Progress in the Wake of Destruction: a Theoretical Analysis of Post-Genocide Rwandan Public Health Funding

Abstract

In the years following the Rwandan Genocide, Rwanda found itself utterly devastated on all fronts. Infrastructurally incapable of addressing the dire circumstances of its citizens, the Rwandan Patriotic Front–led by current Rwandan President Paul Kagame–was tasked with rebuilding from a level of destruction few countries have ever witnessed. Despite the seemingly irrecoverable scenario, in a matter of decades, the country boasted one of the most developed public health systems in East Africa, with HIV treatment now universally accessible in Rwanda, and maternal/infant mortality rates improving dramatically. In the wake of this progress, the question as to how Rwanda’s Ministry of Health was capable of accomplishing such unprecedented public health improvements is raised, especially in the context of the often fraught process of developing countries attempting to fund their own progress. The path to progress for Rwanda hinged on the Ministry of Health’s ability to adequately garner and distribute funding without hindering or distorting the goals of existing policy, and this paper is dedicated to understanding how this was accomplished. Methodologically, this involves the synthesis of two theories of political economy (neopatrimonialism and dependency theory) to develop a coherent structure on what political-economic aspects of funding (and other forms of resource allocation) stagnate growth the most. This structure, based on three variables (policy equity, policy appropriateness, and funding source) is used to then understand how these stagnating features were circumvented by the Ministry of Health, through analysis of annual public health reports published by the government and related organizations, along with external case studies. It is concluded that ministerial autonomy in policy creation and implementation through distribution of funding was significant in accomplishing desirable public health outcomes.