This story began ten years ago when my office at the University of Western Ontario received a letter from Dr. Emile Rwamasirabo, then Rector of the National University of Rwanda. He explained that almost all doctors in Rwanda had either been killed or had fled the country during the genocide. Moreover, the few doctors still remaining in Rwanda, of necessity, were engaged in administration rather than patient care in hospitals and clinics.
Dr. Rwamasirabo was aware that Western had a good medical school and asked if we could help rebuild the Rwandan medical sector. Our reaction was immediate and positive, but who could lead this on the Canadian side? I recalled that my friend Dr. David Cechetto had considerable personal experience in the health field in Africa and was also running a program at Western that sent medical students to Africa for field experience. I invited David to take the leadership role in responding to Rector Rwamasirabo’s request. He took a deep breath – I think David realized immediately that when he said yes, that decision would define the rest of his life – and said he wanted to gather more information, which he did. He travelled to Rwanda and then submitted a proposal to CIDA for funding. It was turned down, so he and I made another trip to Rwanda and submitted a second proposal, which was also turned down by CIDA.
So, we made yet another fact-finding trip to Rwanda, in which it became increasingly clear to us that Rwanda’s needs in the health field went well beyond the training of doctors. In fact, Rwandans we met emphasized the need for all front-line health workers, including nurses, midwives, and trauma therapists. We then submitted a third proposal in which the lead Rwanda institution was the Kigali Health Institute (led by Therese Bishagara) in cooperation with the National University of Rwanda. David engaged several colleagues at Western into the project and also initiated our collaborations with other Canadian universities. This third proposal was successful and David led, over the next six years in cooperation with our Rwandan partners, the Rebuilding Health in Rwanda project.
Two years ago, David submitted another successful proposal, this time for the Maternal, Newborn and Child Health project, which is now well under way. Other posts to this Forum will talk about the details of these two projects. Aided by these two projects and others like them, the determined efforts of the Rwandan people and government have created a resounding success story: various sources report that the infant and child mortality rate in Rwanda has plummeted by somewhere between 30% and 50% over the past ten years. Dr. Cechetto’s two projects have contributed and will contribute to progress in an area–maternal, newborn and child health–where Rwanda is attracting international attention. The reduction in Rwanda’s infant and child mortality rate (like that of Senegal) has been one of the real success stories in international development cooperation.
Let’s reflect on the success of these two projects – why have they worked so well? Here are some of the success factors:
* David Cechetto spent a lot of time in Rwanda listening carefully to the stakeholders in the health sector before he designed the project and before he chose his Rwandan and Canadian partners.
* Throughout the first project, Cechetto sought out the bilateral agencies of other donor countries to stimulate sector-wide complementarity in health care.
* At all levels of the health care system, Rwandans supported Cechetto and his teams with extraordinary commitment and enthusiasm.
* Over the years, Cechetto carefully managed the transition during the duration of the project from one initially led by Canadians to one of almost complete local ownership by the end of the project.
But above all, the participants in the projects had a sincere and long lasting commitment to improving the quality of life of all the people of Rwanda.
Dr. Frederick Keenan is the former Director of the Office of International Research at the University of Western Ontario, and is currently Co-chair (with former Archbishop Emmanuel Kolini) of the Project Advisory Council for the Maternal, Newborn and Child Health project in Rwanda.