Universal Health Care in Rwanda

Dr. Paul Farmer spoke today at Stanford University about “scaling up” health care in Rwanda based on the health care delivery models that his organization “Partners in Health” developed in Haiti. Minus the funny anecdotes and striking visual examples he showed on his slides, a good summary of his talk can be seen in this newsletter in

Rwanda Scales Up PIH Model and also here.

The challenge is how to provide uniformly high quality health care across the entire nations. The government of Rwanda is basing their efforts on a set of ten principles listed in the link.


  1. High quality health care requires a truly comprehensive and integrated approach at all levels
  2. A comprehensive supply chain and procurement system should be in place for drugs, diagnostics and other commodities
  3. Patients should be able to access healthcare without regard to their ability to pay
  4. Healthcare workers should be highly trained and compensated fairly
  5. All health centers should have decent basic infrastructure and functional equipment to support the services they provide
  6. Community health workers are a vital component of the health system
  7. Nutrition is an essential element of any comprehensive health care service
  8. Information and communication technology should be integrated into existing health systems to improve the delivery of health care
  9. Health institutions should be held to the highest standards of care
  10. Comprehensive rural health care must go beyond the purely clinical by providing socio-economic support as well

Point 7 is simple — the best cure for hunger is food because patients can’t recover without proper nutrition. In his slides, Farmer mentioned that point 10 includes education, drinking water, jobs, and other essentials needed for living a decent, productive life. He did not mention microcredit or microlending. When I asked him about that he said they do microlending already, and it should probably be mentioned.

For point 8, he mentioned that the remote hospitals are equipped with satellite uplinks powered by solar panels and generators to communicate back to the PIH center in Boston.

Personally, I would add access to information and communication (the Internet) to this list in point 10 in addition to microcredit.

The common thread that emerged listening to him was the basic human need for “security” in the broadest sense of the word — health security, food security, water security, security from crime, national security, access to information, financial security, job security, personal safety, and so on. A functioning national economy is supposed to provide all this for most if not all of its people. Farmer talked about health security being a “right” versus a “commodity” — in some developed countries a small fraction of the population doesn’t have health security and in other developing countries most of the population doesn’t. I think the idea of listing all these things that together define “human” security needs would help us clarify what can be done to achieve them.

update on feb 13, 2009: compare to Clinics in the US, Expansion of Clinics Shapes Bush Legacy

NASHVILLE — Although the number of uninsured and the cost of coverage have ballooned under his watch, President Bush leaves office with a health care legacy in bricks and mortar: he has doubled federal financing for community health centers, enabling the creation or expansion of 1,297 clinics in medically underserved areas.

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