Landmark Studies in Rwanda, Madagascar Show Success for Universal Care Model

BOSTON (May 16, 2018): Deaths of children under 5 have dropped by nearly 20 percent in just two years in a poor, rural district in Madagascar—despite the island nation’s lowest health spending in the world. This transformation echoes the strength of results charted across the last decade in rural Rwanda, where under 5 mortality dropped 60 percent between 2005 and 2010 in Southern Kayonza and Kirehe districts. Both sets of results were products of a grassroots health system movement founded on principles of public partnership, data science, and universal access to care for all.  
The transformations were led by global health nonprofits PIVOT, in Madagascar, and Partners In Health (PIH) in Rwanda, in partnership with the Ministry of Health in both countries, and are detailed in two new papers published in BMJ Global Health. The baseline conditions of the two study areas are remarkably similar: both Francophone, subsistence agricultural economies, with per capita incomes among the lowest in the world, and nearly identical, staggering under-five mortality rates of 1 in 6. 
At a time when Rwanda witnessed the fastest drops in under-five mortality ever recorded, the remote districts where PIH was working saw rates drop twice as fast. Indeed, the world has tracked Rwanda’s rise as a model for health system transformation, seeing the country’s development as an anomaly as it became the only country in Sub-Saharan Africa to achieve its health Millennium Development Goals. But while Rwanda has been boosted by strong government support and a vast infusion of international resources post-genocide, Madagascar has been politically unstable and largely forgotten by the international donor community.  
That is why, taken together, the results in both countries demonstrate evidence for the global replicability of the ground-up health systems model, with success in vastly different settings. 
Both papers published by BMJ Global Health have renowned global health leaders among their coauthors, with strong ties to Harvard Medical School, PIH and PIVOT. PIH co-founder and chief strategist Dr. Paul Farmer, co-author on the Rwanda study, remarked: “The positive health outcomes in both Rwanda and Madagascar document our collective progress in reinforcing universal coverage as both a moral imperative and an achievable reality. PIH and PIVOT, in partnership with the HMS Research Core and its affiliated faculty, are charting stronger, more equitable, mechanisms for improved care delivery.”

Professor Agnes Binagwaho is senior author on the Rwanda study, having served as the Rwanda Minister of Health from 2011 through 2016. “Through Rwanda's commitment to a universal right to health, we have continued to witness transformation that has rendered our country's health system an example for not only Africa, but for the world,” she said. “We embrace the shared vision and work of our partners in Madagascar. Together, we can pave the way to inclusive health systems that advance equity and health for all people.” Prof. Binagwaho is currently on the faculties of both Harvard and Dartmouth Medical Schools, and is the Vice Chancellor of the University of Global Health Equity, a new Rwanda-based university that trains global health professionals from across the globe.  
Other co-authors on both papers include PIVOT Co-founder Dr. Michael Rich, who was also Executive Director of PIH-Rwanda from 2005-10; Dr. Megan B. Murray, the Ronda Stryker and William Johnston Professor of Global Health at Harvard Medical School; and Dr. Matthew Bonds, Assistant Professor of Global Health and Social Medicine at HMS and co-founder and co-CEO of PIVOT.     
Partners In Health is an international medical organization that helps build and sustain public health systems in poor and underserved communities around the world. Launched in Haiti in 1987, Partners In Health today reaches 7 million people around the world and employs 18,000 people, including 15,000 local community health workers. Learn more about our work at 
PIVOT partners with communities in resource-poor areas to save lives and break cycles of poverty and disease by combining accessible, comprehensive health services with rigorous scientific research. PIVOT has worked in Madagascar since 2014. Learn more at 
Media contacts:  

Amy Donahue, PIVOT, Cell: 203-482-5222

Mike Lawrence, Partners In Health, Cell: 603-970-1239 

Please send donations to: Partners In Health, PO Box 996, Frederick, MD 21705-9942