Learn from Rwanda

When all the big countries just do the talking, a small and troubled country like Rwanda has certainly shown the world how governments should act vis-a-vis its people with its gigantic and 'visionary' healthcare move. It has become the first low-income country to provide universal eye care for its entire population. 

The government has partnered with the organisation Vision for a Nation (VFAN) to train more than 3,000 eye care nurses based in 502 local health centers, prescribing glasses and referring those with serious eye problems to national clinics. In fact, it has become the first low-income country to provide universal eye care for its 12 million population. 

The Government of Rwanda has gone about systematically and simplistically in evolving the programme. The nurses appointed by it have visited each of the 15,000 villages and it was found that 34 per cent of the population needed some form of eye care or the other. Shortsightedness is the most common eye-related ailment in Rwanda and more than 80 per cent eye conditions there are considered preventable. This country ranks 159th on the Human Development Index and only 19.8 per cent of the population have access to electricity. 

Not just universal healthcare but the economics mattered in the decision to launch the programme. Untreated sight conditions, particularly in women, entrap the families in poverty as most of the rural population is involved in coffee bean sorting. By the age of 45, these women are found to be losing their ability to see well and therefore suffer a loss of income. This is also forcing the young girls out of the schools and bringing them to the Bean centers to supplement the household income. This leads to a vicious cycle of continued poverty and it is here that the government decided to strike. 

Rwanda realised that with mortality caused by infectious diseases dropping due to other healthcare initiatives, it was time to tackle the eye problems. Cataract, refractive error and trachoma was found to be affecting 80 per cent population and it was also found that 65,000 people in the country were blind in both eyes. 

We keep hearing even developing countries talk about their people's welfare but it is all a mere hogwash when it comes to work on the ground. Rwanda succeeded where all others failed because of its three-pronged approach: Prioritising geographic equity of service delivery, reducing the cost of access to services and coordinating all partners under a single national plan. 

It has also evolved a primary health care system delivered through 45,000 community health workers through its health centers. A permanent eye care curriculum has been introduced in the eight nursing colleges educating 1,250 health care nurses in primary eye care services and for improving referral guidance. 

As he rolls out primary health care, Narendra Modi perhaps needs to visit Rwanda once. Rwanda did not talk about its programme and never boasted of it. It simply went about its job. It did not do it with eye on votes, too. Perhaps, that is the reason why it has become such a success.