The following post was excerpted from a blog by Dr. Agnes Binagwaho, Permanent Secretary of the Ministry of Health in Rwanda. Read her full piece.


Dr. Agnes Binagwaho

...[The] current top killers do not account for all of [Rwanda's] disease burden. Regretfully, there remains a serious gap in Rwanda’s current health care system. Noncommunicable diseases (NCDs)—probably accounting for about 25 percent of the national burden of disease—have yet to be addressed in a strategic and systematic way. These diseases include cardiovascular disease, cancer, epilepsy, pulmonary disease, and diabetes among others. These are global diseases and yet, more often than not, NCDs are thought to be problems of middle and high-income countries. In such countries, risk factors for NCDs include obesity, tobacco use, and other factors termed poor lifestyle choices. However, in Rwanda, and other developing countries, this is not the case. NCDs are instead linked to malnutrition, infection, congenital abnormalities, toxic environments, and lack of access to basic health care. These are all ultimately caused by poverty. And HIV/AIDS, tuberculosis, malaria and neglected tropical diseases—all diseases endemic to the poorest nations—further contribute to risk factors for NCDs whether treated or untreated.

Inshuti Mu Buzima (IMB)—the sister organization to the Harvard-affiliated non-profit, Partners in Health (PIH)—was invited to work in partnership with the Ministry of Health of Rwanda at the end of 2003. IMB-PIH has put itself at the service of Rwanda’s vision for health care by devoting itself to the needs of the entire populations of three districts. In particular, it has made a unique contribution in the area of chronic care and NCDs. This approach has led to a joint undertaking between the Ministry of Health and IMB-PIH, including a conference in January 2010, which was focused on how to tackle non-communicable diseases in Rwanda. Through such discussions, chronic care integration has been identified as a central unit of strategic planning to improve the health of the Rwandan population. Other units of planning for NCDs include gynecologic care at district hospitals; improving the quality of generalist physician care at district hospitals; histopathology; cancer care; cancer surgery; cardiac surgery and neurosurgery. Now, in January 2011, Rwanda finds itself equipped with a healthcare system capable of launching chronic care integration; and IMB-PIH finds itself prepared to advise, advance and support the effort.

Many Rwandans could afford the prevention and treatment of uncomplicated cases of common diseases such as malaria or pneumonia, but most could not afford the costs of chronic care of HIV/AIDS, heart disease, diabetes, epilepsy or cancer. Therefore, chronic lifelong treatment and managed care for NCDs must be rooted in a publicly-sponsored, tactical and efficient plan to achieve accessibility and affordability. Already Rwanda has taken steps to tackle some of the prevention issues unique to NCDs, including the improvement of household cooking stoves and access to treatment for streptococcal pharyngitis, among myriad other steps. But we have much work to do. And we implore other low-income countries to take seriously the non-communicable ailments of their patient populations—ailments which most of their citizens must simply endure, because they cannot pay for treatment. Rwanda has made great strides in combatting communicable diseases under the leadership of the Government. The Ministry of Health and our development partners affirm our unwavering dedication to preventing and treating noncommunicable diseases, and making chronic care available to all.

Read Dr. Binagwaho's full blog post.