Rwanda’s universal healthcare has inspired a new program at Harvard University and attracted international attention.
Rwanda healthcare and insurance covers about 90% of the citizens. This has undoubtedly inspired medical leaders from around the globe to visit Rwanda and study the country’s unique transformation.
The Harvard Medical School is working with the Rwandan Ministry of Health to teach a course called Global Health Delivery in the village of Rwinkwavu twice a year.
“Rwanda is honestly starting to change the face of global health,” said Dr. Paul Farmer, one of the founders of Partners in Health , a nongovernmental organization that works in Rwanda and other poor countries.
He is also the chairman of Harvard’s Department of Global Health and Social Medicine and one of the faculty members for its course in Africa.
In February, 30 African medical leaders met with Harvard faculty at the training and research center in Rwinkwavu to discuss the challenges of delivering health services in resource-poor settings. Six of these students were trained to become faculty members who will teach future classes, with the next sessions scheduled for July.
During the weeklong course, students and professors discussed case studies and conducted field visits throughout Rwanda. Because all the students are currently health workers — most are employees of the Rwandan Health Ministry — they are able to immediately apply what they learned in the Harvard course to their daily work.
Initially, the course was held only on Harvard’s campus, where students would discuss case studies on the difficulties of delivering medical services internationally.
But the course changed in February. A world away from Cambridge, Massachusetts, health professionals in Rwinkwavu discuss the same case studies.
They also participate in live cases, in which students and faculty members interview doctors, nurses or other health workers, like the head of an organization working to deliver AIDS medications to the poor in Rwanda, to ask them about the challenges of their work.
Visits to Rwandan clinics and hospitals allow students to see health care in action, and give them the opportunity to collaborate with other professionals to discuss solutions.
“To be a good global health provider, it’s good for students to see what others have done,” Dr. Agnes Binagwaho, who is both the Rwandan health minister and a Harvard faculty member, said by telephone.
Seeing potential for the course outside of Massachusetts, Dr. Binagwaho worked with Partners in Health to bring the Harvard curriculum to her home country.
“We hope to have students come from around the world and learn from them as well, and also have the students learning from each other, because they are all coming from countries where there are things ongoing,” she said.
There is now also a new Harvard degree, a Masters in Medical Sciences and Global Health Delivery, which will begin this autumn. Plans to offer a similar degree in Rwanda are under way.
“Above all, you need people who actually do the delivery to tackle the problems,” Dr. Farmer said. He stressed the importance of working not only in Africa, but also with African health care leaders. “Not everyone has the privilege to make it to Harvard — and we needed to reach out,” he added.
The Harvard course is one of the first that focuses exclusively on the challenges of delivering health care. It encourages students to think about how politics, economics and other social factors affect health.
“I don’t know many other groups that are looking at health care delivery as a field of study and bringing that to collaboration with African ministries of health,” said Dr. Joseph Rhatigan, the director of the Global Health Equity residency program at the Brigham and Women’s Hospital, a teaching hospital affiliated with Harvard in Boston.
Partnerships between medical schools and the developing world are increasingly common, but the majority focus on practicing medicine as opposed to delivering care and understanding the effect of social factors, he said.
Dr. Corine Karema, director of the programs for malaria and neglected tropical diseases at the Rwanda Biomedical Center and one of the students in the Harvard course who trained to become a faculty member, said the course made her change the way she looked at medical treatment.
“I’ve been working for a long time in public health, and we used to decide on intervention and strategies if they were cost effective without looking at how the strategy will best affect the patient,” she said.
She said she now had higher expectations. The course taught her to advocate the best treatment available, regardless of cost.
“Too many people in public health have been socialized for scarcity, the idea that we just have to make do with less,” said Dr. Farmer. “That socialization for scarcity has prevented innovation. That’s really what the course is about: confronting the socialization to scarcity and combating it.”
Dr. Farmer and other faculty members drew on their experiences at Partners in Health. For more than 20 years, the organization has worked in Haiti, Lesotho, Mali, Peru and other countries to make once-costly treatments for medical conditions like H.I.V. and tuberculosis available to the poor.
Although professors bring Harvard expertise to the table, they say they take as much away from the course as the students.
“I learn a lot more when I teach experienced people,” said Dr. Joia S. Mukherjee, the medical director of Partners in Health and a Harvard professor who helped organize and teach the course.
“They are all saying, ‘Well, this is what we did here, this is what we did in Haiti.’ The students are learning more from one another than from professors.”
Dr. Farmer recalls students saying in a group discussion, “‘You mean that happened to you, too? Well, we had the same problem in Burundi.”’
“Within five minutes you had five people discussing a very specific problem that they had all faced,” he said.
“That kind of exchange you can’t get out of a classroom, textbook or article. Watching hard-working African health care professionals sharing experiences, just for that hour session alone would have been worth the course.”
The students from Rwanda stay in contact via an online portal, and the case studies are available online as open source information.
“We agreed that in six months, we will all have a case study about something we have done in our daily work and use them as new materials for the Harvard lectures,” Dr. Karema said.
“It’s an outstanding initiative because it relates what is being done in the States to what the needs are overseas,” said Eldryd Parry, founder of THET Partnerships for Global Health, a British organization that works to improve health care in Africa and Asia.
“There is so much in international aid and health that is decided in Washington, and that’s not the mind behind this program. It’s a catalyst for further interest.”
Faculty members have said that the main challenge will be maintaining funding, which is currently supported by Partners in Health, Harvard and philanthropies.
Dr. Pat Lee, who teaches at Harvard but is not affiliated with the course, said, “We have some interesting work to do as educators to adapt to the needs of different learners and tailor the curriculum so that it can be accessible to a variety of audiences.”
That will be critical if Dr. Binagwaho’s vision comes to light. In the future, she hopes to invite health professionals from around Africa and other developing countries to participate.
“We can be the example,” she said, “not teaching in theory, but teaching in practice. If you want the developing world to develop, you have to develop teaching. Courses like this have to grow.”
The Article was first Published in NY-Times
