A Formula for Health Equity
Rwanda has crafted health care delivery with access in mind as well, by deploying community health workers (CHWs) to the country’s 15,000 villages. These local practitioners serve as the gatekeepers to a system that has reduced waiting times and financial burdens by treating patients directly – often at patients’ homes.
The US could also benefit from a CHW program. The US is brimming with educated young people who, as CHWs, could bridge the gap between medical facilities and patients, thereby improving American social capital and health outcomes. As Rwanda’s experience has demonstrated, such programs not only broaden access to health care; they also lower overall costs by reducing unnecessary hospitalizations.
Such programs have been shown to be transferable. Starting in 1997, Brigham and Women’s Hospital supported the HIV+ community of Boston through the Prevention and Access to Care and Treatment (PACT) program. That initiative was based on the CHW model implemented in rural Haiti by Partners In Health – a non-profit health-care organization that integrates CHWs into primary care and mental health.
As a result of that initiative, the government insurer Medicaid spent less money on hospital stays, and inpatient expenditures fell by 62%. Other US communities could, and should, incorporate similar models into their treatment programs for chronic conditions.
Innovation is what kick-started Rwanda’s health-care revival, and progressive thinking is what drives it forward today. For example, health centers established throughout the country provide vaccinations and treat illnesses that village-level CHWs cannot, and have extended obstetrics services to the majority of Rwandan women.
Broadening access further, each district in Rwanda has one hospital, and each region in the country has a referral or teaching hospital with specialists to handle more difficult cases. While some hospitals still suffer from staff shortages, the government has sought to patch these holes through an initiative that employs faculty from over 20 US institutions to assist in training our clinical specialists.
In just over two decades, thanks to homegrown solutions and international collaboration, Rwanda has dramatically reduced the burden of disease on its people and economy. As we look forward, our goal is to educate tomorrow’s leaders to build on the equitable health-care system that we have created. This is the mission of the University of Global Health Equity, a new university based in rural Rwanda that has made fairness, collaboration, and innovation its guiding principles.
As a Rwandan doctor who contributed to building my country’s health-care system from its infancy, I am proud of what we have accomplished in so short a time. It wasn’t magic; it was a formula. Through continued global cooperation, other countries, including developed ones, can learn to apply it.
Copyright: Project Syndicate 2017 – A Formula for Health Equity