Although it is one of the poorest countries in the world, devastated by the 1994 Genocide against the Tutsi and heavily aid-dependent, Rwanda has achieved most of its Millennium Development targets for health. This article discusses how it managed this, when many countries in Sub-Saharan Africa failed to achieve theirs, and assesses the sustainability of its solutions. Determined government policies involving investment in health and education and their energetic implementation with the support of development partners are identified as ultimately responsible for this success in improving the lives of ordinary Rwandans. The major mechanisms for implementation have been the provision of relatively local health centers, payment of health providers by results, setting up an affordable health insurance scheme (with support for those most in poverty) and the appointment of volunteer Community Health Workers who are unpaid but are encouraged and supported to form cooperatives for their own and their families’ support. The effectiveness of this level of community involvement suggests that the “Sustainable Development Goals” which replace the MDGs may also be attainable. A marked reduction in Official Development Assistance because of the success would be counterproductive, however, probably putting the cost of medical and preventative supplies beyond the reach of the average Rwandan citizen.
World Development, Volume 92, April 2017, Pages 103-116,