Rwanda has achieved some of the most dramatic gains in health and poverty-reduction in the world. This small, landlocked African country (the size of Massachusetts, but with twice the population) has developed a primary health-care system with near-universal access to clinical care and insurance. Rwanda has reduced both economic and health-care inequality, and demonstrates how “health equity” helps to build strong societies.
The secret to Rwanda’s success is that its leaders are building “modern institutions on traditional values.” They built a system of community justice, called Gacaca, which integrated their need for nationwide reconciliation with an ancient tradition of clemency. They breathed life back into a civic tradition of Umuganda, where one day a month, citizens, including the president, gather together to weed their fields, clean their streets, and build homes for the poorest among them.
The Year Ahead 2017 Cover Image
In 2015, the government of Rwanda and the Boston-based Partners In Health (PIH), with the help of the Bill & Melinda Gates Foundation and the Cummings Foundation, established the private, not-for-profit University of Global Health Equity (UGHE). The university is founded on the principle that every member of a community deserves the same care and opportunity, and focuses on the delivery of quality health care to those who need it most. Agnes Binagwaho, a co-founder of UGHE who is a former minister of health and an adjunct professor at Harvard Medical School, once said to me, “Why would I want to raise my children in a nation where all children don’t get the same medical care as they do?”
Rwanda’s government has already pledged $43 million to UGHE in land and infrastructure support. Its leaders have launched a two-year, part-time Master of Science in Global Health Delivery to teach how to create national health care in developing countries. Lecturers from Rwanda’s Ministry of Health, Harvard Medical School, Yale University, and Tufts University taught Rwandan students everything from epidemiology to budget management.
Last summer, UGHE began construction on a 250-acre campus in Butaro. This year, 250 professionals from as far away as Mexico and Australia will compete for 25 spots on that campus. Undergraduate and graduate degrees in nursing and oral health, and non-clinical programs in research and health management, are next. In 2018, UGHE’s campus will also be home to a school of medicine. It will provide space for generations of health professionals to learn how to heal patients, comprehend the sociology of disease, and build the health systems that make a strong society.
UGHE’s founders believe that, by the time the university celebrates its ten-year anniversary, 480 students will have graduated; another 870 will be earning their degrees; and over 2,500 professionals will have attended executive education courses. They expect that over 1,000 of the students passing through the UGHE’s doors in that first decade will arrive from the rest of Africa, Asia, Europe, and the Americas.
Rwandans will invite these international students to visit their communities to observe their traditions and learn how to care for their people. The young men and women will attend Rwandans’ weddings and funerals, learn to prepare and enjoy their foods, and acquire some of their language, the portal through which to view their sturdy values. Rwandans will teach their international guests that in Africa, family is an all-encompassing concept, and that, in Rwanda, an entire generation treats the next as its own children. The international network of UGHE alumni, unified by their commitment to realize health equity for their own communities, will become a global force for change.
UGHE will also strengthen Rwandan society. Though regarded by many as one of the safest and least corrupt societies in the world, Rwanda faces a great shortage of doctors and nurses. There are 684 physicians in Rwanda, a total that is far below the 1,182 physicians proposed by the Ministry of Health, and only 27% of the World Health Organization’s recommended minimum of 2,576 physicians.
UGHE has already generated jobs, by hiring local laborers, and has increased access to the region, by creating new roads. It could boost Rwanda’s GDP by 0.5% per year, and every dollar invested in UGHE could generate $2 worth of return in economic development, according to McKinsey & Company.
Some social scientists assert that poverty is not just a matter of poor nutrition, lack of medical care, and inadequate shelter; it also means exclusion from global networks of trade, science and commerce. This isolation is pernicious, because it destroys people’s hope and aspirations for a better life.
UGHE will be Rwanda’s newest institution, a public-private collaboration based on traditional values: community, trust, hard work, and optimism about the future. It will integrate each citizen of Rwanda into global networks of learning.
The Rwandans will accomplish this, as they do many things, because they believe that the only investment that can bring infinite returns is in their children, and because graduates of the University of Global Health Equity will be their sons and daughters, too.
By Michael Fairbanks
Michael Fairbanks is a fellow at the Weatherhead Center for International Affairs at Harvard University, is Chairman of the Board of Silver Creek Medicines.
Brand South Africa welcomes South Africa’s performance in the 2017 A.T. Kearney Foreign Direct Investment (FDI) Confidence Index, as well as in the Africa Investment Index 2016 by Quantum Global’s independent research arm, Quantum Global Research Lab.
South Africa has made a comeback in the 2017 A.T. Kearney Foreign Direct Investment (FDI) Confidence Index, and has been ranked as the fourth most attractive investment destination in Africa according to the latest Africa Investment Index 2016 by Quantum Global’s independent research arm, Quantum Global Research Lab published on Wednesday.
The Quantum Global report is constructed from macroeconomic and financial indicators and the World Bank Group’s Ease of Doing Business Indicators, and also averages the country’s macroeconomic and financial indicators rankings on the six different factors. The report advocates that South Africa received the number four ranking on the Index because it scored well on the growth factor of GDP, ease of doing business in the country and significant population.
Reflecting upon South Africa’s significant improvement, Brand South Africa’s CEO Dr Kingsley Makhubela said, “As a nation, we are cognisant of the role of all South Africans in building the country’s reputation and competitiveness and these improvements emphasise that South Africa is a competent and competitive investment destination and that we are indeed open for business. This also reinforces perceptions about South Africans, from a range of other studies, as hardworking and resilient – despite recent challenges relating to credit downgrades.”
The 2017 A.T. Kearney Foreign Direct Investment (FDI) Confidence Index report said that while overall FDI flows to Africa decreased 5% in 2016 to an estimated $51 billion, South Africa bucked the overall regional trend, with UNCTAD estimating its FDI inflows increased 38% in 2016. South Africa made a comeback in the Index – rounding out the Index in the 25th spot. “This is likely as a result of improving short-term economic prospects and the long-term investment potential in the country’s manufacturing sector,” A.T. Kearney’s report said.
Known as the melting pot of diversity and inspiring new ways that have shaped the nations young democracy, this year – World Economic Forum on Africa will be held in South Africa under the theme ‘Driving economic transformation in Africa through inclusive growth models’ on 03 – 05 May 2017 in Durban, KwaZulu-Natal.
Commenting on this Dr Makhubela concluded: “As a global partner, South Africa commits to the stated objectives of this conference, and it is our hope that this platform will create an enabling environment where we can all share insights on how to better improve the current landscape and map out innovative tactics to accelerate inclusive growth while bringing about sustainable development in the future.”
The New Development Bank recently held its second annual meeting in the Indian capital of New Delhi to discuss the sustainability of financing development projects in its member states.
The multilateral bank was established by the BRICS states of Brazil, Russia, India, China and South Africa. With headquarters in Shanghai, China, it was created to support emerging economies and provide an alternative to the domination of the World Bank and the International Monetary Fund.
But the new bank is already proving to be a replication of the Bretton Woods institutions. This can be seen through the partnerships the new bank is forming as well as its operating posture.
It’s also showing bias towards the development of Asian countries. This is evident from its funding patterns and the recent proposed enlargement of the BRICS bloc. The list of proposed additions includes Pakistan, Bangladesh, Iran, Nigeria, South Korea, Mexico, Turkey, Indonesia, the Philippines and Vietnam. All except three are Asian.
The proposed expansion of the BRICS countries has been justified as a move to strengthen the bloc and fill the void created by rising protectionism in the US. But it has been met with mixed reactions even among member countries. India, for example has expressed its disapproval that BRICS “plus” is China’s ploy to cut New Delhi’s influence in the group by roping in more pro-China countries.
The New Development Bank’s business as usual and its bias towards Asia suggests that it will not become an alternative source of finance. It will not address the key areas of needs for emerging economies like human capital development, poverty alleviation and basic healthcare.
More of the same
The New Development Bank was set up as an alternative to the World Bank and IMF which are viewed to be pushing western agendas. It was to provide a development model that would be sensitive and beneficial to emerging economies. But it’s quickly abandoning this mandate and falling into the trap of operating like the institutions it was created to replace.
In September 2016 the New Development Bank signed partnership deals with the World Bank to co-finance projects. The agreement also aims to facilitate knowledge and staff exchanges. This puts the bank in bed with the institutions it was established to counter.
The bank has also signed memorandums of understanding with the European Investment Bank, European Bank for Reconstruction and Development, the Asian Infrastructure Investment Bank and the Eurasian Development Bank and the International Investment Bank (IIB). The agreements cover co-financing of infrastructure projects, the bulk of which are in Asia.
Perhaps the foundations of the bank were faulty from the start. Its original designers were two former World Bank chief economists, Joe Stiglitz and Nick Stern. Given this history, it’s possibly never going to challenge the world financial order.
Today, the New Development Bank is pushing the corporate-led development model just like the World Bank, the IMF and other Bretton Woods institutions. Their investments are profit-oriented which tends to undermine social justice. Thus similar to the World Bank and IMF, the New Development Bank seems more focused on protecting its investments at the expense of saving the interests of the BRICS citizens.
Over the past decade, the corporate led model has impoverished many people in emerging economies, particularly in Asia. It has led to farmer suicides, large-scale privatization, natural resource looting and environmental degradation.
Funding so far
The New Development Bank has so far made loans of $811 million to entities in four BRICS countries towards energy infrastructure. Of this $300 million went to Brazil, $81 million to China, $250 million to India, and $180 million to South Africa.
For South Africa, the bank has so far not provided any meaningful opportunity to obtain additional finance. The loan of $180 million (R2.6 billion) was given to South Africa’s power utility Eskom to develop 670 MW of power generation and 500 MW worth of renewable energy projects involving independent power producers. This unnecessary loan to an inefficient state owned entity has only contributed to BRICS’s power over South Africa by adding onto the current contingents liabilities dollar-based loans that the government has guaranteed for the next 12 to 20 years.
There are weaknesses in the way in which the New Development Bank works that also raises questions about its intent.
First, the bank’s activities are often shrouded in secrecy. There are no clear official records available to the public about the bank’s activities, decisions and operational guidelines. Analysts have to rely on secondary and tertiary information sources.
Second, the bank is yet to present any socio-economic redress and environmental operational guidelines for communities. This would ensure that its funding does not lead to displacement, evictions, ecological destruction, loss of livelihoods and threats to the basic right to life. These issues have recurred for decades due to projects funded by other multilateral development banks.
Lastly, as a co-financier with development institutions like the World Bank, the bank’s seriousness about promoting transparency, accountability and probity remains questionable.
To strengthen its relevance to emerging economies, the New Development Bank must review the much criticised, inequitable representation of developing countries, especially from Africa. It must also focus more on small-scale investments rather than large-scale infrastructure projects. These often lead to exclusion of people and communities, and aggravate existing vulnerabilities rather than bringing about development.
Misheck Mutize, Lecturer of Finance and Doctor of Philosophy Candidate, specializing in Finance, University of Cape Town and Sean Gossel, Senior Lecturer, UCT Graduate School of Business, University of Cape Town