Womens’ majority participation in Rwanda’s legislature and governing institutions over the past two decades has had a powerful effect in the country’s health and social policy and programs and soon, that impact will be visible globally through a new university that is turning the model of medical education upside down.
The university, and globally impressive results in women’s health and child and maternal mortality, grow from the belief that when women’s status improves, the whole community benefits. This is not unique to Rwanda, of course – think of Grameen’s choice to work with women, and women’s self-help groups all over Africa, India and South Asia.
But it is indisputable that this perspective, and the work of women, has been responsible for Rwanda’s recovery from the genocidal destruction of 1994 in which nearly 20% of the population died and Rwanda became the world’s poorest country, with the world’s highest child mortality and lowest life expectancy at birth. ”They formed local councils, headed judicial proceedings, tilled the land, and rose through the ranks of government. Amazingly, against a backdrop of near total ruin, they ushered in a level of peace and reconciliation that whipped the country into the model of development and gender equality it is today.”
“Rwanda has become a global model for building strong health systems in resource-limited settings,” says Partners in Health, which has worked in Rwanda since 2005, “helping the government fight HIV, improve maternal and child health, and bring integrated, high-quality health care to more than 860,000 people across Burera, Kayonza, and Kirehe districts.”
Agnes Binagwaho, a pediatrician who returned home to Rwanda in 1996 and later became the country’s Minister of Health, sets it out with great clarity in this powerful TED Talk delivered at TED Women in 2019.
“So we know that women, when they use their skills in leadership positions, they enhance the entire population they are in charge of,” said Dr. Binagwaho. “And imagine what would happen if women were at parity with men all over the world. What a huge benefit we could expect.”
In Rwanda, 93% of girls are vaccinated against HPV, protecting them against cervical cancer. Child mortality has been reduced by 75% and maternal mortality by 80%. “In early 2000s, there were nine women who were dying every day around delivery and pregnancy. Today, it’s around two. It’s an unfinished agenda. We still have a long way to go. Two is still too much. But, do I believe that those results are because we had a big number of women in power positions? I do.”
It is a huge change from 1996 when she came home. “The country was devastated. The children I was caring for in the hospitals were dying from treatable conditions, because we didn’t have equipment or medicine to save them. I was tempted to pack my bag and run away. But I debated with myself. And because I’m really dedicated to social justice and equity, and there were only five pediatricians in total for millions of children in Rwanda, I decided to stay.”
It was the women who inspired her. “They had to overcome unbelievable pain and suffering. Some of them were raising children conceived through rape. Others were dying slowly with HIV and forgave the perpetrators, who voluntarily infected them using HIV and rape as a weapon…. Those ladies were really activists of peace and reconciliation. They show us a way to rebuild a country for our children and grandchildren to have, one day, a place they can call home, with pride.”
In 1997, human rights lawyer Alice Urusaro Karekezi spearheaded an effort to have rape punished as a war crime and co-founded the Center for Conflict Management two years later. “You had the majority of the dead—men,” she says. “The majority of the fugitives—men. The majority of the prisoners—men. Who will run the country?” So women, who made up 80% of Rwanda’s surviving population, filled the leadership void.
The 2003 Constitution set a quota of 30% women in all decision-making organs, including 24 of the 80 seats in the Lower House of Parliament. As UN Women explains, those 24 reserved seats are elected by a special electoral college composed of voters from local women’s councils and district councils. Women won 26 other seats of the 53 available, and the youth seat, for 51 seats in Parliament (64%). Women also make up 42% of Cabinet members, 32% of Senators, 50% of judges, and 43.5% of city and district council seats.”
Aided by women’s civil society groups, lawmakers introduced some of the world’s most women-friendly policies. Women were allowed to inherit property in the absence of a will, to use their land as collateral for loans, and to open bank accounts without their husband’s permission. Girls’ education was prioritized through efforts that allowed more of them to attend college, and incentives were created for girls to study traditionally male-dominated subjects.
The idea of creating a university that would advance global health delivery by training a new generation of global health leaders who know how to build and sustain effective and equitable health systems was, in many ways, a logical extension of Rwanda’s woman and family centred approach to governance. But in a larger sense, really, it was an indictment of how current medical school training fails rural areas or people. What was needed, said Partners In Health, was “an institution dedicated to health equity or located in an environment where health disparities are most acutely felt.”
Butare Hospital – Partners in Health on Twitter
The University of Global Health Equity is pioneering a new way of training leaders who will emerge ready to develop health care services and systems that connect neglected communities with essential attention. It focuses on equity and social determinants of health, pairing education in human rights and social justice with rigorous, community-based medical training. The aim is to produce physicians who give quality inclusive care in communities where people live, not just in institutions. The approach to enrolment is inclusive. Students will get their medical education for free on the condition that for six to nine years, they serve the vulnerable across the world. In all its classes, women make up at least half the class.
This idea had emerged in 2013 in Kigali, when the Cummings Foundation proposed a new university to serve, not just Rwanda, but all of Africa and beyond. Launched in 2015 by Partners in Health in collaboration with Rwanda’s government and with funding from the Bill & Melinda Gates Foundation and Cummings Foundation, the university is located in Burera District, about 80 miles north of Kigali.
UGHE’s first students earned masters of science degrees in global health delivery, through a two-year program offered in Kigali and remotely. Phase I fully opened in Butaro in September 2018. Future phases are expected to include nursing and dentistry education. In summer of 2019, UGHE launched its medical degree program, welcoming 30 students to earn bachelor’s degrees in medicine and surgery, along with the master’s in global health delivery, over six and a half years of study. The inaugural medical class of 2025 includes 20 women and 10 men, all from Rwanda.
“This will be transformative in ways we can’t yet even imagine,” said Ophelia Dahl, chair of the PIH Board, back in 2014. And indeed, it is.
Let us give the final word to Dr. Binagwaho. “Twenty-three years ago, I went back to Rwanda, to a broken Rwanda, that now is still a poor country but shining with a bright future. And I am full of joy to have come back, even if some days were very difficult, and even if some days I was depressed, because I didn’t find a solution and people were dying, or things were not moving enough. But I’m so proud to have contributed to improve my community. And this makes me full of joy.”
How women helped rebuild Rwanda. Inclusive Security.
How women are stepping up to remake Rwanda. National Geographic, Oct. 15, 2019
The story behind the university. University of Global Health Equity.
Cover image: This picture of the UGHE campus at Butare, in rural Rwanda, is from the university’s Twitter image.