Image: Alumna Alida Ngwije from Rwanda.
Alida Ngwije hails from Rwanda, the fourth smallest country in Africa, and renowned for the worst genocide nearly two and a half decades ago. Enter the new millennium, and ‘the land of a thousand hills’ has continued to make significant strides in development. Today, Rwanda is famed as the country with the largest female representation among parliaments around the world and was recently touted by the United Nations Environmental Program (UNEP) as the ‘cleanest city in the planet’. However, Rwanda’s most impressive gain yet is her investment in health.
Following the genocide, Rwanda’s health facilities lay idle, with the vast majority of the population unable to pay for the services offered. In response, the Ministry of Health initiated a pilot project in 1999 to provide health insurance in three districts: Kabutare, Byumba and Kabgayi. The initiative saw premiums paid into a local risk pool administered by communities to provide accessible and affordable healthcare for all. Encouraged by the success of the project, in 2004, the government began to extend access to the universal health cover across the country. At present, the homegrown health policy, Mutuelle de Santé (French for public health insurance), is accessible to a majority of citizens and financed by tax revenue, foreign aid, and voluntary premiums based on one’s income. In essence, the wealthiest pay an equivalent of AU$ 10 per year while the poorest pay nothing in what is the most significant public health insurance scheme in sub-Saharan Africa. The Ministry of Health’s statistics suggests that it covers over 90% of the population and caters for 90% of their medical bills. Despite this significant investment, Rwanda’s non-communicable Diseases National Strategic Plan July 2014 – June 2019 highlights the lack of trained healthcare providers as a critical challenge to be addressed to improve the quality of service delivery for the prevention and control of non-communicable diseases (NCDs).
At the time when Rwanda was steadily rebuilding her health systems, Alida Ngwije aspired to work in the research field, using new technologies to diagnose diseases better. Her first job was in a university teaching hospital where she headed the TB department. She was in charge of introducing and implementing advanced technologies to diagnose TB and multi-drug resistant tuberculosis (MDR TB). Gradually, she developed a keen interest in understanding the health dynamics of patients she diagnosed with TB. “I wanted to know how many patients took their medication as prescribed and how many got cured. In the process, I realised that I wanted to learn more about collecting and using data to tell the success and challenges of medicating TB patients. However, I did not have the skills or capacity to achieve this vision,” she says.
Her vision was realised in 2013, when Alida was selected for an Australia Award scholarship to pursue a Master of International Public Health degree at the University of Sydney, Australia. She describes the opportunity as an ‘incredible experience’. The course content provided her with knowledge on controlling infectious diseases such as malaria and HIV/AIDS, as well as NCDs. She describes her award saying, “It covered all the aspects of health systems in developing countries with their challenges and existing initiatives, as well as biostatistics and epidemiology. Australia’s advanced education system, coupled with availability of learning materials, participatory and practical course delivery strategies and targeted assistance throughout the course, made the learning experience forever memorable for me. It confirmed for me that I was in the right place.”
This new knowledge equipped Alida with the requisite skills to identify critical gaps that existed in the health system in Rwanda. The program boosted her critical thinking skills as well as her self-esteem. Most significantly, the course provided much-desired clarity to her career path. In 2015, when Alida returned to Rwanda, she was promoted as a Laboratory Systems Coordinator and tasked with overseeing the process of laboratory accreditation. Her award-acquired skills in statistics were resourceful in helping her evaluate the impact and cost-effectiveness of lab accreditation processes. Her facilitation skills came in handy in guiding the implementation of the accreditation process. New knowledge on health systems strengthening helped her to use a broader perspective in designing and implementing laboratory quality systems.
Currently, Alida works with the Clinton Foundation on a project dubbed 3DE (Demand Driven Evaluation for Decision). The project seeks to generate reliable evidence that fills information gaps identified by government ministries, in the hope that it will catalyse the implementation of cost-effective action, policy formulation or program roll-out.
“When I look back, I know that I am where I wanted to be, and my country is benefitting from the skills I gained from my award experience. At the same time, it gave me a lifelong package to confidently and successfully give back to my community and my country in general,” she concludes.
Alida is a member of the Australia Awards Women in Leadership Network (WILN). The network is made up of over 350 female award Alumni who focus on leading change in their various spheres of influence, throughout the continent. For more information on the network, click here.