A surprising model for health system improvement

In the debate over how to improve health care in the US, systems in other countries are often held up as models.  You know, countries like Rwanda.

Yes, Rwanda.

A thought provoking piece yesterday on The Atlantic made that comparison, citing analysis by Dr. Paul Farmer.  From the article:

Over the last ten years, 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 percent over the last decade and the maternal mortality ratio dropped by 60 percent over the same period. Even as the population has increased by 35 percent since 2000, the number of annual child deaths has fallen by 63 percent. In turn, these advances bolstered Rwanda’s economic growth: GDP per person tripled to $580, and millions lifted themselves from poverty over the last decade.

One explanation for this dramatic improvement is that the genocide in Rwanda allowed for a clean slate upon which a new program could be built.  Farmer and others reject this explanation, however.  A recent report focuses more on interdepartmental coordination and central planning with health as a priority.  The article is a good summary and the BMJ research paper with Farmer as lead researcher has more details.

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One thought on “A surprising model for health system improvement

  1. Great article, very well presented. I especially like the debunking of the clean slate hypothesis, which was my first thought. I see similar things in Ghana, which recently nationalized its health care system- I am meeting people in rural villages that are now more likely to seek preventative care than many of the Americans I know. Not only are we lagging behind the developed world in the US, we are in many ways lagging behind the developing world as well. Be sure to check out the link at the end, on how rural Mississippi is learning from Iran’s health model.

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