have their own businesses, which has led to a chain reaction of employment and economic opportunity. USADF works with small holder farmers, youth, women and girls and recovering communities to empower them and assist them in programs to become part of Africa’s growth.

Joy Ndungutse and Janet Nkubana are sisters and went to USADF as experienced artisans needing to grow their business. After getting orders from Macy’s and other U.S. buyers, these women knew that they couldn’t fulfill these orders alone. With USADF, the sisters were able to build their business up and in the process of that, change the lives of five thousand women within their community.

Another example of women exercising their power is from Eastern Burkina Faso, where a woman named Madame Henriette saw an opportunity just by sitting in the shade one day. Shea trees produce fruit that are high in antioxidants and moisturizers, but collecting the shea would be very labor intensive and difficult for one woman. So in 1998, Henriette started the Association Ragussi, where she used the help of local women to help her collect the shea and turn it into something that would bring them profits.

USADF helped Henriette with Association Ragussi to where it is, growing on a large scale, and they brought in simple training while also improving the work environment for the women. Association Ragussi continued its growth when it got a contract with L’Occitane of France, which uses shea in their toiletries sold all over the world. Following this, Henriette started producing her own line of cosmetics that primarily sells in Ouagadougo, the capital of Burkina Faso. In the three years that Ragussi has been an association, it has doubled its revenues, thanks to the 1,259 members that helped it along the way.

Rwanda and Burkina Faso are showing impactful changes for women who empower the community with opportunities to grow. Thanks to these local opportunities and the USADF, the women and everyone involved in helping them are able to pay school fees, save money and build assets for the future.

– Brooke Smith

Sources: ONE, ADF
Photo: Flickr

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Female Farmers Aided by Simple Tools

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In order to earn a living in developing countries, many women have turned to farming. According to a recent report done by the Purchase for Progress program (P4P), women are responsible for 60 to 80 percent of food production in developing countries.

The World Food Programme (WFP) has helped these women with opportunities through its P4P program. Through this program WFP uses its purchasing power to bridge the gap for farmers who work on smaller scales. The program provides agricultural training and markets that will be reliable and profitable for their crops. Developed five years ago, P4P has since helped thousands of female farmers in 20 developing countries.

Five women have shared their personal involvement with P4P.  After the death of her husband, Chaltu Bultom Ede of Ethiopia became the head of the household. Through P4P, Ede learned basic business skills, received a loan and consequently was able to afford oxen and other necessities, like seeds and fertilizer for her farm.

Generoza Mukamazimpaka from Rwanda learned how to produce higher quality crops and through WFP she was able to sell them in competitive markets. With her money that she earned,  she bought a cow and uses its waste to make biogas, which in turn is used for cooking.

Carmelina Oloroso has also benefited from P4P. She has learned how to use effective agricultural techniques in Guatemala. Her new skills have tripled her production rate. She stores her profit in a savings account, which she recently used to buy extra land.

Koné Korotoumou, from Mali and Esinta Jickson, from Malawi have both experienced the empowerment and independence that P4P provides women.  Like Jickson put it, “We know we’re equal to the men, and that has improved our standing in the community.”

– Brooke Smith

Sources: World Food Programme, ONE, World Food Programme 2
Photo: Flickr

Gorillas in Rwanda Help Development

Volcanoes National Park in Rwanda is home to over 500 gorillas that are changing the face of Rwanda’s communities. A tourism revenue-sharing scheme allows five percent of the annual income in the national park to be distributed among local areas.

Mountain gorillas in Rwanda are an endangered species that can only be found along the borders between Rwanda, Uganda and the Democratic Republic of the Congo. They attracted more than 1 million tourists between the years of 2006 and 2013 and generated $75 million in revenue for the national park system.

With this large amount of money coming in, the Rwandan government created a system where five percent of the national park’s income would be divided among surrounding communities.

According to the Rwanda Development Board, more than 39,000 people have benefited from this program.

Since the program’s conception in 2005, $1.83 million has been distributed to fund 360 community projects across the country. These projects have included things like roadwork, building bridges, bee keeping, water and sanitation projects, handiworks and small and medium enterprises.

Many of these initiatives have had a focus on sustainability. Conservation of nature is a priority for Rwanda, as it has such a positive impact on the country as a whole.

In addition to community projects, the money has been used for various public works. The Rwandan government built 57 primary schools throughout 13 districts, reaching about 13,700 students in the past 10 years. Twelve health centers have been built in areas where health care was previously difficult to acquire.

There is a lengthy process to determine which projects will receive funding from the tourism revenue program.

The Rwanda Development Board analyzes each community to ensure funds are allocated to the appropriate initiatives.

“We sit down with community leaders and decide how to distribute the money according to the priorities in the area, to address the issues that prevail in the area,” said Telesphore Ngoga, the conservation division manager at The Rwanda Development Board.

The tourism revenue-sharing scheme has allowed communities to thrive in a way that would not be possible otherwise.

“Local residents are the primary beneficiaries as it has helped set up community businesses and income generating projects that has improved lives and the communities’ economy,” said Rwanda’s Prime Minister, Dr. Pierre Damien Habumuremyi.

– Hannah Cleveland

Sources: The Guardian, Rwanda Eye
Photo: The Guardian