Kigali, Rwanda

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.

Rwanda 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 in 2011-2019, which "aimed to build the health education infrastructure and health workforce necessary to create a high quality, sustainable health care system in Rwanda." Yale was one of the eight medical schools, one school of public health, six schools of nursing and two schools of dentistry that helped achieve this goal over eight. (Click to read a powerpoint summary and the original full project proposal.) The major goal of this group was 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 signed a Memorandum of Understanding with the Rwanda MOH to participate in the project. Yale was represented by three clinical departments (Internal Medicine, Pediatrics and Ob/Gyn) as well as the School of Public Health. The Department of Medicine recruited generalists for one-year assignments, as well as subspecialists for three months, in Rwanda.

This was 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 were honored to be a member of this consortium.

The Rwanda site was a provisional site for J&J Global Health Scholars in 2010-11 and 2011-12, and now hosts Global Health Scholars and PA students.

Faculty from Internal Medicine, Ob/Gyn and Pediatrics had been can be recruited through the Yale and Rwanda Government's Human Resources of Health (HRH) Project for short or longer term rotations. This multi-year project has now ended, but there may be similar opportunities in the future.

Through an exchange program, two rising Chief Residents from the main teaching hospital in Kigali spend one month of observation at Yale New Haven Hospital, learning about the role of the Chief Resident as mentor, teacher and administrator.