An evening with Agnes Binagwaho – Minister of Health of Rwanda

A few days ago, we attended the Annual Lecture organised by THE LANCET. The Editor is still the ever pleasant Richard Horton, who we met when we attended the lecture for the first time. At that time, The Lancet had invited Professor Adenike Grange to speak at the lecture series early in her short stint as Minister of Health in Nigeria (watch her talk HERE). This time, the lecture which is held in collaboration with the University College London (UCL), had another female colleague, the current Minister of Health from Rwanda, Dr Agnes Binagwaho. Nigeria Health Watch has been following Dr Binagwaho for a while on twitter (@agnesbinagwaho), and have experienced the passion she displayed in her engagement with the world through social media, but nothing can quite prepare you to meet Dr. Binagwaho. The first indication that it would be an evening to remember was the title of her talk; “Charity does not Rhyme with Development”.

Readers will note that next year will mark 20 years since the terrible few months in Rwanda’s history; the genocide of 1994. The events subsequently cannot be described as anything less than a miracle. Therefore, when asked to describe what has made this “miracle” possible Dr. Binagwaho offered these simple concepts – “Ownership, equity, science, participation, and sustainability.” Relating it to the health sector, she started her talk by quoting her president in saying the “MDGs should not be seen as the ceiling but as the floor”. She then went on to illustrate what Rwanda was doing to prove this point.

While acknowledging that Rwanda has benefited a great deal from support coming from outside the country, she regretted that aid funds are so fragmented and divergent from country needs, and that it often had minimal impact. Illustrating this with the number of different indicators her Ministry had to report on, to several donors. She noted that when she started working on HIV/AIDS, she had to report on 800 indicators. She implored donor agencies to come up with one framework for evaluation. In addition, she offered a brand new course idea for a University to offer; a Masters in NGO Management!

Dr. Binagwaho then reiterated a concept that is so critical for development – that we cannot fight diseases without fighting poverty. She reminded the audience of one of the greatest aid efforts in the world; the Marshall plan for Germany after World War II. During the When the implementation of the Marshall plan, the only indicator that mattered for Germany was economic growth, and not a myriad of other indicators of process. She wondered why this is not the same for the development aid coming to Africa.

But, she went on to list some indicators that you just cannot ignore relating to the evolution of the health sector in Rwanda.

  • In Rwanda, deaths from AIDS, Malaria and TB have been reduced by more than 80%
  • Rwanda has achieved over 90% coverage for the 11 vaccines on its EPI schedule (WHO recommends 6!)
  • In Rwanda 96% of children are in school

I was then left with what was for me Dr. Binagawaho’s most memorable quote of the day; “Rwandans are getting “addicted” to good health care, and now they are willing to pay for it”. She explained how Rwanda was slowly introducing fees using a very innovative approach linked to affordability. She illustrated the importance of three key aspects of the health sector; human resources, role of technology and the role of data!

She ended her talk with this quote from Dr .Martin Luther King Junior – “True compassion means more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring”.

To get the details of how this impacts on the progress in Rwanda – we propose that you watch the talk, soon available on THE LANCET website!

A brand new “ultra modern” hospital in the heart of Rwanda

At the end of the event, we asked the Honourable Minister a simple question; on why we don’t see the same type of progressive leadership in other African countries except a few. She avoided the question by saying that there is the same progress happening in other African countries (except that she spoke more!). We beg to disagree!, and the data out of so many African countries proves our point. Yes Agnes Binagwaho does speak very very eloquently, but being a good speaker is not enough. Like we said on twitter (@nighealthwatch) – we left the venue extremely proud of being African, but sad that we cannot point to equivalent success in Nigeria. Maybe one day……we will.

Watch the talk HERE

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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