Two decades ago, Rwanda suffered a terrible genocide. It was a society that had imploded — and so it became the world’s synonym for a failed state. And yet. Today, Rwanda — even Rwanda — has built a public healthcare system.
umair haque

As you have suggested, Rwanda has made great progress in the delivery of healthcare to their citizens. Nevertheless, I find it irresponsible that you would fail to acknowledge the contributions of American taxpayers to Rwanda’s progress. This is especially troubling since you have emphasized Rwanda’s progress to support your conclusion that the US, and the rest of the Anglosphere, are “going backwords”.

In the charts below, produced by Rwanda’s Ministry of Health (MOH), the health funding tracking data (FY 2011–2013) indicates that the US contributed more to health spending during this period than Rwanda’s own government. Maybe the neolibs and neocons in Congress that appropriate US foreign aid do have a heart after all.

Rwanda MOH Health Funding Sources Tracking Data, FY 2011-2013 (Most Recent Data Available)

Source: Rwanda Health Resource Tracker, Output Report August 2013
Republic of Rwanda, Ministry of Health

Below, I have included USAID’s description of the allocation of US tax revenue to support Rwanda’s health system during the same period. They seem to have a substantial influence on healthcare delivery in Rwanda.

“Health programs constitute about two-thirds of USAID/R’s assistance and span a wide variety of issues, including: health systems strengthening, HIV/AIDS and malaria prevention, and family planning and maternal and child health. The USG support also extends to other health system strengthening pillars. For example, the USG underwrites salaries and equipment (e.g., mobile phones, personal digital assistants) for health care workers at the national, facility, and community levels. The GOR vision is to emphasize long-term training for missing specialties in Rwanda.”
“With regard to health commodities, the USG invests in ensuring the availability of pharmaceuticals, equipment, and supplies for health service delivery. This includes capacity-building of the national medical store to forecast, procure, store, and distribute health commodities; as well as assistance to the coordinated procurement and distribution system for all health commodities; technical assistance for the Pharmacy Department in MOH, and plans to support the establishment of the planned National Medicines Authority and the national pharmacovigilance system; support for an expanded cold chain in support of the introduction of new vaccines; and technical assistance to develop and implement PBF incentives within the supply chain system.”
“Improving the quality of services provided is another key area of both the GOR and the USG systems support. The USG is providing technical and financial assistance to the MOH to develop a national accreditation system for tertiary and secondary health facilities, as well as the laboratory network. Quality improvement modules are also being incorporated into preservice curricula at institutions receiving USG assistance and a central level cadre of quality improvement supervisors is being developed with technical support from USG partners.”

Historically, the US taxpayer has been a great friend to Rwanda since the stabilization of their society in 1998. If you are interested in reviewing the substantial USAID contributions to Rwanda and other Sub Saharan countries in Africa, you can track the US taxpayer expenditures on this interactive map. Simply select a country’s flag with your mouse and a dialogue box will appear that includes all former and active projects for each country. Individual project details are also available through this portal. I have included an example below which details USAID activities and “total obligations” of US tax revenue committed for the project ($1.44 billion in this case!).

Rwanda and Sub Saharan Africa have also benefited from significant investments from US corporations and other private US philanthropic organizations. Many US Companies have invested in Rwanda to take advantage of their business friendly tax incentives which include a flat 15% corporate rate for any foreign corporation that wishes to expand their toxic capitalism in Rwanda. I understand that Bill and Hillary Clinton have many excellent and discreet contacts in the region. Of course, you have to contribute to their private foundation to access them.

US taxpayer contributions through foreign aid do not include the money invested in federal grants and scholarships to encourage more Rwandans to enter the medical field. Unfortunately, this hasn’t worked out so well as most eventually choose to remain in the US to pursue their medical career.

Presently, Rwanda only has 5 cardiologists to face the growing threat of heart disease which is emerging as the leading cause of death in the country. Perhaps they can convince a few of the 5,000 cardiologists from Sub Saharan Africa that are practicing in the US to return and participate in the thriving public health system in Rwanda. The pay represents only a small fraction of their potential income in the US but their patriotism will surely be rewarded with a position at Rwanda’s largest and most prestigious medical facility, King Faisal Hospital in Kigali, pictured below.

Rwanda’s decision to privatize the hospital in 2015 was met with anger by many in the country since only wealthy Rwandans and government officials can afford private care, but removing the hospital from the corrupt control and management of the Ministry of Health, that has plagued the public health system in recent years, will increase access to services that are not currently available in the country such as brain surgery, spinal cord surgery and cancer treatment.

Rwanda is taking steps to eliminate pervasive corruption in their public health system. They recently sacked their Health Minister after an audit revealed troubling fraud, waste and misuse of funding at both the national and local levels of the public health system. Unfortunately, she was one of Bill and Hillary’s close contacts. I’m sure they will miss her.

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