Reduced Premature Mortality in Rwanda: Lessons from Success.

Rwanda has been transformed. Mass violence has not recurred within the country’s borders, and its gross domestic product (GDP) has more than tripled over the past decade. Growth has been less uneven than in other countries in the region, partly because both local and national governments have made equity and human development guiding principles of recovery. Recent studies suggest that more than one million Rwandans were lifted out of poverty between 2005 and 2010, as the proportion of the population living below the poverty line dropped from 77.8% in 1994 to 58.9% in 2000 and 44.9% in 2010.3 Life expectancy climbed from 28 years in 1994 to 56 years in 2012. It is the only country in sub-Saharan Africa on track to meet most of the millennium development goals by 2015. Although metrics for equity are disputed, it is an increasingly well known fact that Rwanda today has the highest proportion of female civil servants in the world. Some have characterised Rwanda’s rebirth as good fortune or as a “black box” case with few lessons for others. However, as doctors and researchers who have worked for a decade with Rwanda’s Ministry of Health and its development partners, we contend that the country’s approach to strengthening its health system offers insights for other countries faced with persistent poverty and lagging health indicators.