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Rhode Island Hospital physician part of Rwanda Human Resources for Health Program

Collaboration with U.S. academic institutions is largest-scale global health partnership between American universities and a low-income country
RIH Rwanda 1
Photo: Barbara Kinney, Clinton Foundation

Adam Levine, MD, is an emergency medicine physician at Rhode Island Hospital and director of the Global Emergency Medicine Fellowship at the Alpert Medical School of Brown University. Levine has been providing care in Rwanda for several years, and is now part of an important collaboration between U.S. academic institutions and Rwanda to train medical personnel.

Levine explains that for much of the past several decades, the field of global health has focused on the material aspects of health care delivery in poor countries: building clinics and hospitals, increasing access to cheap medications and vaccinations, distributing bed nets to prevent malaria or packets of oral rehydration solution to treat diarrhea. All of these things are incredibly important and have certainly saved many millions of lives.

“In recent years there has been an increasing focus on what is arguably the most valuable resource within any health care system: human resources. All the medications and supplies in the world won’t do patients much good if there aren’t doctors and nurses and paramedical staff and community health workers trained to use them, and to teach patients to use them,” Levine says.

That is why the Rwanda Human Resources for Health (HRH) program is so important. Levine explains, “As part of the HRH program, I am now working with a small team of faculty from Brown University and other institutions to develop the first emergency medicine training program in Rwanda. As I have learned during my time there, one of the wonderful things about knowledge and training is that they are inherently renewable resources. Unlike drugs and equipment, knowledge never has a stock-out, never breaks down, and never stops working when the power goes out.”

Levine adds, “In my experience, improving medical provider training also has the effect of improving other components of the health care system, since trained doctors and nurses feel empowered to demand the medications, equipment and efficient systems that they know they need in order to save patients’ lives."

For more on the HRH program, see the press release below on a special report that appears in the latest edition of the New England Journal of Medicine.

On November 21, 2013, the New England Journal of Medicine releases a special report detailing the largest-scale global health partnership ever initiated between American universities and a low-income country. On the heels of a World Health Organization warning in Brazil last week that the world faces a shortage of 7.2 million health workers, the article’s publication marks a pivot away from short-term missions and contracts toward long- term partnerships to bridge workforce gaps. Announced by Rwandan President Paul Kagame and former US President Bill Clinton in 2012, Rwanda’s Human Resources for Health Program is a seven-year, $150 million collaboration between the US and Rwandan government and 25 leading US academic institutions. Former US Global AIDS Coordinator and US Ambassador for Global Health Diplomacy, Dr. Eric Goosby—senior author on the article—launched the program in Kigali in 2012. Each year, more than 100 American health care professionals from medicine, nursing and midwifery, dentistry and health management work in Rwanda alongside Rwandan faculty to build residency programs, strengthen instruction quality, and substantially increase the output of new health workers.

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Photo: Barbara Kinney, Clinton Foundation

“Rwanda’s example, and the Human Resources for Health Program in particular, have the potential to transform global health by serving as a model for any country that wants to increase the efficiency of foreign aid and improve the health of its people. The launch of this program has been the highlight of a decade of partnership, and I'm excited by its possibilities,” said President Clinton.

Since 2000, Rwanda has reduced mortality due to HIV, tuberculosis, and malaria by nearly 80%, and the country’s life expectancy has more than doubled since the mid-1990s. As deaths from major infectious diseases have plummeted and as HIV patients live longer, chronic noncommunicable diseases account for a growing proportion of Rwanda’s disease burden— especially among the HIV-positive patient cohort. Rwanda’s Human Resources for Health Program will increase the number of Rwandan faculty available to train future health

professionals. By dramatically increasing the number, quality, and skill level of Rwandan clinicians and health sciences educators, the program aims to build the health education infrastructure and workforce needed to create a sustainable and advanced health care system.

“By simply reallocating existing funds, this partnership is allowing Rwanda to move from a brain drain to a brain gain of unprecedented magnitude in the health sector,” said Dr. Agnes Binagwaho, Rwanda’s Minister of Health and lead author of the new article. “Together, we are training a highly skilled health workforce built to last, and equipping them with the tools they need to save lives. In essence, we are investing in Rwanda’s greatest resource: its people.”

The program’s $150 million budget is comprised of US President’s Emergency Plan for AIDS Relief (PEPFAR) funding that is channeled through a cooperative agreement from the Centers for Disease Control and Prevention directly to the Rwandan Ministry of Health, along with support from The Global Fund to Fight AIDS, Tuberculosis and Malaria. In an unprecedented move to improve efficiency of existing foreign aid, the US government redirected funds from projects completed by non-governmental organizations to the Ministry of Health, lowering administrative costs and freeing funds for the new program. Because every American university partner agreed to no overhead and less than 7% administrative costs, Rwanda’s Human Resources for Health Program represents a unique model for foreign aid focused on greater efficiency, country ownership, and sustainable development. The Clinton Health Access Initiative has helped to convene the American consortium of schools and academic medical centers.

“At its very best, academic medicine integrates service delivery, teaching, and research in a virtuous cycle. For Harvard and our many American partners in this consortium, contributing to this program has been an opportunity to not only serve and improve care delivery in Rwanda, but also to learn much that we can apply back in the United States,” says Dr. Paul Farmer, cofounder of the nonprofit Partners In Health and University Professor at Harvard University.

By the program’s conclusion in 2018, Rwanda’s specialist physician capacity will have more than tripled, and the proportion of the country’s nurses with advanced training will have increased by more than 500%. An additional 550 physicians, 2800 nurses and midwives, 300 oral health professionals, and 150 health managers will have been newly trained in Rwanda—all of whom will have signed contracts to work in the country for a certain number of years based on the degree they obtain. Thereafter, the Rwandan government plans to fully finance the health workforce and medical education system on its own.

To learn more about Rwanda’s Human Resources for Health Program, please visit: