Rwanda is a country in East Africa with a population of ten million people. It is recovering from one of the worst genocides in the 20th century, when approximately 900,000 people were killed in 1993.
Although Rwanda is one of the poorest countries in the world, it has one of the best organized health care systems in Africa. All citizens are able to obtain health care insurance for $2 per year. The actual cost of care per citizen is between $14-20, with one half coming from government sources and the remainder from international donors. The care is provided by through an organized network that includes local health clinics, district hospitals and ultimately three referral hospitals. The referral hospitals include University Teaching Hospital of Butare, University Teaching Hospital of Kigali and King Faisal Hospital, also in Kigali. Patients can only use these hospitals if they are referred through the network. King Faisal Hospital is a public-private hospital that provides care to private patients, patients with private insurance and patients referred from the other two referral hospitals. The latter group includes any citizen with national insurance who is referred through the network for highly specialized care not available in other hospitals.
Rwanda has one medical school located in Butare as part of National University of Rwanda (NUR). Recently, to better align training with health needs of the country, the medical school was shifted from Ministry of Education to Ministry of Health (MOH) with the plan to develop a new campus in Kigali. Under this plan, the three referral hospitals will serve as the teaching hospitals for the medical school.
A major challenge faced by Rwanda is training of health care workers, including specialists and subspecialists. Yale's Department of Medicine and the Yale Global Health Leadership Institute visited Rwanda, and began to work with the MOH and the Clinton Health Access Initiative on the development of Human Resource For Health (HRH) Project, which "aims to build the health education infrastructure and health workforce necessary to create a high quality, sustainable health care system in Rwanda." Yale is one of the eight medical schools, one school of public health, six schools of nursing and two schools of dentistry that has agreed to help achieve this goal. (Click to read a powerpoint summary and the full project proposal.) The consortium has agreed to recruit 52 FTE physicians, 42 nurse-educators, six health management mentors and two dental faculty for the present academic year. The major goal of this group is to help create a modern educational structure, improve undergraduate and postgraduate curriculum, and assist in training of specialists and subspecialists in collaboration with Rwandan faculty.
Yale has recently signed a Memorandum of Understanding with the Rwanda MOH to participate in the project. Yale is represented by three clinical departments (Internal Medicine, Pediatrics and Ob/Gyn) as well as the School of Public Health. The Department of Medicine has agreed to recruit 1-2 generalists for one-year assignments as well as 4-6 subspecialists, each spending three months in Rwanda. Click here for more information about working with HRH.
This is the first project of its kind bringing together several major institutions in this country to work with Rwandan colleagues to help improve the human capacity in health. There is much to be learned from this project and we are excited to be a member of this consortium.
Clinical Opportunities in RwandaThe Rwanda site was considered a provisional site for J&J Global Health Scholars in 2011-12. This was done after a site evaluation by co-directors of the J&J Program as well as by a Global Health Scholar in 2010-11. We are sending four Yale/Stanford J&J Global Health Scholars to this site in 2012-13.
Educational Opportunities in Rwanda
In addition to the HRH project, the following project is underway:
- Teaching Evidence-Based Medicine: We are working with colleagues from the University of Edinburgh's Global Health Academy to train key faculty at Rwanda School of Medicine in evidence-based medicine. The initial component involves training three faculty in a year long project to become the key trainers in three clinical departments. This project which is funded by British Council will be implemented in 2011-13 academic years. As preparation for this project, one of our faculty, Dr. Andre Sofair, Associate Professor of Medicine and Public Health, spent six weeks in Rwanda in summer of 2011 as a Yale/Stanford Johnson& Johnson Global Health Scholar. During his visit he conducted an introductory course in EBM and Clinical Epidemiology for faculty and residents in the NUR teaching hospitals. Four Rwandan physician spent two weeks in Edinburgh, then came to Connecticut for another two weeks in January of 2012. Dr. Sofair and Dr. Auguste Fortin returned to complete the training experience in December of 2012.