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Week of 12.18.09

Africa: House Calls and Health Care

Can a breakthrough health care innovation in Rwanda work in the U.S.?

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In rural Rwanda, the simple and time-tested idea of medical house calls is not only improving the health of the community, but stimulating its economy as well.

This week, NOW travels to the village of Rwinkwavu to meet the Rwandan doctors, nurses and villagers who are teaming up with Boston-based Partners in Health and the Rwandan government to deliver medicine and medical counseling door-to-door. Would such an innovation work in America?

In the capital of Kigali, NOW's David Brancaccio sits down with Rwandan President Paul Kagame to talk about international aid and Kagame's ultimate vision for a healthy, financially-independent Rwanda.

This show is part of Enterprising Ideas, NOW's continuing spotlight on social entrepreneurs working to improve the world through self-sustaining innovation.

This show was originally broadcast on September 11, 2009.

Related Links

Web Features

Reporter's Notebook
David Brancaccio reflects on how the Rwandan people are recovering from the trauma of their past.

Slide Show: A Revived Rwandan Hospital
Photos from an innovative program run in part by the Boston-based group Partners in Health.

Interview: Rwandan President Kagame
Why Kagame believes universal health care is critical.
The Skoll Foundation

Skoll Forum 2009: Social Entrepreneurship: Shifting Power Dynamics (pdf). Includes an essay from Partners in Health Co-founder Paul Farmer.

Partners in Health: Program in Boston
The non-profit Partners in Health has developed a Prevention and Access to Care and Treatment (PACT) program to serve HIV patients in Boston. The program trains and employs community members to make home visits to help HIV patients in need.

Partners in Health: Testimony of Joia Mukeherjee
Mukeherjee, the Medical Director of Partners In Health, testified to the House Subcommittee on Africa and Global Health

Rwandan Ministry of Health

WHO: Task Shifting Guidelines
Recommendations from the World Health Organization on "task shifting" - a process in which tasks are moved to less specialized health workers in countries where there is a shortage of health workers.

The United States President's Emergency Plan for AIDS Relief
Information on America's initiative to combat global HIV/AIDS.

Financial Times: Africa Has to Find Its Own Road to Prosperity
Op-ed by the Rwandan President Paul Kagame on how and when to go about ending foreign aid to the world's poorest countries.

The William J. Clinton Foundation

The United Nations' "Milennium Goals"

Viewer Comments

Commenter: SR
my comment is for those who say that People in rural areas in Rwanda are poor( trying not to agree with progress made), they should tell us compared to when? were they better before?? honestly speaking, were any Rwandan better before or during genocide than now? i think even planners and executors of genocide are better in todays Rwanda than before
The fact is that every day that comes Rwandans become better and better by any standards! we thank God for the current leadership. PIH and other partners keep it up to make our country better, ignore negativists, you know the truth on ground!

Commenter: Marian Livers
The partnership mentoring support of persons with health challenges is one that could be universal with great benefits to socities.
Africa and the Paul Farmer effort could be an example that moves the planet in the direction of personal responsibility which includes family size..and nutrition.

Commenter: Edward J. Dodson
As some may be aware, the French documentary filmmaker, Philippe Diaz, has just released "The End of Poverty? Think Again" in theaters around the U.S. His treatment is highly critical of "the North" and the IMF and World Bank policies that burdened the newly-independent developing countries with debt, then mandated shifts to cash crops and exportation of resources in order to service high levels of debt.

This has me wondering whether Rwanda is one of the rare exceptions -- a developing nation that managed to escape the debt trap and to maintain control over its productive land in the interest of its citizens.

Another documentary filmmaker, Fred Harrison, has recently produced a film (titled "The Silver Bullet") that examines three African nations. Two of the three -- Zimbabwe and Mozambique -- have imploded for many of the same reasons offered by Philippe Diaz. The third, Botswana, has thrived (at least relatively speaking) because the government has demanded the the DeBeers diamond producers compensate Botswana's citizens for the control over the diamond resources granted. One sees a parallel with the royalties paid to Alaska residents by the oil companies who are permitted to extract oil reserves from Alaska's subsurface.

What all nations who are suffering most seem to have in common is severe forms of concentrated control over nature -- whether this is locations in the cities and towns, natural resource-laden lands, rights of way for rail or air traffic, agricultural land.

Commenter: Walter
Wow, am I impressed with Rwanda! National health insurance, an intensive directly observed therapy program for TB and HIV, community health workers, an economy growing 11% per year, and a building boom. They spend 1% of what we spend on health care and get remarkable results. The lessons is that we squander our money in America on corporate profits while they use a real public health model for delivering health care.

America is always trying to teach other countries how to do things the American way. It is time for us to start listening.

Commenter: Sarah Bachman
Very interesting show.

Other organizations training para-professionals similar to PIH's include Gonoshasthaya Kendra in Bangladesh (, which has been in operation 30 years; some other programs supported by or affiliated with PIH can be found using the PIH website,

Dr. Farmer's comments about the cost of poor health care, and the need for health care workers to be paid, are well-taken. To paraphrase: The "cost" of door-to-door workers is not simply the dollar cost of their training and salary, but also the opportunity cost of failing to help people access affordable health care.

Commenter: John Hanson
Leave it to PBS and NOW to promote privitization and corporations while putting lipstick on a pig rather than prmoting a single payer health care plan or a socialized plan like the rest of the free world has. Some Americans apparently do not realize PBS had been infiltrated by special interests, foundations and corporations a very long time ago. Like CSPAN (who is controlled by the cable companies and the cable companies are controlled by the networks)...many of PBS's leadership plays a duel role. The difference between "main stream media" such as, CBS, NBC, ABC, CNN, CSPAN, FOX and so called "public tv" like PBS is that PBS disguises themselves more but its leadership is still controlled by corporate america and special interests in an indirect manner. America has been hijacked by facists. Anti-trust laws have been broken to the point of national security and these cronies all need to be held accountable.

Commenter: Paul M.
A country as small as Rwanda. We should learn from them. A lesson, care for one another. Plastic bags are banned.Something so little speaks volumes for the people and how they care about their little corner of this blue marble we all share.

Commenter: Felix.R
Well, it is amazing to find people who try to think positively, people who believe that things are possible. Each long journey start by the first step, and the courage to take the first step makes the meaning to the rest. Keep up the good job and solidarity!

Commenter: Ann Carroll
David and gang
Great show and great story from Rwanda. It's exciting to see Dr. Farmer's work in action.
Keep the stories coming.

WETA watcher in Alexandria VA.

Commenter: Iribagiza
As a Rwandan, I am sorry to see other vicious and angry people like Shaka who are ignorant and call President Kagame a murderer based on baseless claims of French and Spanish judges who right now have been called to their very courts for allegedly bribing witnesses to tell lies about Kagame and the Genocide. FDLR is killing people in Congo, and why is the UN transporting guns to Congo, why does MONUC lose their guns so fast or maybe they sell their guns to FDLR. What is so hard to understand about Rwanda's quick progress towards development in all areas, Health Care as seen above is just one aspect of success in the country and those who cannot believe that people are moving on after the genocide should just quit and bury themselves in the sea of guilt and shame because they choose not to accept that all Rwandans can live together and progress in peace. shaka should read some more if not see for himself whats happening and quit listening to wrong westernized ideologies of the French and Spanish incapacitated judges.

To Mahoro's comment,Education too has been revised, unlike the previous francophone system that only left people incapacitated on the job market because they lacked skill to do their jobs.

There is the current 'Nine- Year Basic Education' that aims to eliminate primary school dropouts. With Rwanda's limited resources at least the poorest children can study untill High school O- level examinations for free. Where else do you find this in East and Central Africa? There is nothing propagandarish about this, it was done away with after the genocide, actions speak louder than useless and hateful mantra.

Commenter: Ben-Rwanda
this is ridiculous to coment saying that our president kills people!!.i think that you're not sure of what you're talking about guy!!you should visit Rwanda and see the truth!!
Please give PIH staff to do their job;i instead appreciate its modal that saves poorest of poor!!!!

Commenter: Beaner
when a patient goes to the clinic, often times they are turned away because there is not enough time for the doctors to see the amount of patiens needing attention. So, what ends up happening is, the sick that are only paying using thier "cheap" insurance will most likely be sent away, and patients that can pay are seen and treated. Another thing that makes this whole concept even worse is the people who are seeking medical assistance usually have to travel a far distance to get to a clinic, they mostly travel by foot and cant afford to take a minibus. While I feel PIH is an amazing organization, the health care system in Rwanda is far from better then that we have here in the US.

Commenter: mukanba alain
I saw your interview with Kagame and you're trying to make him look like a hero with all the health care plan for Rwanda. You did not specify where he will get his money. Is it with the bloody money (6 million people that have died) in Congo that he will finance his plan? Please go in Kivu and try to interview people and ask them who is the killer. A good journalist always finds the truth. No one until now has spoken for the 6 million deaths in Condo and who is ultimately responsible.

Commenter: Mahoro
This is really cynicism. People are starving in rural areas ,people are very poor and their children are kicked out of high schools because of lack of school fees.A handful of leaders and their families and friends are making fortune and building Kigali to turn visitors attention from seeing the misery and poveerty in the countryside.How do you judge such a situation ? come on !Stop propaganda please and help people in Rwanda !!!

Commenter: Shaka
This is so naive...Kagame is a mass murderer indicted for genocide, war crimes, crime against humanity and terrorism (leading to the death of at least 4 million people) by spanish and french justice. How can you possibly present him as some kind of model? What you are showing disturbing Kagame says something and the people universally follow? Are you kiddin me? Do you they don't wear shoes because they like it? I think it's racism to even try to present a mass murderer as someone capable of doing any good. Kagame killed people and is still killing people in congo and what you're doing is just plain propaganda!

Commenter: margaret w.
First of all it's not "health care", it's insurance for sick care. I will NOT support forced subscribing to private insurance companies . . . we do not need to use money from the sick to prop up bankrupt for-profit insurance companies whose priorities are providing shareholder dividends, humongous CEO salaries and golden parachutes and expensive corporate bureaucracies.

I would suppport a plan like Canada's, all inclusive, single payer. If people wanted additional insurance they could buy a policy from a private insurer. I lived and worked in Canada (Alberta) for several years as a 'landed immigrant' (i.e. green card status) and was very impressed and happy with their insurance program. Here is one Canadian's comment published on the Boulder Community Network, in Boulder, Colorado: Canada's Single Payer Health Care System - It's Worth a Look

Now I am on Medicare and I like it. We should have Medicare for all. And pay for it with a Tobin Tax (a fractional tax on all speculative stock market trades/sales . . . they caused the problem why shouldn't they have to pay for the damage they caused, and we have to pay sales taxes on our purchases/transactions, who not them?? It would generate billions of dollars!) What I've heard from several doctors who have read the 1000-page bill (which isn't necessarily the one that will be passed!) is that it is heavy with limitations, penalties, restrictions, rationing (based on actuarial statistics re age/illlness), invasions of privacy, and would prevent doctors from practicing outside the system (charity, etc.).

Commenter: autumn
I support single payer health care... my sister in law just died at 53, worked all her life, but had no coverage. She needed help and didn't 'qualify'. This country should be ashamed. I had better coverage when I was on gov't welfare than now working. I don't trust congress. I do believe in Obama. I can only hope something will get better. It is the cost of health care that helped bring down the car companies, it is the shameless agricultural practices that are destroying our earth and health.
If we would stop breeding the planet might recover.

Commenter: M. Withey
I watched Africa: House Calls and Health Care last evening, and I'm urging others to to to your web site today-- others for whom Paul Farmer is a hero and role model. I watch weekly.

Commenter: Kim Christensen
You talked about treating HIV on a community level in Rwanda. I didn't hear any talk of distribution of condoms to the young ladies and men who received the drugs who could in turn spread the disease to their spouses.

Commenter: Nathan Ketsdever
This was a fantastic feature. I hope you do even more work in the area of social entrepreneurship and base of the pyramid--the people who live on less than $2 a day.

David Brancaccio mentioned that there are other innovative programs which this web feature highlights, but its not very clear which resources he was referring to. I assume he was speaking to the Skoll Foundation publication....but I'm really not sure.

Thanks for all your great work!

Commenter: Laurien
I am Laurien
contact at
I appreciate your show on Rwanda with her healthcare and Dr Paul Farmer. I agree with the Accompagnateur-concept because people who need help are mostly in rural area.
I would say that even though Rwanda does not have enough resources as other countries, Rwandan people both inside and outside can combine together to build the country.
Thank you for showing my country's progress.


Commenter: lee hersh
We should have free medical screenings in malls- paid for by the mall merchants. The screening could include blood pressure, glucose, body mass index, and cholesterol..

I accessed this web site to vote.
As for Obama's speach this week, I found it to be very enlightening and he reaffirmwed his commitment to health care reform

My vote is in favor of Obama's efforts, even before the speach; He has merely reinforced his position.

Africa: House Calls and Health Care

Reporter's Notebook: Horror and Hope in Rwanda

Slideshow: A Revived Rwandan Hospital

Extended Interview: Rwandan President Paul Kagame

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