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Question: Which developing countries are doing the best job with health care delivery?


Josh Ruxin: One of the greatest successes in global public health, particularly in Sub-Saharan Africa over the last decade, is Rwanda. It’s no coincidence that I moved there with my family three years ago to help make a contribution. It was one of the countries where I never faced corruption and where I saw the government really took a firm lead in making a vision of good health for all a reality.


They’ve done this a couple of different ways. They’ve actually made use of financing from the Global Fund to Fight AIDS, TB and Malaria, from the Presidential Emergency Plan for AIDS Relief, and other donors in order to really improve the quality of overall health care. Unlike other countries which get thrown money and just focus on AIDS, and all the resources suddenly scrambling and look at AIDS, Rwanda has been very smart about it and they’ve actually said, “We’ve got to take a look at our burden of disease. We’ve got to improve overall health care at the health center level, at the health post level.” And they’ve gone out and slowly but surely really ramped up the overall level of care for the average Rwandese.


What does that actually look like on the ground? One of the major plans for Rwandan health care is called Health Mutuelle. Rwandans are expected to spend about $2 per capita per year for a suite of services. If they show up with their Health Mutuelle card, they’re provided malaria care, basic infection, immunizations, all the basics actually get done for them. They’ve essentially bought into an insurance fund.


Rwanda is one of the few countries in Sub-Saharan Africa that has a plan quite like it and has the percentage of participants that Rwanda has got today. So this is actually been one of the key ingredients to their success.


I’ve had some concerns of my own about reaching the very poorest of the poor who don’t have that $2 but the government of Rwanda and some of the donors have actually stepped in and said, “For those who are extremely poor, we will cover your health care because we recognize for you to be productive, you’ve got to have access to health care.”



What they’re striving for of course is universal health care. They want to make sure that there’s health care for all, and that no one’s discouraged from showing up at a hospital or a health center if they’re terribly ill, if they don’t have health insurance. This is a really tricky political football in Rwanda right now, but over all they’ve been doing a really good job figuring out how to get this online.


One for the original challenges that one of my teams noticed was that the Health Mutuelle card required a photograph, and a lot of people didn’t have a photograph, so one of the very simple solutions that my Access Project team rolled out was putting webcams in the health centers, on the Health Mutuelle computers. A 1995 webcam ended up taking these digital photographs for free and removing this barrier to accessing Health Mutuelle. We saw the uptake increase dramatically at the sites that started using these webcams.



Recorded on: June 3, 2009.


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