I am so blessed to receive many questions mostly from young Rwandans seeking alternative sources and analysis of our country’s realities. Most of my young readers seek clarity because they believe neither official statistics nor Rwandan newspapers’ interpretations of official sources, least of all, the New Times, which is mouthpiece of government.
That is the context of this question recently-posed to me: WHAT STATISTICS WILL COME TO HAUNT PRESIDENT PAUL KAGAME WHEN OUT OF OFFICE?
My answer is simple. Out of many exaggerated achievements, health will reveal the extent of delusional grandeur of Paul Kagame and his government. Let us explore the claims of achievement versus reality in the health sector.
PRESIDENT KAGAME’S CLAIMS OF HIS ACHIEVEMENTS IN HEALTH SECTOR
Here is how the Rwandan President explains how he has achieved what he terms “quality health care for all.”
“In 1994, the Rwandan government was faced with a health sector with a destroyed infrastructure and very few health professionals. Less than two decades later, the Rwandan health sector is globally recognised for its remarkable improvement in the quality and access to health services. The introduction of community based health insurance- Mutuelle de sante, transformed what was once a luxury into universal and affordable access to health. In addition to insuring access, the introduction of a performance based financing system has been put in place to ensure quality services. Health coverage has now exceeded 90%…Innovative practices such as the introduction of community health workers responsible for delivery of primary health care, the nationwide community nutrition surveillance program and the widely accessible family planning and reproductive health services have all contributed to the impressive reform of the health care system…Today, what was once considered an insurmountable challenge has become one of the greatest examples of success stories in Africa.”
HEALTH REALITIES ON THE GROUND
It does not take much to show that on the basis of health personnel alone, achieving “quality health care for all” in Rwanda is pure fantasy. Here are the current Rwandan ratios of health professionals to the population in 2012:
* Physicians per 10,000 population: 0.6%
* Nursing and midwifery personnel per 10,000 population: 6.9%
* Dentists per 10,000 population: 0.1%
* Pharmacists per 10,000 population: 0.05%
* Environmental and public health professionals per 10,000 population: 0.1%
* Psychiatrists per 10,000 population: 0.05%
When you consider these pathetic ratios, the Kagame rhetoric that “what was once a luxury” has been turned “into universal and affordable access to health” seems rather sad. Imagine this gentleman talking about “health coverage that has now exceeded 90%:” on the basis of what personnel? Since when did the introduction of community health workers become “Innovative practice”? In the rest of the world, that is a routine practice. And how can a ratio of 0.1% community health workers to 10,000 people translate into quality service delivery? And this is “one of the greatest examples of success stories in Africa”?
What a sick joke!
TINY FORMAL EMPLOYMENT BASE
There are other factors at work that reveal the delusions of the Kagame regime in as far as health is concerned. Rwanda remains an essentially a subsistence economy where most people eke a living in the rural areas – over 80% are trapped in this existence. The formal wage economy employs no more than 265,660 people – this is the figure of “all salaried workers” in Rwanda who constitute “actively contributing members” to the social security fund as of December 2012.
If only 265,660 people are employed out of 11 million, how in the world can Kagame possibly finance what he calls “quality health for all”? Remember nearly half his budget comes from donations.
MOST COLOSSAL LIE FOR KAGAME GOVERNMENT
If you are regular reader of RPF’s New Times newspaper you will have noticed how Rwanda is presented as a higher achiever in every imaginable developmental category. That is Kagame style as shown above when he boasts of creating a “quality health for all” which he grandly declares to be one of Africa’s greatest success stories. But unless a miracle happens between now and when Kagame leaves office, of the many of exaggerations, half truth and outright lies peddled by his regime, health will be the most colossal tall-tell of all.