The Government of Rwanda created the Human Resources for Health (HRH) Program to build the health education infrastructure and health workforce necessary to create a high quality, sustainable healthcare system in Rwanda. The HRH Program addresses the most challenging obstacles to high quality healthcare in Rwanda, which are a critical shortage of skilled health workers, poor quality of health worker education, inadequate infrastructure and equipment in health facilities, and inadequate management of health facilities.
The program will include a partnership with 13 US institutions including 7 leading medical schools, 5 nursing and midwifery schools, and 1 health management school. The institutions will send more than 100 faculty members to Rwanda annually to assist medical, nursing, public health schools and teaching hospitals and to mentor Rwandese educators and students.
The participating Medical Schools in the Rwanda HRH Program are Harvard University, Brown University, Yale University, Dartmouth College, Duke University, University of Virginia, and Columbia University. The Nursing Schools are Duke University, New York University, University of Illinois at Chicago, University of Maryland, and Howard University. In addition, the Yale School of Public Health will take part in the program.
The Rwanda HRH Program exemplifies a new paradigm of country ownership with bilateral donors. The Government of Rwanda, through the Ministry of Health, will financially manage the HRH Program. US Government funds (along with Global Fund money) will flow to the Government of Rwanda who will directly contract US Universities.
These US schools have agreed to work under a reformed set of aid principles. For the Rwanda HRH Program, these US institutions have agreed to take no overhead and to work for 7% administrative costs. This is a new paradigm for US foreign aid.
The program will also involve significant investment in equipment for Rwanda's referral and district hospitals to upgrade training capacity and the range of service delivery that is provided.
The Rwandan Ministry of Health launched the HRH Program in the summer of 2012 to create a world class health education and research infrastructure by increasing the quality and quantity of Rwandan doctors, nurses and midwives, and health managers.
The Ministry of Health is convening a consortium of 13 top-ranked US schools institutions to provide 100 faculty members to be based in Rwanda each year of the program. US faculty will support clinical bedside mentorship as well as didactic teaching in Rwanda. By the end of the seven-year program, Rwanda will be able to sustain a high quality health care system and health education infrastructure without foreign assistance.
Over 500 medical specialists will be trained and the education level of nearly 2,000 nurses and midwives will be upgraded through the Rwanda HRH Program.
Since the Genocide ended more than 18 years ago, Rwanda has achieved remarkable improvements in the health sector. Life expectancy in Rwanda has increased from 28 years in 1994 to 55 years in 2010. Maternal mortality has decreased from over 1,000 to 400 deaths per 100,000 people. 90% of Rwandan children ages 12-23 months have received all recommended vaccines. As of December 2002, approximately 800 people in need of antiretroviral therapy were receiving it. Today, more than 100,000 people living with HIV in Rwanda are receiving antiretroviral therapy, which is more than 90% of those in need.
Despite these accomplishments, Rwanda still faces critical shortages in its health workforce, with regards to both quantity and skills. Indeed, the health worker density in Rwanda is only .72 per 1,000 persons, which is less than one-third of the WHO minimum density of 2.3 - the threshold required to achieve some of the most basic health outcomes. (Ministry of Health, 2011; WHO, 2006) In most cases, Rwanda's ability to ensure adequate levels of healthcare for its citizens is hampered by insufficient equipment and infrastructure at Rwandan healthcare and training facilities, as well as by a lack of individuals with high quality training in healthcare and healthcare management.
Currently, Rwanda has only 633 physicians for a population of over 10 million people. There are only 6,970 Rwandan nurses, about 90% of whom have the lowest level of nursing training available.