Rwanda: From Genocide to Astonishing Health in Just 16 Years

Back in 1994, the Rwandan genocide decimated the country's population by 800,000. Fast forward 16 years, though, and Rwanda is poised to become one of the only African nations to successfully meet the Millennium Development Goals for child and maternal mortality. How did this happen?

The Millennium Development Goals are ambitious: a 75% reduction maternal mortality reduction and a 66% reduction in infant mortality over 1990 levels by 2015. But in just the last few years, Rwanda's made incredible strides toward hitting them. Child mortality has dropped 30% since 2005 alone.

So let's take a look at what Rwanda's doing right:

A quick review from All Africa points to a key few measures: To begin with, the growth in assisted child births, which rose from 39% to 52% between 2005 and 2007. Secondly, immunization rates, which hit an incredible 95% by 2008. And finally, the use of insecticide-treated bed nets, which skyrocketed from 4 to 67% of the population in just three years, from 2004 to 2007.

What's behind this progress? Well, All-Africa points to the rise of “mutuelle” insurance system, which insures Rwandans for a $2 annual fee. But I'm skeptical. In 2006, the Rwandan total per-capita health expenditure was $210. That's double what it was just three years prior. Two dollars is a minuscule fraction of the $210 expenditure, so I would tend to think the real progress in Rwanda shouldn't be credited to the insurance system. Instead, it's the outgrowth of a massive overall investment in health on the part of the government and the international community.

As I've previously blogged here, often, insurance can create bureaucracy without generating revenue. And though 85% of the Rwandan population is covered by mutuelles, it's likely that the 15% who aren't are also the poorest and most likely to suffer maternal complications and infant death.

Rwanda appears bent on achieving national insurance coverage. That's commendable and absolutely astonishing, given the country’s history. It shows tremendous planning ability, excellent ability to prioritize and enviable ability of the government to function. (Ahem, U.S. Congress.) But wouldn’t it be wiser to create a single-payer system and avoid the bureaucracy? What's more, Rwanda's track record so far suggests that at the end of the day, it's not just insurance that counts, but overall investment levels, too.

Photo Credit: Bitin.fr