Rwanda’s Commemoration: Something in the present worth talking about

It is coming to almost two decades now since the 1994 Genocide against the Tutsi. The first decade dwelled on repairing and laying a new foundation for the nation. This culminated into the promulgation of the new Constitution in 2003. The second decade was about building on that foundation. Throughout the two decades, the tragedy has remained in the public memory, being commemorated for a week beginning the 7th of every April – which will be Sunday this week. Two things make the commemoration important on the national – and global – calendar. The first is in the essence of the public memory, which is to collectively remind of a past and tie it to a hopeful future. The second is that, by commemorating, we recognise the past and bring it into our immediate present. In Rwanda, the past is one thing, but the present is something worth talking about in the fruits of the foundation laid in the aftermath of the 1994 tragedy. The fruits are apparent in many places one may look in the present, though perhaps nowhere more starkly than in the health sector. This was recently brought to the fore by writer Neal Emery in The Atlantic Magazine in the article, Rwanda’s Historic Health Recovery: What the US Might Learn, that gained popular circulation in the social media, especially in the Rwandan blogosphere. Taking stock of achievements in health care in the country, Emery notes the connection between health, equity and poverty reduction. Over the last ten years, he writes knowledgeably, Rwanda’s health system development has led to the most dramatic improvements of health in history. Rwanda is the only country in sub-Saharan Africa on track to meet most of the Millennium Development Goals. Deaths from HIV, TB, and malaria have each dropped by roughly 80 per cent over the last decade and maternal mortality ratio dropped by 60 per cent over the same period. Even as the population has increased by 35 per cent since 2000, the number of annual child deaths has fallen by 63 per cent. In turn, these advances bolstered Rwanda’s economic growth. For Rwanda, Emery observes, health equity is both a matter of ethics and epidemiology: Access to health care for all citizens is a prerequisite for controlling diseases and for continued economic growth to lift more Rwandans out of poverty. One may not talk about health care in Rwanda without mentioning Mutuelles de Santé, the universal health insurance scheme. Focusing particular attention on providing for vulnerable populations, he notes, the community-based health insurance programme has more than halved average annual out-of-pocket health spending and significantly cut the rate of households experiencing health care bills that force them into poverty. Not many countries may lay to such a claim; which makes health care provision one of the achievements in Rwanda’s difficult journey, since the near-debilitating tragedy being commemorated this month, worth the travel. Though Rwanda has its detractors and is by no means perfect, through its health sector it presents a compelling example of “rising from the ashes” in post-conflict recovery. Emery is bold in stating this: For Syria and Mali, Haiti and Yemen, Rwanda’s rebuilding should offer hope that they, too, can remake their countries and recover from crises in the coming decades. While the specific context of Rwanda cannot be replicated, Rwanda’s focus on evidence-based policy, central planning, health systems, and equity access to care should be heeded both by countries looking to rebuild their health systems and those with strong systems already in place. This column hopes it will not be too much of a cliché if we recall that saying about getting back on your feet after a fall: One picks himself up, brushes off the dust and walks, head high, towards self-realisation. A dark past may never be erased from memory, but a bright future always beckons. That seems to be the lesson. Twitter: @gituram