Rebuilding Rwanda’s healthcare from the ashes of genocide

RWANDA – Rwanda has transformed its healthcare system from the ground up, overcoming immense challenges to provide universal coverage and quality care for its citizens thirty years after the 1994 Genocide. 

The genocide had a devastating impact on Rwanda’s already fragile healthcare infrastructure, with hospitals and clinics destroyed, medical personnel killed or fled, and essential supplies depleted. 

“Getting treatment at the time was a huge struggle. We had to move with machete cuts infected with gangrene for 30km to get dressings and disinfectant,” recalls Mariane Muhawenimana, a genocide survivor.

In the aftermath, the new government led by the Rwanda Patriotic Front (RPF-Inkotanyi) had to rebuild the healthcare system from scratch.

“The changes have been many and transformative for the past 30 years I have been working in this sector,” says Dr. Barbara Joy Mukamabano, a pediatrician who has witnessed the transformation.

The government prioritized training doctors and nurses and 1995, introduced the Community Health Workers (CHW) program to complement existing services. 

“Those days, a mother would come with a sick child and you wouldn’t find any medicine to give her or a laboratory to send her to do tests. A child would come with a simple respiratory condition but there were no machines to check that,” Mukamabano recounts.

Today, Rwanda boasts a robust universal healthcare system, with 97.3% of the population covered by ‘Mutuelle de Sante’. 

“There was no insurance for ordinary citizens. People would fall sick or get involved in an accident and they just go home and wait to either heal or die because they did not have money to seek treatment,” Mukamabano explains.

The country now has 2,067 public and private health facilities, including eight national referral hospitals, four provincial hospitals, and 510 health centers.

“All doctors had gone, including General Practitioners and we were less than 100. Now we are talking about over two thousand doctors now, from less than 100,” says Dr. Emmy Agabe Nkusi, one of Rwanda’s first neurosurgeons.

Nkusi, who returned to Rwanda in 1998 after training abroad, recalls the challenges of starting a neurosurgery department with limited resources. 

“They told me I have to learn how to use old equipment. I got offended but definitely they were telling the truth,” he says, describing how he had to improvise with rudimentary tools.

Despite the daunting task, Rwanda has made remarkable progress in healthcare over the past three decades.

 “Particularly as a paediatrician, I happy that today, when a woman walks into a health facility with a sick child on her back, that child will go back home alive,” Mukamabano reflects, noting the significant reduction in infant mortality rates.

While challenges remain, Rwanda’s healthcare transformation is a testament to the country’s resilience and determination to rebuild from the ashes of genocide.

 As Mukamabano says, “the young generations, especially girls, need to take advantage of the immense opportunities available to them, study and come back to contribute to the country’s vision, because there is more work to be done.”

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