a reborn nation

“Rwanda lost almost everything – infrastructure, human resources, even the confidence of the people. We had to build the country from scratch,” said Dr Diane Gashumba, Rwanda’s Minister of Health. "We must raise awareness and involve everyone in the effort to rebuild our country. The difference is that our leadership has decided to invest in people and build from the community level upwards.

From 1990 to 2017, life expectancy in Rwanda increased by 33 years, faster than any other country in Africa.

Other numbers are equally impressive: the number of new HIV infections fell from 13,000 in 2004 to 7,000 in 2018; the number of HIV-infected people on antiretroviral therapy rose from 3,000 in 2004 83% by 2017.

In exceptional cases, more than 91 percent of the country's population has health insurance, most through a community health insurance scheme called Mutuelles de Santé.

How did the country emerge from these challenges in such a short period of time? How Rwanda invests in the health of its people holds some answers.

Perhaps because the country lost so many lives so quickly, Rwandan leaders decided early in the rebuilding process that it needed to work harder and faster to save lives. When the genocide ended in <> October 1994, the health care infrastructure was destroyed.

Today, there are many high-tech health solutions, such as the delivery of medical supplies to remote villages by drone. The technology goes beyond drones to encompass other elements, including a seamless information management system that sends real-time messages of individual health cases, all the way down the health ministry hierarchy - from community health workers to ministers.

Dr Gasumba said that from the beginning, the government recognized that health was a top priority in rebuilding the country. A large part of the health investment includes deploying more than 58,000 community health workers who travel through villages looking for anyone showing signs of illness - from a high fever to a persistent cough - and linking them to care and treatment.

Disease surveillance for community health workers is pretty much what it sounds like: watch for signs of disease. It is the bread and butter of community health work and is essential in the fight against infectious diseases such as tuberculosis and malaria. As the first line of defense against the disease in her community, Esther Mukagatare spends a lot of time finding people with TB that the health system may have missed. Her living room serves as a consulting room, from which she performs simple triage and sometimes tests for diseases such as malaria.

Cedric Irakiza, a 14-year-old orphan, came to Esther's village about a year ago to live with a foster family. Esther supports everyone in the village and oversees the new arrivals as she works to ensure everyone in her care stays healthy.

When Esther heard that Cedric had a persistent cough, she accompanied him to the health center for a checkup. At the health centre, he was screened for tuberculosis and tested for HIV.

Community health workers also perform non-routine work to protect the public from diseases such as malaria. During a recent visit to the Bugsera district, community health worker Vincent Niyindorera kicked off his shoes and socks and pulled his trousers up to his knees. He is demonstrating how he spends his six-hour night shift luring mosquitoes to bite him. He then captured the insects to assess the effect of indoor residual spraying on malaria prevention.

At the end of his shift, he sends the mosquitoes to a lab where etymologists Jackie Mupfasoni and Annonciata Kagoyire work to understand the mosquitoes' feeding habits and collect real-time data on the insects in the village.

The lab sought to understand whether the deadly Anopheles mosquito exists and whether it harbors malaria parasites that can be transmitted to humans. Niyindorera's work is being used to make policy and program decisions quickly to ensure that no Rwandan dies unnecessarily from disease. His work is helping lead the fight against a disease that is killing many in this country.

Of all the innovations transforming the health of Rwandans, community health workers top the list. These men and women (60% are women) are distributed across the country as the first line of defense against disease. They educate the public, they treat diseases, and they help prevent possible outbreaks.

Dr Gashumba said: "We have a health system built from the community level, the household level, a health system that is more focused on the preventive element rather than the curative aspect. We have decentralized everything to make sure the services are close to the people.

At a busy border crossing between Rwanda and the Democratic Republic of Congo, health workers and leaders have moved to prevent Ebola from entering the country. The entire region has been on high alert since the Ebola outbreak, which has killed more than two people in the Democratic Republic of Congo.

The genius of Rwanda's community health work program is that it doesn't just stop at fighting disease, but goes much further—as a mechanism to energize the local economy. Through local government-backed cooperatives, community health workers pool their savings and knowledge to invest in different economic sectors.

Higher economic output creates a virtuous circle, with each country helping to boost the other: as health outcomes improved in Rwanda, the country experienced a remarkable economic boom—an average growth of more than 10% over the past seven years %. Beautiful flat roads and skyscrapers are being built at one of the fastest rates in the world.

Rwanda is a new place, in stark contrast to a country roiled by genocide 25 years ago. This disparity is evident not only in economic progress, but also in a new generation of young people who see themselves as citizens of a country rather than members of this or that ethnic group. Rose Yambabariye, 22, a student hired to keep books on community health workers at a shopping center in Karonji, captured the change succinctly, “Today, we don’t have Tutsis or Hutus. We are all Rwandans.