Rapid declines in child and maternal mortality in Rwanda, Madagascar share common roots

June 22, 2018 by Amy Donahue, Harvard Medical School
Strengthening integrated health systems in rural Madagascar (pictured) and Rwanda has produced rapid improvements in health. Credit: PIVOT

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 having the lowest health-spending level in the world. This transformation echoes the strength of results seen 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 achievements were products of grassroots movements to build and strengthen systems founded on principles of public partnership, data science and universal access to care for all.

"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," said Paul Farmer, the Kolokotrones University Professor of Global Health and Social Medicine at Harvard and co-founder and chief strategist of nonprofit Partners in Health, one of the co-authors of the Rwanda study.

The health systems transformations were led by Partners In Health (PIH) in Rwanda and the nonprofit organization PIVOT in Madagascar, and, in partnership with the ministries of health in both countries. Both teams included faculty members from the HMS Department of Global Health and Social Medicine. The results are detailed in two new papers published in BMJ Global Health.

"PIH and PIVOT, in partnership with the HMS Global Health Research Core and its affiliated faculty, are charting stronger, more equitable, mechanisms for improved care delivery," Farmer said.

Many of 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-5 mortality rates of 1 in 6.

At a time when Rwanda witnessed the fastest drops in under-5 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 for health projects and a vast infusion of international resources in the aftermath of the 1994 genocide, Madagascar has been politically unstable and largely forgotten by the international donor community.

That is why, the study authors say, the results in both countries taken together demonstrate evidence for the global replicability of the ground-up health systems model, with success in vastly different settings.

"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," said Agnes Binagwaho, HMS senior lecturer on global health and , senior author on the Rwanda study, and Rwanda Minister of Health from 2011–16. "We embrace the shared vision and work of our partners in Madagascar. Together, we can pave the way to inclusive that advance equity and health for all people."

Explore further: Task force identifies ways US health care systems can learn from the world

Related Stories

Task force identifies ways US health care systems can learn from the world

April 10, 2018
Millions of Americans have the same life expectancy as the American national average in the 1970s, according to a new task force report from the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai. ...

Building stronger health systems could help prevent the next epidemic in Madagascar

January 4, 2018
The peak epidemic season for plague in Madagascar is fast approaching and the severity of these outbreaks could be significantly reduced with improvements to their public health system, argues Matthew Bonds from Harvard Medical ...

Rwandan child mortality sharply on the decline

September 25, 2015
After the genocide in the mid-1990s, Rwanda initiated major social and health reforms to improve the survival of all children. In his dissertation, Aimable Musafili from Uppsala University and the University of Rwanda reports ...

Great ideas come from everywhere: Improving global health through reverse innovation

August 30, 2013
The idea that insights from the healthcare systems of low-income countries might be transferable from low to high-income countries is becoming increasingly common in global health and innovation publications. One journal ...

Recommended for you

Genes may control how tough it is to stop drinking

September 25, 2018
(HealthDay)—When they give up booze, some alcoholics have more severe withdrawal symptoms than others. This discrepancy may come down to genetics, researchers say.

Why industry influence on research agendas must be addressed

September 25, 2018
Industry influence on the research agenda—and the tactics employed by tobacco, pharmaceutical, food, mining, chemical and alcohol companies to drive questions away from those most relevant to public health—is the focus ...

Study analyzes numbers, trends in health care data breaches nationwide

September 25, 2018
Health plans—entities that cover the costs of medical care—accounted for the greatest number of patient records breached over the past seven years, according to an analysis of U.S. health care data conducted by two Massachusetts ...

New study finds concurrent use of prescription drugs and dietary supplements could pose health risks

September 25, 2018
A new University of Hertfordshire study found that using certain over-the-counter herbal medicines and dietary supplements alongside prescription drugs could pose serious health risks, especially amongst older adults.

It's not just for kids—even adults appear to benefit from a regular bedtime

September 21, 2018
Sufficient sleep has been proven to help keep the body healthy and the mind sharp. But it's not just an issue of logging at least seven hours of Z's.

Most nations falling short of UN targets to cut premature deaths from chronic diseases

September 21, 2018
People in the UK, US and China have a higher risk of dying early from conditions like cancer, heart disease and stroke than people in Italy, France, South Korea and Australia.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.