By Liz Lin
On April 2nd, 2014, Dr. Jean Luc Nkurikiyimfura presented his experience as the Director of the HIV Clinic at Kigali University Teaching Hospital or CHUK (Centre Hospitalier et Universitaire de Kigali), explaining the strong positive trends the country was experiencing with regards to HIV/AIDs management. Specifically, he explains the success with committed leadership, a network of community health workers, and partnerships with international groups.
Rwanda is a small country in central Africa, about the size of New Hampshire with ten times the population. It is also a poor country with a GDP ranked 203 out of 227 countries. Dr. Nkurikiyimfura points out that for a population 11 million, health professionals are scarce: there are only 625 MDs, 8273 RNs, and 240 midwives. Yet, Rwanda has come a long way in providing for its people.
The devastating effects of civil war and genocide in the 1990s, with rates reaching 1 million Tutsi and sympathetic Hutu people slaughtered by Hutu majority in 3 months, can be further quantified by a life expectancy of 28 years in 1994. Dr. Nkurikiyimfura, going back to his home at the end of the decade, recalls the country smelling of death, with corpses still strewn about the land. Since then, the life expectancy has steadily improved to 53 years alongside a 86% reduction of malaria related death. More strikingly, 5-year mortality after birth has decreased from 186 to less than 50 per 100,000 births, not only reaching pre-genocide levels, but also reaching rates lower than the average in Sub-Saharan Africa.
Dr. Nkurikiyimfura’s HIV clinic has also had remarkable success in providing access and treatment for HIV/AIDs patients in all aspects from diagnosis, treatment, to follow-through. Prophylactic measures reduced the incidence of HIV vertical transmission, and in 2012 less than 2% of newborns had the virus compared to 11.6% in 2005. With a target demographic of children and adolescents, the clinic also educates for community change from within. Dr. Nkurikiyimfura attributes the success due to the committed leadership, citing the government to be the “least corrupt” compared to surrounding countries and effective in allocation of resources. The community-based focus, with community health workers placing an emphasis on maternal care and child health, and a triage-like system in treatment, builds a strong foundation for public health. Furthermore, community health workers create a network of personal contact to help with treatment adherence through organization of group support and home visits. Finally, the international support, especially from NGOs, is critical.
Some reasons for success may prove to be challenges in the future, speaking to the multi-faceted nature of global health. International support is the least sustainable in the long run, though critical for now. Understandably, with the poverty of the country,Dr. Nkurikiyimfura estimates 80% of the allocated money to fight HIV comes from outside sources. Right now, Rwanda has been justifying the investment, for example, from the Global Fund, with numbers. However, the long term success of combating HIV in Rwanda depends on change from within. Taking communities into context for the treatment of disease is essential: the health care structure must come from the community and not be imposed based on what outsiders might think may work. “Imihigo,” a term defining a pledge to achieve for communal good, is a concept with traditional roots. Dr. Nkurikiyimfura states traditional concepts, including “imihigo,” are key for sustainable development and continued momentum from the Rwandan people
By showing relevance and results through numbers, fighting HIV in Rwanda is a success story. A government committed to forming a strong health care system proves to NGOs and funding sources that it is committed to succeed and builds a partnership of trust in receiving the financial resources needed to effect change. The Rwandan people, pledging “imihigo,” have a strong stake to help themselves and is creating a sustainable network of community health workers and educated citizens.