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Mar 27, 2018

Back to Nepal from Rwanda - Post 13 / 24 (Jan 2018)

Back to home after one glorious year in Rwanda, although I was supposed to be there for at least 2 years. I visited this beautiful country of 1000 hills to  explore an idea of peace, social justice and innovative global health projects. In addition, I wanted to peep into Rwandan perspective on poverty, structural violence, equity and equality, and social inclusion. There I had great opportunities to meet public health leaders and fighters like Prof. Paul Farmer (Harvard University), Prof. Agnes (Former Health Minister, Rwanda Government/current VC of UGHE), Dr. Alex Coutinho (Executive Director, Partners in Health, Rwanda), Dr. Peter Drobac (FormerExecutive Director, Partners in Health, Rwanda / Current CEO, Skoll Foundation, UK) and many beautiful minds exploring their global health aspirations in Rwanda, where Health System Strengthening (HSS) activities are being implemented based on scientific evidences  generated by local health research bodies. On this background, there are few observations that stand out and imprinted in memory from brief but important encounter with friendly Rwandan health professionals working both in government and non - governmental sectors:

National Leadership: The present day understanding of "health" encompasses "total health", which means health of an individual is influenced by all possible factors from family structure, social practices, culture, climate, infrastructure, housing, economic policies, peer circle, advertisement, environment, law and enforcement and so on. Simply, it means "health" is in overall a developmental as well as social agenda. Testimony to this statement is the global movement of Sustainable Developmental Goals (SDG). Therefore, ill health and diseases are byproduct of socio - economic or behavioural or to go further negative consequences of political instabilities with resulting social unrest, poverty, insecurities and uncertainty. All these consequences that can be seen and felt in places with political unrest can lead to public health disasters (eg cholera outbreak in Sudan), which leads to mounting morbidities and mortalities from water borne illnesses to malnutrition affecting the most vulnerable people in the communities. In order to tackle and solve the root causes of these socioeconomic consequences, the only answer is strong leadership bringing good governance and their accountability to the people. In this respect, I have come to conclusion from 1 year of stay that Rwanda is being led by dedicated, committed and visionary leadership at social and political front. Mr. Paul Kagame, President of this beautiful country of 1000 hills has been instrumental in charting "knowledge based" economic and developmental path. Also, it is very important to note that Rwanda is considered one such East African country escaping poverty and conflict stricken early 1990s to rising economic success story at present. All these success can be attributed to stable government and good governance in all sectors including health care delivery. One such example is the ban of plastic since 10 years. Now, Rwanda is considered the cleanest country in Africa.

Leadership within health: In Rwanda, I also observed that health ministry is led by dedicated public health physicians / clinicians both at political front as well as administrative appointments. The principle idea that governs these appointments is that "right person, right job" which means that managing people's health is the primary role of health professionals and not that of "traditional " beaureucrates or administrators like it used to be / is being practiced in Nepal or India called "Babucracy". It is said that Rwandan ministry of health was streamlined through rigorous health system strengthening initiatives during Dr. Agnes for 2 terms as health minister. Dr. Agnes is also a paediatrician and an academician of high status championing the need for strong health informatics system for Data Derived Decision (3D) Making as well as "in house" research capacity to guide national health policies. It is not exaggeration in saying that it is Dr. Agnes's contribution in injecting the practice of evidence based policy decisions based on data generated from operational researches carried throughout Rwanda.

Focused but integrated approach to health care delivery: In the global health arena of implementation science, I would definitely say that the kind of work that is being done in close collaboration between Rwanda Ministry of Health and Partners in Health (PIH), Rwanda is an example that is commendable. This collaboration is such an example in the field of public health that change your perspective on how external developmental partners (EDP) should approach in dealing with public health, agriculture or climate or forestry issues. The simple goal that PIH is working hard to achieve is health system strengthening such that staff, stuff, space and system issues are addressed so the health centre can function in a sustained way. For this, I worked in Rwinkwavu hospital and 4 S's are taken care pretty well providing local people quality health care services. In addition, another remarkable achievement that Rwanda Ministry of Health is able to achieve is > 80 % coverage in health insurance (muetuelles) as a part of achieving universal health coverage (UHC).

Umuganda (or volunteering): Sometime, it is said common sense is uncommon. This means, we tend to waste our time and energy on either complex or petty things, while forgetting the basics or fundamentals. Simply saying, we need to exercise our common sense routinely and also focus on fundamentals and the culture of team work. In Rwanda, people from all sectors of lives come together during Umugunda day for social volunteering every month. In this event, all people join hand for social rebuilding from cleaning roads, parks to building schools. Since this is a monthly activities, this is also a social movement led by local as well as national leaders. Also, there are many other interesting events carried out during this days. Another event that I liked is the "car free day", when you do not see any vehicles, bringing family and children in the open and bringing people together closer in social sphere.

Now in Nepal, we are hoping for a stable government with good governance, transparency and accountability as its core guiding principle. Also, we have to say that we are in the best of time or (5% probability) worst of time depends on us. I am hopeful, we are in the best moment of our history  to turn current challenges into opportunities to rebuild our country. In this respect, we have many lessons to learn from Rwanda in its struggle to come out of genocide horror to peace and prosperity in short period of time. Therefore, there are plenty of opportunities in front of us to capitalise for the well being of all Nepalese people - the choice is up to us.

In my next post(s) - I will try to explore the idea of peace, social justice, poverty, structural violence, equity and equality, social exclusion and innovative global health projects.

March 26, 2018
Dipayal, Doti

Anuj in Himalayas

Hi i am connecting disqus with my blog for healthy interaction and open dialogue