Rwanda's Potential to Achieve the Millennium Development Goals for Health

AuthorRoger Sapsford,John Rwirahira,Pamela Abbott
Published date01 June 2015
Date01 June 2015
Rwanda’s Potential to Achieve the Millennium
Development Goals for Health
Pamela Abbott, Roger Sapsford, and John Rwirahira
This article examines the feasibility of meeting the Millennium Development Goal targets for health
in Rwanda, which has rebuilt a health system after the 1994 genocide. The target for underweight
children has been achieved, and others are on track or virtually achieved: measles immunization,
antenatal care, under-f‌ive and maternal mortality, and 100 percent adult take-up of antiretroviral
drugs for AIDS. Even the targets for use of modern contraceptives and for qualif‌ied attendance at
births are not beyond reach. The appointment of community health workers and the introduction of
universal health insurance have been important success factors. Some targets will not be met by
2015, however. Despite progress, the infant mortality rate will not fall to the target level, nor the
target for young people’s knowledge of AIDS. Extreme poverty has declined, but not to the target
level. Also, targets can mislead. For example, young children may now be receiving suff‌icient food
on average, but the extent of stunting suggests that it is not the right food.
KEY WORDS: Rwanda, Millennium Development Goals, health and nutrition
For the last 14 years the Millen nium Development Goals (MDGs) have
united and informed the glo bal partnership for develo pment, in Rwanda as
elsewhere. The MDGs form part o f the country’s strategic plan EDPRS1
(Economic Development and Poverty Reduction Strateg y; Ministry of Finance
and Economic Planning, 2007 ) and have been continued into its successor,
EDPRS2 (Ministry of Finance and Economic Planning, 2013). This article look s
at the health-related eleme nts of the MDGs. Rwanda is aiming for a su bstantial
reduction in child mortality; a substantial impro vement in maternal health ; a
reduction in the incide nce of HIV/AIDS, malaria , and other diseases; and a
substantial reduction in hunger and malnourishme nt. The specif‌ic targets t hat
have been set are:
reducing the infant mortality rate by two thirds
reducing the maternal mortality rate by three quarters
achieving universal access to reproductive health
World Medical & Health Policy, Vol. 7, No. 2, 2015
1948-4682 #2015 Policy Studies Organization
Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.
halving and beginning to reverse the spread of HIV/AIDS
achieving universal access to treatment for HIV/AIDS for all who need it
halving and beginning to reverse the incidence of malaria and tuberculosis
halving the proportion of people who suffer from chronic hunger.
The article outlines successes, near successes, and likely failures to meet
targets. We also consider the extent to which the targets do answer the problems
whose solution was their purpose and what problems remain to be solved even
after the targets have been met.
Rwanda is a small, landlocked, densely populated country in the middle of
Africa, with few exploitable natural resources. It is still recovering from the
impact of the 1994 genocide against the Tutsi, which destroyed the economy and
social order and badly damaged the infrastructure. It now has a growing
economy but is still substantially aid-dependent. The government is stable, with a
continued emphasis on good governance. Accountability and citizen participation
have been central to this, despite the fact that the system is strongly controlled
and centralized (Abbott, Mugisha, & Lodge, 2014). Nowhere is this more important
than in the sphere of health, because this is an area where solutions cannot be
imposed top down. The poverty of Rwandans underlies and colors everything
else about their lives, including their health. In a poor nation, improving health
means governments taking strong and consistent action but it also requires
communities and individuals to take responsibility.
A Note on Methods
The article is based on readily available Rwandan survey statistics plus inputs
from other research projects and evaluations. The data used to measure progress are
mostly taken from Rwanda Demographic and Health Surveys (RDHS) in 1992, 2000,
2005, 2010; the Interim RDHS in 2007-8; and the EICV surveys (“Integrated Living
Conditions Survey”—the acronym is from the French) in 2000-1, 2005-6, and 2010-11.
The graphs are the authors’, drawn from published data and new analysis of survey
datasets. Where no specif‌ic publication is cited the f‌igures represent the authors’ own
analysis. The datasets are available on the National Institute of Statistics Rwanda
Census had also been published recently at the time of writing (Census, 2012), and
these are cited where appropriate; the Census is obviously the most recent and
reliable source, but it does not cover the detail to be found in the various surveys.
Limitations and Biases
The two major survey series use large multi-stage stratif‌ied samples of
households within which informants are selected randomly for face-to-face
interviews in whichever of Kinyarwanda, French, or English was their preferred
language. The design and quality-control procedures of the surveys and the
Census should give a reasonable degree of reliability.
102 World Medical & Health Policy, 7:2

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