Former College President Jim Yong Kim may have moved on to the World Bank, but his legacy remains. Claire Wagner '10 and Cameron Nutt '11 are part of a Rwanda-based Partners in Health research team headed by Paul Farmer, who, along with Kim, cofounded the nonprofit health care organization in 1987. Their research, published on Jan. 18 in British Medical Journal, finds that Rwanda has emerged from a state of sectarian violence to become a model of public health in the past decade, achieving the steepest declines in mortality from AIDS, tuberculosis and malaria in recent history.
Rwanda has made tremendous progress since the 1994 genocide, in part due to the revamped health care system, Nutt, a research fellow at the the Dartmouth Center for Health Care Delivery Science, said.
The percentage of the population living below the poverty line declined to 44.9 percent from 77.8 percent between 1994 and 2010. Average life expectancy also rose within roughly the same time period to 56 years from 28 years between 1994 and 2012.
Rwanda's progress can be largely attributed to the government's commitment to expanding health care's accessibility and efficacy, Nutt said.
"The Rwandan government has attacked the deadliest diseases in the most vulnerable parts of the population," he said.
Approximately 50,000 health workers elected by their villages have played key roles in improving prenatal and neonatal care.
The study found that these efforts have resulted in a 70.4 percent decrease in mortality for children under five between 2000 and 2010.
Through policies such as subsidizing medical costs and paying bus ride fares for the poorest AIDS patients, Rwanda is one of two countries in Africa that meets the United Nation's goal of universal access to anti-retroviral AIDS medication.
The Rwandan government subsidizes the costs of other medicines and vaccines for the general population.
Vaccines for the human papillomavirus, for example, are distributed through schools and have led to 93 percent coverage.
"The distribution of HPV vaccines through schools is something you don't see in the West," Wagner, a research fellow at the Global Health Delivery Partnership in Boston, said.
The country's success in health care is the product of a responsible and proactive leadership, headed by Rwanda's Minister of Health, Agnes Binagwaho. Binagwaho was awarded an honorary doctorate from the College in 2010 and visited campus last summer.
"The minister is always at the forefront, trying to make the taxes work for the poorest first," Nutt said.
Many Rwandan health care programs receive funding from the President's Emergency Plan for AIDS Relief as well as other sources, reflecting the more expansive relationship between the Rwandan government and the United States, Nutt said.
International universities, including Dartmouth, have also helped Rwanda advance its health care system. Geisel is part of the Human Resources for Health Program, a partnership with U.S. medical schools funded by the U.S. government and developed by Binagwaho in August 2012, which provides support and training to Rwandan officials.
Each university sends full-time faculty to train their Rwandan counterparts at teaching hospitals in Kigali, Butare and Rwanda. For the next seven years, these universities will help train and create a sustainable group of skilled medical workers.
Although American universities will play a large role as partners to Rwanda's health care system, the Human Resources for Health Program is largely driven by Rwanda's constituents, especially officials at the Ministry of Health and medical faculty of the National University of Rwanda.
Dartmouth's relationship with Rwanda's health care system is large and growing. The Rwandan director of monitoring and evaluation in the Ministry of Health, Jean Pierre Nyemazi, is currently a student in the Master of Health Care Delivery Science Program. Elizabeth Miranda TDI'12 interned with the ministry of Health for a research project on chronic malnutrition. Anna Roth '13 interned at the Ministry to study malaria trends, and Sunil Bhatt '14 is currently there researching vaccines.
Continuing foreign aid and cooperation will help carry Rwanda through the current global economic turmoil and tackle the challenges it faces in the future, Nutt said.
The success of new health care policies in Rwanda offers valuable lessons for the rest of Africa, Wagnersaid. Strong national leadership and cooperation has provided the foundation for most of the country's successes.
While Rwanda's dramatic declines in mortality from AIDS, tuberculosis and malaria offer insight into possible health care solutions, they should not be seen as a general cure-all.
"Though the core lessons from Rwanda's success are a hopeful message, they should not necessarily be copy-pasted," Wagner said.
Nutt and Wagner are research fellows for Binagwaho. Farmer, the team's leader, is a professor at Harvard Medical School.
Nutt is a former member of The Dartmouth Staff.